Pediatric Emergency Care Champions (PECCs) of the Week:
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The Pediatric Committee of the Florida College of Emergency Physicians (FCEP) presented the PEM Workshop on Neonatal Emergencies at the EMerald Coast Conference on June 2, 2019. According to our champions, the workshop was well attended and well received!
From left to right:
Front row: Drs. Vanessa Perez, Cristina Zeretzke-Bien and Tricia Swan
Back row: Drs. Shiva Kalidindi, Nicholas Erbrich, Todd Wylie and Joseph Grantham
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Encourage others to sign up for the PEDReady listserve & weekly newsbrief, the PE
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ARL, by sharing this link:
http://bit.ly/flpearl
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Focus | Pediatric Burns: Flame or Scald
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Did You Know...
- Approximately one-third of burn injuries in the U.S. occur in the pediatric population.
- Burns are the fifth leading cause of unintentional injury-related death in children.
- Younger children (≤ 4 years) are more likely to sustain scald burns caused by hot liquids or steam, while older children are more likely to sustain burns that are caused by direct contact with fire or flames.
- The hands, head, chest and face are common areas to see scald burns.
- Scald burns related to microwaved food or children opening microwave oven doors are increasing! Children as young as 12 months have sustained burns by this mechanism.
- Beware! Approximately 10–20% of pediatric burns are not accidental. Every child with burn injuries must have a thorough history and physical exam. Does the injury pattern and history match the exam?
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Key Management Pearls:
General
- Burn management has 3 phases: early resuscitative/initial stabilization, wound management, and rehabilitative/reconstructive.
Airway
- The primary survey focuses on airway patency and burn severity. Facial burns or the presence of soot, carbonaceous sputum, or singed nasal hairs are red flags for impending airway edema.
Hypothermia
- Children are at increased risk of hypothermia, especially after being undressed and doused with water, saline or other measures to cool the burn! Keep them warm with dry sheets or blankets.
Pain Control
- Burns are very painful and frightening to children. Don’t forget analgesia and distraction. Opioids such as morphine or fentanyl or subdissociative ketamine may be necessary. Remember that fentanyl is short-acting. If there is no IV access and the child is in significant pain, consider intranasal (IN) medications. For IN medications, use the most concentrated formulation with an atomizer and 1 mL/nare max.
- Ketamine (analgesic dose): 0.1 to 0.3 mg/kg IV; 0.5-1.0 mg/kg IM; 0.5-1.0 mg/kg IN or agency/ED policy
- Fentanyl: 1-2 mcg/kg IV; 1.5-2 mcg/kg IN (100 mcg max initial dose)
- Morphine 0.1-0.2 mg/kg IV
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Pediatric Dosing Resources:
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Wound Management
- After cooling the scald burn (no ice), initial ED/EMS wound care consists of covering burns with a dry, sterile sheet or dressing.
- Avoid antiseptic solutions (such as povidone–iodine) and topical antibiotics in patients who are being transferred to a burn center so the specialty burn service may visualize the wounds.
Fluid Management
- Fluid management is based on degree and percentage of BSA. Children have nearly 3 times the BSA to body mass ratio of adults.
- The Rule of Nines is a useful and practical guide for calculating the extent of the burn in adult patients, but some modifications must be made while applying this formula to children due to larger heads and smaller lower extremities.
- When time and resources are limited or the burn is small or unusually shaped, use the palmar hand surface (including the fingers) to represent approximately 1% of BSA.
- There are numerous formulas for estimating fluid management based on BSA and type of burn. The most recent ATLS recommendations are listed below. Children < 30 kg require the addition of maintenance fluids. Be sure you know your agency/ED policy or contact your closest Burn Center for their policies or recommendations.
- The 2018 MyATLS mobile app includes a pediatric burn calculator to determine fluid administration as do other pediatric emergency mediation systems.
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Advanced Trauma Life Support Student Course Manual: American College of Surgeons; 10th edition, 2018.
Documentation and Disposition
- If not admitted, all burn patients should be re-evaluated at 24–48 hours to ensure proper wound healing, assess pain control and to examine for signs of infection.
- Significant/life threatening burns require rapid transfer to a burn center and may require air transport depending on distance and local policy.
- Note: Not all burn centers accept pediatric patients
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2. Upcoming Pediatric Emergency Conferences
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The Forensic Investigation in Child Physical Abuse:
Making a Difference Together
June 13–14, 2019 |
Gainesville, FL
Hosted by: The Shaken Baby Alliance
This conference is designed for multi-disciplinary teams that investigate cases of child physical abuse. CME available!
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Kid Care Trauma Conference
July 9, 2019 |
Jacksonville, FL
Hosted by: UF Health Jacksonville
Approved for 8 nursing hours and 7 EMS hours
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CLINCON 2019
July 17–19, 2019 |
Orlando, FL
Hosted by: EMLRC
Designed for the entire spectrum of emergency care providers. General conference lectures include
The Pregnant Patient Skills Lab, Tips & Tricks for Blue & Barely Breathing Baby
and more!
Access Brochure
Pre-Con Workshop:
Managing Pediatric Cardiac Arrest
July 17, 2019 | 8:00-12:00 pm
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Symposium by the Sea 2019
August 1-4, 2019 | Boca Raton, FL
Hosted by: Florida College of Emergency Physicians (FCEP)
FCEP's annual meeting & educational conference, Symposium by the Sea, is designed for emergency physicians, residents, students, physician assistants, nurses and allied health professionals interested in emergency care.
Pediatric Trauma Workshop
August 2, 2019 | 9:00 am to 12:00 pm
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Pediatric Care After Resuscitation (PCAR) Course
Dec 2-3, 2019 | Jacksonville, FL
The mission of TCAR (Trauma Care After Resuscitation) Education Programs is to expand the knowledge base and clinical reasoning skills of nurses who work with injured patients anywhere along the trauma continuum of care, particularly in the post-resuscitation phase.
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Thanks for being a Pediatric Champion!
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The Florida PEDReady Program
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