Home > Browse Emergency Issues
<< An Evidence-Based Approach To Pediatric Burns
Diagnostic Studies
Laboratory Evaluation
Laboratory studies are important in the management of burn injuries. Since burn injuries can lead to anemia, a complete blood count should be obtained in order to establish a baseline prior to therapy. Transfusion of blood products is controversial in burn care; however, the transfusion of blood products may be necessary in major burns. Therefore, a type and screen should be obtained on any patient with a major burn injury. Electrolytes are important for different reasons in burn management. Hypoglycemia can occur due to decreased glycogen stores in children and should be corrected promptly.47 Special attention should be given to blood, urea, nitrogen (BUN), and creatine measurement as renal insufficiency can develop due to intravascular hypovolemia, shock, or myoglobinuria in burn patients.42 If rhabdomyolysis from muscle injury is suspected from either an electrical injury, extensive thermal injury, crush, or blast mechanism, a creatine kinase level should be obtained as well as a urinalysis with microscopy. There is ongoing research focused on lactate levels and base deficit measurements in an attempt to specify parameters for the fluid resuscitation of burn paatients.43 Cochran et al in 2007 found that the mortality was higher in burn patients with lactate levels that trended up after 6 hours. It is not clear from this study if this is specific to the physiology of a burn injury or if it is a surrogate measurement for shock.43 If inhalation injury is a possibility an arterial blood gas and carboxyhemoglobin level should be evaluated early in the resuscitation process.
Radiographic Evaluation
Experts often recommend initial chest radiographs of all burn patients. However, in a recent study of chest radiographs in non-intensive care burn patients with no history of inhalation injury, only 7.2% of radiographs revealed any abnormality, and none of the abnormalities changed the management or outcome of the patient.44 Chest radiographs should be obtained in the presence of inhalation, electrical, or blast injuries. Although it is rare to see abnormalities on an initial chest x-ray even in the presence of inhalation injury, it may be beneficial to have a baseline reference radiograph in this situation.45 Additional radiographic evaluation should be chosen according to the mechanism of burn and associated traumatic injuries.
Laboratory studies are important in the management of burn injuries. Since burn injuries can lead to anemia, a complete blood count should be obtained in order to establish a baseline prior to therapy. Transfusion of blood products is controversial in burn care; however, the transfusion of blood products may be necessary in major burns. Therefore, a type and screen should be obtained on any patient with a major burn injury. Electrolytes are important for different reasons in burn management. Hypoglycemia can occur due to decreased glycogen stores in children and should be corrected promptly.47 Special attention should be given to blood, urea, nitrogen (BUN), and creatine measurement as renal insufficiency can develop due to intravascular hypovolemia, shock, or myoglobinuria in burn patients.42 If rhabdomyolysis from muscle injury is suspected from either an electrical injury, extensive thermal injury, crush, or blast mechanism, a creatine kinase level should be obtained as well as a urinalysis with microscopy. There is ongoing research focused on lactate levels and base deficit measurements in an attempt to specify parameters for the fluid resuscitation of burn paatients.43 Cochran et al in 2007 found that the mortality was higher in burn patients with lactate levels that trended up after 6 hours. It is not clear from this study if this is specific to the physiology of a burn injury or if it is a surrogate measurement for shock.43 If inhalation injury is a possibility an arterial blood gas and carboxyhemoglobin level should be evaluated early in the resuscitation process.
Radiographic Evaluation
Experts often recommend initial chest radiographs of all burn patients. However, in a recent study of chest radiographs in non-intensive care burn patients with no history of inhalation injury, only 7.2% of radiographs revealed any abnormality, and none of the abnormalities changed the management or outcome of the patient.44 Chest radiographs should be obtained in the presence of inhalation, electrical, or blast injuries. Although it is rare to see abnormalities on an initial chest x-ray even in the presence of inhalation injury, it may be beneficial to have a baseline reference radiograph in this situation.45 Additional radiographic evaluation should be chosen according to the mechanism of burn and associated traumatic injuries.
Sign up for free access