Dr Ingrid Salna1, Mrs Rebbeca Schrale1, Mr Andrew Castley1
1Royal Hobart Hospital, South Hobart, Australia
Background: despite numerous prevention efforts, burn injuries still remain a significant health concern for children and adolescents. Recently it has been estimated that 664 people aged 10-19 years of age present for care of their burn injury in Victoria alone1. There however exists difficulties and question marks when managing a burn injury in a teenager, an almost adult.
Method: a case report of a teenager who presented to the Royal Hobart Hospital (RHH) after sustaining a burn injury will be discussed, specifically looking at difficulties in care and how they were overcome to provide the best possible outcome.
Results: a 16-year-old female patient presented to the RHH after sustaining an 17% total body surface area flame burn when an accelerant was used on an open fire. She required five operations in theatre for initial debridement, dressing changes and grafting. Special considerations for her care included initial fluid resuscitation, which due to her weight she was resuscitated as an adult and consent for medical procedures. Her overall care was further complicated by management of undiagnosed anxiety/behaviour disorder, as well as poor participation and subjective low pain threshold. She also required acute pain service input.
Conclusion: teenagers may not be the most common age group to present with a burn injury. However, they can have complex and special needs specific to their age group. Initial fluid resuscitation should depend on their body weight as well as any comorbidities, but commonly will be the same as adults. A child 16 years and over can consent to their own medical treatment as validly as they are an adult, however they may be younger depending on the level of maturity and the nature and complexity of the medical treatment. The treating surgeon should be aware of the increasing incidence of behavioural and mood disorders, that may affect pain perception, as well as rehabilitation and participation in burn injury patients. As like many other populations, there is a greater need for better education for preventing burn injuries and improving burn injury outcomes.
Dr Ingrid Salna is a current unaccredited plastics registrar at the RHH. She completed her medical training in South Australia and has a broad research interest, including burns, reconstructive surgery and surgical history.