Answer:
a) Pediatric burn patients should be resuscitated according to body surface area and not weight because the standard adult relationships between surface area and weight do not hold true in children. The most common formula is 5000 cc per square meter of BSA burned plus 2000 cc/sq meter BSA over the first 24 hrs, with half the volume administered during the first 8 hrs. The subsequent 24 hrs requires 3750 cc/sq meter BSA burned plus 1500 cc/sq meter BSA. This should be titrated to keep urinary output 1-2 cc/kg. Lactated ringers is suitable for the first 24 hrs.
b)Venous access can be problematic in pediatric burn patients. The femoral or saphenous vein offer good temporary sites. Intraosseous administration of fluids is another alternative, with rates up to 100 cc/hr possible.
c) The small aperture of the pediatric trachea predisposes it to obstruction. A small amount of airway edema can result in significant decrease in the cross-sectional area.
d) Burn injury causes dramatically increased metabolic rate and pediatric patients have limited stores to meet the augmented demands. Enteral feedings should be started almost immediately post-burn. Caloric demands are related to burn size and body surface area. Infants require 2100 kcal/sq meter plus 1000 kcal/sq meter of burn area. A child requires 1800 kcal/sq meter BSA and 1300 kcal/sq meter burn area. Adolescents require 1500 kcal/sq meter BSA and 1500 kcal/sq meter burn area.
e) Thermoregulation is altered because pediatric patients have increased surface area to volume ratios, less insulating fat, and lower muscle mass for shivering, making them susceptible to hypothermia. Ambient temperature should be 28-33 deg. C at 80% humidity.