Page 81 - ATP-P 11th Ed

e. In children with burns >30% TBSA, early administration may reduce overall resuscita-
tion volume.
f. Monitor resuscitation in children, like adults, based on physical examination, input, and
output measurements, and analysis of laboratory data. SECTION 1
g. The well-resuscitated child should have alert sensorium, palpable pulses, and warm
distal extremities; urine should be glucose negative.
h. Cellulitis is the most common infectious complication and usually presents within 5
days of injury. Prophylactic antibiotics do not diminish this risk and should not be used
unless other injuries require antimicrobial coverage (penetrating injury or open fracture).
i. Most antistreptococcal antibiotics such as penicillin are successful in eradicating infec-
tion. Initial parenteral administration is advised for most children presenting with fever
or systemic toxicity.
j. Nutrition is critical for pediatric burn patients. Nasogastric feeding may be started im-
mediately at a low rate in hemodynamically stable patients and tolerance monitored.
Start with a standard pediatric enteral formula (i.e., Pediasure) targeting 30–35kcal/kg/
day and 2g/kg/day of protein.
k. Children may rapidly develop tolerance to analgesics and sedatives; dose escalation is
commonly required. Ketamine and propofol are useful procedural adjuncts.
l. When burned at a young age, many children will develop disabling contractures. These
are often very amenable to correction which may be performed in theater with adequate
staff and resources.
m. Seek early consultation from the USAISR Burn Center (DSN 312-429-2876 (BURN);
Commercial (210) 916-2876 or (210) 222-2876; email burntrauma.consult.army@
mail.mil).
n. Opportunities for pediatric surgical care provided by Non-Governmental Organizations
(NGOs) may be the best option but require the coordinated efforts of the military, host
nation, and NGOs.
Rule of Nines
On the DD Form 1380 the percentage of coverage on the casualty’s body will need to be
documented. The Rule of Nines will help with the estimation. The below figure shows the
approximation for each area of the body:
a. Eleven areas each have 9% body surface area (head, upper extremities, front and backs
of lower extremities, and front and back of the torso having two 9% areas each).
b. General guidelines are that the size of the palm of the hand represents approximately
1% of the burned area.
c. When estimating, it is easiest to round up to the nearest 10.
d. If half of the front or rear area is burned, the area would be half of the area value.

70 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 71