Pediatric emergency medicine trisk 1965 1965
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Young children are vulnerable to orofacial burns, especially of the lips ( Fig.
90.9 ). These full-thickness burns of the upper and lower lips and oral
commissure usually involve mucosa, submucosa, muscles, nerves, and blood
vessels. The lesion usually has a pale, painless, well-demarcated, depressed center
with surrounding pale gray tissue and erythematous border. After a few hours, the
wound margin extends and marked edema occurs. Drooling is common. The
eschar separates in 2 to 3 weeks and bleeding may occur at this time; granulation
tissue gradually fills the wound. Scarring may produce lip eversion, microstomia,
and loss of function. Damage to facial or even carotid arteries may result in
delayed hemorrhage. Devitalization of deciduous and secondary teeth may occur.
FIGURE 90.9 Patient with electrical burns to the corner of the mouth after biting on an
electrical cord. (Courtesy of Evaline Alessandrini, MD.)
Inadequately debrided burned or gangrenous tissue provides a medium for
infection. Staphylococcal, pseudomonal, and clostridial species are common
pathogens in the extremities. Streptococci and oral anaerobic organisms may
infect mouth wounds.
Management and Diagnostic Studies
The first step in emergency management ( Table 90.9 ) is to separate the victim
from the current source. The rescuer must be well insulated to avoid becoming an
additional casualty. If the current cannot be shut off, wires can be cut with a
wood-handled ax or appropriately insulated wire cutters. In cases of lightning,
contact with the victim does not pose any threat to the rescuer, and treatment may
be started immediately.
Any victim in cardiopulmonary arrest should be resuscitated promptly
following the guidelines discussed in Chapters 7 A General Approach to the Ill or
Injured Child , 8 Airway , and 9 Cardiopulmonary Resuscitation . Prolonged
