Burns is common hazard and could be of various types. Scald burns are most common in children due to accidental spillage of hot water, milk, tea etc. In a child, even a 30 percent burn can pose threat to life due to their large surface area and low immunity. We present below a success story of a burn survivor.
3 1/2 years old female child was brought to casualty with complaints of Accidental Hot water Burns to body (chest and below). She was walking backwards when she stumbled against a bucket containing hot water and fell into it leading to burns. Her mother quickly stripped her off her clothes and she was taken immediately to a local hospital. Emergency care was given and patient was the brought to our emergency. Dressing of the burns had also been done.
In our casualty, she was seen by Team Plastic Surgery and Paediatrics. She was dehydrated hence fluid resuscitation was continued as per Parkland formula. She was assessed to have >60% superficial (grade2) with some deep burns to back, hands (medial aspect of both arms), chest, complete perianal area with buttocks, thighs and some part of both legs. The biological dressing was done. She had significant soakage and needed more fluids than calculated by the Parkland formula, she was started on IV Antibiotics. Investigations revealed High WBC counts and electrolyte disturbance. Albumin infusion was started as S.Albumin was low and discontinued when Albumin reached 2. Electrolyte and calcium disturbances were managed accordingly
Aggressive nutritional rehabilitation was done by RT feeds. Supplements were added as soon as she started tolerating feeds well.
Dressings were done regularly by Plastic Surgeon with good wound debridement. Antibiotics were stepped up as per clinical condition and culture reports. She developed increased respiratory distress with wheezing. X ray showed early ARDS like picture. She was given respiratory support in form of CPAP and gentle physiotherapy was initiated. She responded gradually, breathlessness settled. She developed high spiking fevers which were almost continuous. Cultures were sent for investigation. Antifungal was started, suspecting fungal infection. CPAP was gradually weaned off. Fever too subsided. Though WBC counts showed a rising trend, the child was clinically better with only intermittent fever hence same antibiotic was continued.
She was completely weaned off Oxygen day 18th and she maintained saturation on room air, without any respiratory distress. She required a blood transfusion. RT was removed, and a trial of complete oral alimentation was given. Oral intake improved over a few days. Aggressive nutritional rehabilitation was done with the help of a team of dieticians.
At Discharge: Child was accepting well orally. Most of the wounds were healing. She was discharged on oral antibiotics, nutritious diet with advice for regular dressings of the healing wounds. The child required 1 skin graft for deep burns which healed well under the care of the Plastic surgeon.
On Follow up, the child had recovered very well, all wounds had healed and the child was put on pressure clothing for the scar. Presently she is attending school like a normal child and has no behavioural issues. She is growing well as per CDC growth charts and is at par with other children of her age.
Senior Consultant Pediatrics
Department of Paediatrics
Senior Consultant – Plastic Surgery
Department of Plastic, Cosmetic and Reconstructive Surgery