burn_and_electrocution in children: management and complications

burn and electrocution managemnet in children

1. DR MOHSIN WAQAR PGR Paediatrics STH sahiwal

2. INTRODUCTION

3. epidemiology:  Fire and burn deaths 3rd leading cause of unintentional deaths in children 49% TBSA 2018:50% death for kids with >98% TBSA

4. CLASSIFICATION OF BURNS: ACCORDING TO THICKNESS

5. CLASSIFICATION OF BURNS ACCORDING TO CAUSE

6. PATHOPHYSIOLOGY OF BURNS Thermal injury can produce a complex injury response in the skin that typically follows a common pattern of tissue response. With deep burns, there may be a clear-cut area of fullthickness skin necrosis that is irreversible. Surrounding this area is usually an area of ischemia. Tissue in this zone may survive or die, depending on the preservation of blood flow. Infection, exposure, and dehydration may promote ischemia, resulting in progression of the area of ischemia into necrosis. Surrounding the ischemia zone is usually an area of hyperemia. Increased blood flow in this zone is promoted by numerous mediators that are liberated from the injured tissues.

7. Drowning Dr Malik MOHSIN WAQAR ABDUL

8. Defination The Process of experiencing respiratory Impairment from submersion/immersion into liquid. It is a form of asphyxia

9. Causes of Drowning Child younger than one year. (B athtubs, Household buckets ) 1 to 4 years : ( Pool, irrigation ditches, ponds, Rivers ) School age : ( swimming, boating, Ponds, Rivers, Canals, natural water reservoirs ) Adolescent : ( dangerous underwater breath holding behavior DUBB, s. 70% deaths in natural Water reservoirs. Underlying conditions : Epilepsy, Cardiac issues, Alcohal use, water sports, ASD

10. Classification According to water type . Fresh water drowning & salt water drowning According to Temperature : warm water ( temp >20°c ) , cold water ( Temp <20°c ) , very cold water drowning ( Temp <5°C )

11. Types of drowning 1. Wet drowning : water inhaled in lungs Cause severe chest pain. Death occur due to Cardiac arrest or ventricular fibrillation. No pleasant recollection on resuscitation. 2. Dry drowning : water don’t enter lungs. On resuscitation panoramic views of past life. Death due to Laryngeal spasm  in rush of water from nasopharynx & larynx. 3. Secondary / Near drowning : a submerged victim who is resuscitated and survived for 24hours . Death due to cerebral anoxia & irreversible brain damage. 4. Immersion Syndrome : Death by cardiac arrest due to vagal inhibitIon . Mostly seen im suicidal cases.

12. Cause of death Asphyxia Hypothermia Laryngeal spasm Ventricular fibrillation Vagal inhibition Exhaustion Injury

13. Signs & Symptoms 70% kids develop symptoms within 7 hours Coma, agitated alertness. Cyanosis, cough, Frothy white sputum Tachypnea , tachycardia Rhales , rhonchi & sometimes wheeze Low grade fever Signs of associated trauma should be Sought Most important is history

14. Systemic effects Lungs : ARDS, pulmonary edema Heart : Myocardial dysfunction, arterial hypotension, Dec cardiac output, arrhythmia Kidneys : ATN, Cortical necrosis, Renal failure Vascular Endothelial injury :  DIC, Hemolysis , Thrombocytopenia. GIT : bloody Diarrhea with mucosal sloughing., liver n pancreatic enzymes raised. Erosion of normal mucosal protective barriers To bacteremia & pulmonary infections.

15. Evaluation & Management 4 things determine the outcome in drowning patients 1. Duration of submersion 2. Speed of rescue 3 . Effectiveness of resuscitatory efforts 4. Clinical course

16. Mainsaty is ventilation

17. Management Pre hospital management Hospital management 1. ED management 2. PICU management 3. Cardio respiratory management 4. Management of hypothermia 5. Neurological management.

18. Prehospital management AbC Initiation of ventilation is the only way to interrupt The submersion time & cpr . C-spine control, Backboard Iv line, Oxygen, Monitor, pulse ox  saturation Acidosis correction by NahCO3 Passive rewarming Rapid transport to hospital All drowning victims needs evaluation at hospital

19. Hospital management Observe for 6-8 hours Check vitals Reaccess cardiorespiratory and Neurological Examination If sp02 Achieved n symptom’s decrease patient can be discharged.

20. Management in ED AbC Iv, o2, monitor, pulse ox Cxr AbG , s Electrolytes Trauma workup

21. According to GCS GCS >12. O2 to keep spo2>95%  Observe 6h  No chest signs  Spo2 normal No investigation , discharge Gcs >12. 02 to keep spo2>95% observe 6H chest signs present Require o2  detoriates  shift to a monitor bed Gcs <13. High flow o2  Endotracheal intubation  CXR, Labs, continues Cardiac monitoring and Frequent reaccessments .

22. Cardio pulmonary resuscitation Ett iNtubation Adequate oxygenation ( Bipap , HFNC ) Fluid resuscitation Inotropic support If persistent cardiopulmonary arrest on arrival along with  apnea , Submersion time >10min , No response to cpR done for 25min, absence of pupillary response , hyperglycemia .

23. NeuRological Major manifestation is Seizures after hypoxic brain injury. 2 nd intracranial hypertension  raised Icp . Phenytion is recommeded . Benzodiazepenes , barbiturates & other anti convulsant also have a role but nor proven Comatose patients having seizures always have a poor prognosis

24. Hypothermia management Passive external . Dry blankets, warm environment Active External. Bring a heat source Active internal . Warm iv fluids , warm fluida through NG tube

25. Systemic management Acute renal failure: diuretics, Fluid restriction, dialysis if required Bloody diarrhea : Bowel rest, nasogastric suction Fever : common in 50% patients within 24h. Paracetamol Antibiotics : Prophylactic, only if pneumonia is suspected.

26. Prevention is always better than cure

27. Thanks