For more than 20 years, Children’s Mercy Kansas City has served children, families and referring specialists for burn care. As the regions ONLY pediatric exclusive burn unit, electrical, chemical and frost bite burns are cared for, with access to every pediatric subspecialty all within a pediatric hospital.
Join Dr. Aguayo has he helps guide first responders, emergency practitioners and primary care providers on when to seek out the care of a burn care specialist.
Pediatric Burns: When To Refer To A Burn Care Specialist
Featured Speaker:
Learn more about Pablo Aguayo, MD
Pablo Aguayo, MD
Pablo Aguayo, MD, is the Associate Director Trauma, Critical Care, Burns at Children’s Mercy Kansas City. He received his medical degree from the University of Texas, San Antonio, TX, completed his residency at the University of Kansas, Kansas City, Kansas, and completed fellowships in Surgical Critical Care, and Pediatric Surgery at Children’s Mercy Kansas City, Kansas City, MO. Dr. Aguayo is certified in general surgery and surgical critical care, and he is an Assistant Program Director Surgical Critical Care Fellowship; Assistant Professor of Pediatric Surgery, University of Missouri-Kansas City School of Medicine.Learn more about Pablo Aguayo, MD
Transcription:
Dr. Michael Smith (Host): Our topic today is “Pediatric Burns: When to Refer to a Burn Care Specialist.” My guest is Dr. Pablo Aguayo. He is the Associate Director of Trauma and Critical Care and Burns at Children's Mercy Kansas City. Dr Aguayo, welcome to the show.
Dr. Pablo Aguayo (Guest): Thank you. Thanks for having me.
Dr. Smith: Tell us first, a little bit about how you got started or interested in burn care treatment and how that brought you to Children's Mercy?
Dr. Aguayo: Sure. I actually was exposed to adult burns as a resident at the University of Kansas back in 2005-2006. It was a rotation as part of general surgery training and I actually enjoyed it quite a bit. It was a busy service and I was able to perform a lot of the procedures, take care of these very sick patients. That was my first exposure to it. I subsequently did a couple other rotations on that service and found that I really was interested in this type of patient population. I ultimately did a trauma critical care fellowship at Children's Mercy Hospital, at which time I was responsible for taking care of all of our burn patients with our staff, and found that pediatric burns was just fascinating. It was a great experience for me taking care of these patients. It was something that I could do that wouldn't consume all of my time, so it would allow me to do general surgery but, in addition, I could also do some of the burn care. Most of the burns we see in the pediatric world are fairly small, less than ten percent of total body surface area burns. A lot of it is out-patient management which is great for the patients and then, there are a few bigger burns that we get throughout the year. The combination of me being interested in pediatrics in general and then my experience with the pediatric burns and the adult burns is what really solidified it. When I came to Children's Mercy to finish my pediatrics surgery fellowship, there was a position available as one of our burn surgeons was retiring and another one of our burn surgeons was moving on to become Surgeon in Chief at another hospital and so it was perfect for me at that time and, of course, I just ended up staying.
Dr. Smith: You had mentioned that a lot of the burns in the pediatric population can be managed in an out-patient type setting, which brings up the question when is it appropriate for a pediatric burn patient to be in the hospital as an in-patient? When should we refer to a burn specialty unit? Let's start with the first responders. I think that's a group of practitioners that we often forget about. Do you have any advice for the first responder when it comes to burns?
Dr. Aguayo: That's a great point. They are the first people that see these burns and the majority of the time, if they're called out for a burn it's probably something that's fairly significant. We usually would like those seen in the emergency department. Generally speaking, the first responder's main responsibility with regards to burns is going to be, if the burn is not a very big burn, so, it's less than 5-10%, does the story makes sense? Does the injury correspond to the story that's being told? We do see instances of neglect or abuse, so they would be the first line of defense against that.
Dr. Smith: So, this brings up another question, though. In that setting when there is a call out for an ambulance, what are the most common types of burns that we see in the field?
Dr. Aguayo: They're mostly scalds. About 60-70% of what we see in pediatric burns are scald injuries, things like soups, hot coffee, kids reaching out and pulling down a hot pan with either grease or with water off the stove. Those are, by far, the most common followed by contact burns is what we see here. We see a lot, especially in the winter, where younger kids who are just barely learning to walk actually walk up to the fireplace and they have those glass protectors over the fire. Those get really hot and, of course, what they do is they put their hands on it as they are walking. So, we see a fair number of those.
Dr. Smith: Now, when we go from the first responder, and, in most cases, you're right--they are taking them into the emergency room. When we get the pediatric burn patient to the emergency room, what are some of the things that you think are signals or red flags to really call in the burn specialist?
Dr. Aguayo: Sure. There are actually very specific details. There are ten injury patterns or ten types of injuries that American Burn Association recommends that they be seen by, or they be referred to, a burn center. Those are actually on the ABA website. It’s ameriburn.org. They include things like larger burns. So, greater than ten percent total body surface area burns is to be seen at a burn unit or a burn center. Burns that involve some of the extremities like the hands, the feet and the perineum and also the face, and then any third degree burn. These third degree burns are important because, most of the time, depending on how big they are they will not heal for a long-long time, and what that means is that the longer it takes to heal, the more chance that it's going to become hypertrophic or it's going to form a large scar there. So, we really want to avoid that. Then, things like chemical burns and inhalation injuries, those are also something that should be seen at the burn center. Even if they don't appear to be significant, there are certain chemicals that can cause significant damage. There are, of course, electrical injuries, or inhalation injuries that can cause significant damage that we can't really see or may not appreciate immediately but that will manifest in a matter of time.
Dr. Smith: Are these ten signs that a patient should be seen at a burn center, are these well-known in the community centers with pediatric primary care physicians or is this a teaching opportunity for Children's Mercy?
Dr. Aguayo: I think it's a good teaching opportunity. I don't think that a lot of the primary care providers are aware of these criteria. Some of them are pretty obvious. If you have a big 20% burn, most primary care physicians are obviously not going to try to treat that but sometimes I think that they overlook the hand burns because it may be a relatively small burn on a small kid. Those hand burns can cause significant problems long term or the flash burns to the face that don't look very deep but ultimately will cause a lot of swelling and maybe closure of the eyes because they're so swollen. It is certainly helpful to get this information out to a community pediatrician and family practitioners. A good thing is that a lot of these pediatricians and family practitioners don't see a lot of burns. The bad thing is that they don't have a lot of experience with them. One of the key components of assessing a burn is not only the extent of how big the burn is but also how deep it is. It's difficult, even for someone who's done it for a long time, to determine the depth and so it becomes even more difficult, obviously, for someone who rarely see these burn to try to determine in a short time in an out-patient setting, how deep these burns are, how long approximately will it take to heal, and what should I be doing in the interim?
Dr. Smith: Dr. Aguayo, you've given us some really good tips to know how to manage these patients as a first responder, in the emergency room and in primary care practice. I want to thank you for the work that you're doing and the passion that you have for the burn victims. Thank you for coming on to the show today. You're listening to Transformational Pediatrics for Children's Mercy Kansas City. For more information, you can go to childrensmercy.org. That's childrensmercy.org. I'm Dr. Mike Smith. Thanks for listening.
Dr. Michael Smith (Host): Our topic today is “Pediatric Burns: When to Refer to a Burn Care Specialist.” My guest is Dr. Pablo Aguayo. He is the Associate Director of Trauma and Critical Care and Burns at Children's Mercy Kansas City. Dr Aguayo, welcome to the show.
Dr. Pablo Aguayo (Guest): Thank you. Thanks for having me.
Dr. Smith: Tell us first, a little bit about how you got started or interested in burn care treatment and how that brought you to Children's Mercy?
Dr. Aguayo: Sure. I actually was exposed to adult burns as a resident at the University of Kansas back in 2005-2006. It was a rotation as part of general surgery training and I actually enjoyed it quite a bit. It was a busy service and I was able to perform a lot of the procedures, take care of these very sick patients. That was my first exposure to it. I subsequently did a couple other rotations on that service and found that I really was interested in this type of patient population. I ultimately did a trauma critical care fellowship at Children's Mercy Hospital, at which time I was responsible for taking care of all of our burn patients with our staff, and found that pediatric burns was just fascinating. It was a great experience for me taking care of these patients. It was something that I could do that wouldn't consume all of my time, so it would allow me to do general surgery but, in addition, I could also do some of the burn care. Most of the burns we see in the pediatric world are fairly small, less than ten percent of total body surface area burns. A lot of it is out-patient management which is great for the patients and then, there are a few bigger burns that we get throughout the year. The combination of me being interested in pediatrics in general and then my experience with the pediatric burns and the adult burns is what really solidified it. When I came to Children's Mercy to finish my pediatrics surgery fellowship, there was a position available as one of our burn surgeons was retiring and another one of our burn surgeons was moving on to become Surgeon in Chief at another hospital and so it was perfect for me at that time and, of course, I just ended up staying.
Dr. Smith: You had mentioned that a lot of the burns in the pediatric population can be managed in an out-patient type setting, which brings up the question when is it appropriate for a pediatric burn patient to be in the hospital as an in-patient? When should we refer to a burn specialty unit? Let's start with the first responders. I think that's a group of practitioners that we often forget about. Do you have any advice for the first responder when it comes to burns?
Dr. Aguayo: That's a great point. They are the first people that see these burns and the majority of the time, if they're called out for a burn it's probably something that's fairly significant. We usually would like those seen in the emergency department. Generally speaking, the first responder's main responsibility with regards to burns is going to be, if the burn is not a very big burn, so, it's less than 5-10%, does the story makes sense? Does the injury correspond to the story that's being told? We do see instances of neglect or abuse, so they would be the first line of defense against that.
Dr. Smith: So, this brings up another question, though. In that setting when there is a call out for an ambulance, what are the most common types of burns that we see in the field?
Dr. Aguayo: They're mostly scalds. About 60-70% of what we see in pediatric burns are scald injuries, things like soups, hot coffee, kids reaching out and pulling down a hot pan with either grease or with water off the stove. Those are, by far, the most common followed by contact burns is what we see here. We see a lot, especially in the winter, where younger kids who are just barely learning to walk actually walk up to the fireplace and they have those glass protectors over the fire. Those get really hot and, of course, what they do is they put their hands on it as they are walking. So, we see a fair number of those.
Dr. Smith: Now, when we go from the first responder, and, in most cases, you're right--they are taking them into the emergency room. When we get the pediatric burn patient to the emergency room, what are some of the things that you think are signals or red flags to really call in the burn specialist?
Dr. Aguayo: Sure. There are actually very specific details. There are ten injury patterns or ten types of injuries that American Burn Association recommends that they be seen by, or they be referred to, a burn center. Those are actually on the ABA website. It’s ameriburn.org. They include things like larger burns. So, greater than ten percent total body surface area burns is to be seen at a burn unit or a burn center. Burns that involve some of the extremities like the hands, the feet and the perineum and also the face, and then any third degree burn. These third degree burns are important because, most of the time, depending on how big they are they will not heal for a long-long time, and what that means is that the longer it takes to heal, the more chance that it's going to become hypertrophic or it's going to form a large scar there. So, we really want to avoid that. Then, things like chemical burns and inhalation injuries, those are also something that should be seen at the burn center. Even if they don't appear to be significant, there are certain chemicals that can cause significant damage. There are, of course, electrical injuries, or inhalation injuries that can cause significant damage that we can't really see or may not appreciate immediately but that will manifest in a matter of time.
Dr. Smith: Are these ten signs that a patient should be seen at a burn center, are these well-known in the community centers with pediatric primary care physicians or is this a teaching opportunity for Children's Mercy?
Dr. Aguayo: I think it's a good teaching opportunity. I don't think that a lot of the primary care providers are aware of these criteria. Some of them are pretty obvious. If you have a big 20% burn, most primary care physicians are obviously not going to try to treat that but sometimes I think that they overlook the hand burns because it may be a relatively small burn on a small kid. Those hand burns can cause significant problems long term or the flash burns to the face that don't look very deep but ultimately will cause a lot of swelling and maybe closure of the eyes because they're so swollen. It is certainly helpful to get this information out to a community pediatrician and family practitioners. A good thing is that a lot of these pediatricians and family practitioners don't see a lot of burns. The bad thing is that they don't have a lot of experience with them. One of the key components of assessing a burn is not only the extent of how big the burn is but also how deep it is. It's difficult, even for someone who's done it for a long time, to determine the depth and so it becomes even more difficult, obviously, for someone who rarely see these burn to try to determine in a short time in an out-patient setting, how deep these burns are, how long approximately will it take to heal, and what should I be doing in the interim?
Dr. Smith: Dr. Aguayo, you've given us some really good tips to know how to manage these patients as a first responder, in the emergency room and in primary care practice. I want to thank you for the work that you're doing and the passion that you have for the burn victims. Thank you for coming on to the show today. You're listening to Transformational Pediatrics for Children's Mercy Kansas City. For more information, you can go to childrensmercy.org. That's childrensmercy.org. I'm Dr. Mike Smith. Thanks for listening.