Airway management in both acute and reconstructive burn patients can be a major challenge for evaluation, intubation, and securing the airway in the setting of altered airway structure. Airway evaluation in both acute and reconstructive patients includes examination for evidence of laryngeal and supraglottic edema and structural changes due to trauma and/or scarring that will impact the successful approach to acquiring an airway for surgical procedures and medical recovery. The approach to acquiring a successful airway is rarely standard laryngoscopy and often requires fiberoptic bronchoscopy and a variety of airway manipulation techniques. Tracheostomy should be reserved for those with classic requirements of ventilatory and/or mechanical failure or severe upper airway burns. Even securing an airway for surgical procedures, especially with patients suffering injuries involving the head and neck, can be nonstandard and requires creative and flexible approaches to be successful. After much trial and error over the past 30 years in a large burn center, our multidisciplinary team has learned many valuable lessons. This review will focus on our current approach to safe airway management in acute and reconstructive burn patients.

This retrospective study investigated burn features and predicted factors for death of pediatric burn patients in Vietnam. The results showed that pediatric burn accounted for 48.1% of total admitted burn patients. Preschool children and boys were predominant, burns were mostly caused by scald (76.2%) and the majority of patients lived in a rural area (64.1%). In addition, 94.5% had burn size less than 30% total body surface area and deep burn injury was seen in 45.5% patients. Moreover, a significantly higher incidence of deep burn injury was recorded in preschool age, patients living in a rural area, and non-scald burn. Overall LA50 was 81.5% and a significantly higher mortality rate was seen in non-scald burns, older children, extensive burn and inhalation injury. Multivariate logistic analysis indicated that only burn extent and inhalation injury were independent risk factors for death. An increased 1% of burn extent resulted in a .7 probability unit of death (OR=1.08) and this was 2.16 in the case of inhalation injury (OR=8.67). This health issue should be highlighted in order to develop appropriate policies and intervention measures in developing countries.
Cette étude rétrospective s’est penchée sur les caractéristiques et les facteurs de risque de mortalité des brûlures de l’enfant au Vietnam. Ces brûlres représentent 48,1% des hospitalisations dans notre centre. Les garçons d’âge préscolaire sont la sous- population prédominante. Les ébouillantements sont majoritaires (76,2%), de même que l’origine ruale (64,1%). L’immense majorité (94,5%) des brûlures touche moins de 30% SCT et l’atteinte n’est profonde que dans 45,5% des cas. Les brûlures sont plus profondes chez les patients ruraux préscolaires non ébouillantés. La SL (Surface Létale) 50 était de 81,5% ; les facteurs de risque de mortalité étant l’âge et la surface plus élevés, l’inhalation de fumées et la brûlure non due à un liquide. En analyse multivariée, seules la surface et l’inhalation de fumée ressortaient. Ainsi, l’augmentation de 1% de SB la probabilté de décès de 0,7 (OR 1,08) quand l’inhalation de fumée l’augmente de 2,16 (OR 8,67). Ce problème de santé publique doit être mis en avant afin de développer une législation et des mesures de protection adaptées dans les pays en développement.

Burns represent a large portion of injuries attending emergency departments each year, with children accounting for the biggest proportion. Appropriate first aid has been shown to help improve the outcome of burns, and decrease the need for surgical intervention. Several studies outside of Ireland demonstrate inadequate parental knowledge of burns first aid, but few evaluated interventions to improve knowledge. Consequently our aim was to assess parental/caregiver knowledge in Ireland, and determine if knowledge levels could be raised following a short educational video intervention.
An educational video based on current European and British best practice guidelines was produced and shown to parents/caregivers waiting in the Pediatric Outpatients Department after a previously validated pre-intervention questionnaire was completed. A post intervention questionnaire was completed following the video. Questionnaires assessed demographics, previous experience and included scenarios to test parental knowledge.
112 parents/caregivers (81.3% female (n = 91), 18.8% male (n = 21)) were questioned. Baseline knowledge was found to be poor overall, however this significantly improved with a simple educational video (pre-score 31.9%, post-test mean score knowledge 92.1%). Pre- and post-test scores showed a statistical significance (x2 = 71.117, P < 0.001, 95% CI).No other variables analysed were shown to be statistically significant predictors of pre- or post-test scores (all p > 0.05).
The study found poor parental knowledge of burns first aid in Ireland and shows the use of an educational video was effective in raising knowledge levels.

The purpose of this study was to determine the immediate effect of adding Virtual reality (VR) to conventional burn rehabilitation program on pain and range of motion (ROM) in children with burn injuries during rehabilitation sessions after burn.
Twenty-two pediatric children (13 boys & 9 girls) with burn injuries and inpatient hospitalization participated in this study. Their age ranged from 9 to 16 years old with 2nd degree deep partial thickness burn of TBSA (10%-25%). They were randomly classified into study and control groups of equal numbers; control group receive passive ROM and stretch exercises, and study group receive the same treatment of the control group in addition to VR training. children in the study group wear the Oculus Rift DK2 as a means for VR and they allowed to choose the favorite video they would like to view before starting the study. The children feel like they are actually in a game. The pain was measured using VAS and the maximum range-of-motion of the joints using electronic digital goniometer before and immediately after the rehabilitation session.
There was a significant decrease in pain intensity and increase of ROM after application of VR in the study group and a significant difference between groups after treatment for pain and ROM p < 0.05.
Based on the current findings adding VR to the rehabilitation program of pediatric burn victims had an immediate effect on decreasing pain and increase ROM.

BACKGROUND: Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes.
METHODS: Children (n = 102) aged 0-7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression.
RESULTS: The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97).
CONCLUSIONS: Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

Management of the pediatric burn patient presents a variety of clinical challenges for the pediatric anesthesiologist. Despite the high incidence of burn injuries, standard management strategies are far from universal. The complex physiologic changes presented by burn injuries present airway management and resuscitation challenges and mandate careful consideration of adequate nutritional support. Long hospital stays with frequent operations and dressing changes necessitate creative approaches to anxiolysis and pain control. Underutilized modalities warranting further research include regional anesthesia and nonpharmacologic approaches, such as virtual reality. Further research and collaboration between burn centers are needed to standardize care for this population.

Pediatric burn injuries are a major cause of death and injury, occurring mainly in resource poor environments. Recovery from burns is widely reported to be constrained by physical, psychological, relationship and reintegration challenges. These challenges have been widely described, but not the enablers of psychosocial recovery. This is especially true in pediatric burn research, with few multi- perspective studies on the recovery process.
This qualitative study involved 8 focus group discussions (four with 15 children post-burn injury, four with 15 caregivers) and 12 individual interviews with staff working in pediatric burns that explored the psychosocial needs of children after a burn and the enablers of their recovery. Purposive sampling was utilized and recruitment of all three categories of participants was done primarily through the only hospital burns unit in the Western Cape, South Africa. The interviews focused on factors that supported the child\'s recovery and were sequentially facilitated from the child and the family\'s experiences during hospitalization, to the return home to family and friends, followed by re-entry into school. Thematic analysis was used to analyze verbatim interview transcripts.
The recovery enablers that emerged included: (i) Presence and reassurance; indicating the comfort and practical help provided by family and close friends in the hospital and throughout the recovery process; (ii) Normalizing interactions and acceptance; where children were treated the same as before the injury to promote the acceptance of self and by others especially once the child returned home; and (iii) Sensitization of others and protection; signifying how persons around the child had assisted the children to deal with issues in the reintegration process including the re-entry to school.
This study indicates that the psychosocial recovery process of children hospitalized for burns is enabled by the supportive relationships from family members, close friends and burn staff, present during hospitalization, the return home, and school re-entry. Support included comfort and physical presence of trusted others and emotional support; affirmation of the child\'s identity and belonging despite appearance changes; and the advocacy and protection for the re-entry back into the school, and more generally the community.

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Cardiac stress is a critical determinant of outcomes associated with severe thermal injury. The cardiovascular response to a catecholamine-mediated surge from severe burns passes through two phases. Initial hypovolemia with myocardial depression leads to a low cardiac output, which then progresses to a hyperdynamic-hypermetabolic phase with increased cardiac output.

Ceramic and metal hair straightening and curling irons are common household items which reach up to 450°F in as little as five seconds. Of particular concern is the threat these devices pose to children. Our objective is to characterize and bring attention to this preventable injury in the pediatric population. Retrospective records from a high-volume level I trauma center and regional burn center from 2011-2015 were analyzed. Inclusion criteria were defined as patients <11 years of age, as those presenting with burns above this age were more likely to be utilizing the tools for hair styling. A total of 59 patients were identified with an average age of 2.4 years. The average burn size was 0.30%, with an average 0.24% 2nd degree TBSA. The etiology of the burns included touching a hair iron that was within reach (61%), pulling a hair iron\'s power cord (15%), stepping/rolling/jumping onto a hair iron left on the ground (17%), and hair irons falling (7%). The majority of households were comprised of unemployed (64%), single (60%) parents. CPS consult was required for 20% of patients. Grafting and excision was necessary for 20% of patients The pediatric population is at risk for accidental burns with household hair irons. These burns typically have a small TBSA, but may require excision and grafting and extended follow-up.
Les lisseurs et fers à friser, en céramique ou en métal, sont des objets courants au domicile. Leur température peut monter à plus de 230°C en quelques secondes. Le risque qu’encourent les enfants est préoccupant. Nous avons explorés ces brûlures afin de déterminer des stratégies de prévention. Nous avons analysé rétrospectivement les données d’un CTB régional, recueillies entre 2011 et 2015. Nous n’avons retenu que les brûlures atteignant les enfants de 11 ans au maximum (59 cas, âge moyen 2,4 ans), les enfants plus âgés étant susceptibles d’utiliser ces instruments à leur propre bénéfice. La surface brûlée était de 0,3 % dont 0,24 % de 2ème degré. La brûlure était consécutive au toucher d’un ustensile atteignable (61%), à la traction sur le cordon d’alimentation (15%), à la marche dessus (17%), à la chute de l’objet (7%). Les familles concernées étaient en majorité monoparentales (60%) sans emploi (64%). Les services de protection de l’enfance ont été sollicités dans 20% des cas. Les enfants sont particulièrement à risque de brûlures lors d’accidents domestiques, pouvant impliquer des fers à friser et des lisseurs. Ces brûlures sont typiquement peu étendues mais peuvent être profondes, nécessiter une greffe et un suivi prolongé.