(burns OR frostbite) AND pediatric

pediatric thermal burn frostbite clinical guideline first aid fluid resuscitation referral criteria

/tmp/workspace

https://cpr.heart.org/en/resuscitation-science/2024-first-ai…

Wilderness Medical Society frostbite clinical practice guideline rapid rewarming 37 39 ibuprofen blisters

/tmp/workspace

mkdir -p "/tmp/workspace/pediatric-burn-frostbite-reference/src" "/tmp/workspace/pediatric-burn-frostbite-reference/output" && python - <<'PY' from reportlab.lib.pagesizes import letter from reportlab.lib import colors from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.enums import TA_LEFT, TA_CENTER from reportlab.lib.units import inch from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, KeepTogether, PageBreak from reportlab.pdfbase.ttfonts import TTFont from reportlab.pdfbase import pdfmetrics from reportlab.lib.colors import HexColor from reportlab.pdfbase.pdfmetrics import stringWidth from reportlab.pdfgen import canvas from reportlab.lib.utils import ImageReader from pathlib import Path out=Path('/tmp/workspace/pediatric-burn-frostbite-reference/output/Pediatric_Thermal_Burn_and_Frostbite_Quick_Reference.pdf') NAVY=HexColor('#14324A'); TEAL=HexColor('#067C78'); ORANGE=HexColor('#D95D39'); RED=HexColor('#B42318'); PALE=HexColor('#EEF5F7'); LIGHT=HexColor('#F7F9FA'); GOLD=HexColor('#F6E9C8'); GRAY=HexColor('#53616C'); GREEN=HexColor('#E6F4EE') styles=getSampleStyleSheet() styles.add(ParagraphStyle(name='Title2', parent=styles['Title'], fontName='Helvetica-Bold', fontSize=19, leading=22, textColor=NAVY, spaceAfter=3)) styles.add(ParagraphStyle(name='Sub', parent=styles['Normal'], fontName='Helvetica', fontSize=8.2, leading=10, textColor=GRAY, spaceAfter=7)) styles.add(ParagraphStyle(name='H', parent=styles['Heading2'], fontName='Helvetica-Bold', fontSize=10.3, leading=12, textColor=colors.white, spaceBefore=5, spaceAfter=4)) styles.add(ParagraphStyle(name='B', parent=styles['BodyText'], fontName='Helvetica', fontSize=8.25, leading=10.1, textColor=HexColor('#192833'), spaceAfter=2)) styles.add(ParagraphStyle(name='Small', parent=styles['BodyText'], fontName='Helvetica', fontSize=7.15, leading=8.5, textColor=HexColor('#263640'), spaceAfter=1.3)) styles.add(ParagraphStyle(name='Tiny', parent=styles['BodyText'], fontName='Helvetica', fontSize=6.55, leading=7.7, textColor=GRAY, spaceAfter=1)) styles.add(ParagraphStyle(name='Callout', parent=styles['BodyText'], fontName='Helvetica-Bold', fontSize=8.1, leading=9.6, textColor=RED, spaceAfter=1)) def P(t, sty='B'): return Paragraph(t, styles[sty]) def section(title, body, color=TEAL): head=Table([[P(title,'H')]], colWidths=[7.15*inch]) head.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,-1),color),('LEFTPADDING',(0,0),(-1,-1),7),('RIGHTPADDING',(0,0),(-1,-1),7),('TOPPADDING',(0,0),(-1,-1),3),('BOTTOMPADDING',(0,0),(-1,-1),3)])) box=Table([[body]], colWidths=[7.15*inch]) box.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,-1),LIGHT),('BOX',(0,0),(-1,-1),0.4,HexColor('#C9D8DF')),('LEFTPADDING',(0,0),(-1,-1),7),('RIGHTPADDING',(0,0),(-1,-1),7),('TOPPADDING',(0,0),(-1,-1),5),('BOTTOMPADDING',(0,0),(-1,-1),5)])) return KeepTogether([head,box,Spacer(1,5)]) def bullets(items, style='B'): return [P('• '+x,style) for x in items] class NumberedCanvas(canvas.Canvas): def __init__(self,*args,**kwargs): canvas.Canvas.__init__(self,*args,**kwargs); self.pages=[] def showPage(self): self.pages.append(dict(self.__dict__)); self._startPage() def save(self): n=len(self.pages) for state in self.pages: self.__dict__.update(state) self.setStrokeColor(HexColor('#B8C7CE')); self.setLineWidth(.4); self.line(0.68*inch,0.47*inch,7.82*inch,0.47*inch) self.setFont('Helvetica',6.8); self.setFillColor(GRAY) self.drawString(0.7*inch,0.31*inch,'Pediatric thermal burn and frostbite quick reference | For trained clinicians') self.drawRightString(7.8*inch,0.31*inch,f'{self._pageNumber} / {n} | 02 Sep 2026') canvas.Canvas.showPage(self) canvas.Canvas.save(self) doc=SimpleDocTemplate(str(out),pagesize=letter,leftMargin=.68*inch,rightMargin=.67*inch,topMargin=.52*inch,bottomMargin=.62*inch) story=[] story += [P('Pediatric Thermal Burn & Frostbite','Title2'), P('Point-of-care quick reference for initial assessment, stabilization, and specialist escalation. Use alongside local protocols and pediatric formulary.','Sub')] story.append(section('FIRST 60 SECONDS: BOTH INJURIES', [ P('<b>ABCDE first.</b> Remove from the source, remove wet/hot clothing and constricting jewelry. Protect child from hypothermia. Assess pain early and give weight-based analgesia. Check glucose in young children, altered mental status, or major injury.', 'B'), P('<b>Escalate immediately</b> for airway concern, shock, altered consciousness, significant hypothermia, circumferential injury, major trauma, suspected non-accidental injury, or inability to provide safe follow-up.','Callout') ],NAVY)) burn_left=[P('<b>Stop the burn.</b> Remove clothing/jewelry only if not adherent. For chemical exposure: brush off dry chemical, then copiously irrigate; seek product-specific advice. For electrical injury: monitor for associated trauma/arrhythmia and obtain specialist advice.','B'), P('<b>Cool promptly:</b> clean cool running water, ideally <b>5-20 min</b>. Avoid ice, ice water, toothpaste, butter, and topical home remedies. Keep the rest of the child warm and monitor young children for hypothermia.','B'), P('<b>Cover:</b> clean dry non-adherent dressing or cling film laid lengthwise. Do not wrap circumferentially. Elevate limbs.','B')] story.append(section('THERMAL BURNS: IMMEDIATE CARE',burn_left,ORANGE)) assess_data=[ [P('<b>Assess</b>','Small'),P('<b>Practical point</b>','Small')], [P('Depth','Small'),P('Superficial: red, painful, blanches, dry. Partial thickness: blistered, moist, painful. Deep/full thickness: mottled white/brown/charred, dry, reduced sensation. Depth evolves: reassess.','Small')], [P('Size','Small'),P('Count partial- and full-thickness areas only. Use <b>age-adjusted Lund-Browder</b> in children. Child palm including fingers is about 1% TBSA for scattered small burns.','Small')], [P('Airway','Small'),P('Facial/neck burns, enclosed-space fire, soot, voice change, stridor, respiratory distress, altered mental state or CO exposure: early senior/burn-center/anesthesia input. Do not wait for edema.','Small')], [P('Exam','Small'),P('Neurovascular status distal to circumferential burns. Document pattern, depth, TBSA, photos per policy, timing/mechanism, and safeguarding history.','Small')], ] t=Table(assess_data,colWidths=[1.05*inch,6.1*inch],repeatRows=1) t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,0),PALE),('GRID',(0,0),(-1,-1),.3,HexColor('#C9D8DF')),('VALIGN',(0,0),(-1,-1),'TOP'),('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5),('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4)])) story.append(section('THERMAL BURNS: ASSESSMENT',t,ORANGE)) fluid=[P('<b>When to start:</b> Formal IV resuscitation is generally indicated for a child with <b>&gt;10% TBSA</b> burns. Use local burn-center threshold and protocol; establish IV, or IO if necessary in shock/urgent access. Small burns: oral fluids if clinically appropriate.','B'), P('<b>Common initial framework:</b> Lactated Ringer 3-4 mL × weight (kg) × %TBSA over first 24 h, measured <b>from time of injury</b>. Give half in first 8 h, remainder over next 16 h. Children require maintenance fluids, often with glucose where indicated.','B'), P('<b>Titrate hourly, not by formula alone:</b> perfusion, mental state, temperature, age-appropriate hemodynamics, acid-base status and urine output. A commonly used target is <b>≥1 mL/kg/h if &lt;30 kg</b>; use local target for larger children. Avoid fluid creep.','B')] story.append(section('THERMAL BURNS: FLUIDS AND ONGOING CARE',fluid,ORANGE)) ref=[P('<b>Discuss/transfer to pediatric burn service:</b> >5% TBSA in a child; any deep partial- or full-thickness burn; face, hands, feet, genitalia/perineum, or major joint; circumferential burns; inhalation injury; electrical or chemical burns; associated trauma/comorbidity; suspected abuse; or concern about pain control/wound care/follow-up.','B'),P('<b>Do not routinely give prophylactic systemic antibiotics.</b> Update tetanus prophylaxis according to immunization status and wound type. Follow local choice of topical dressing.','B')] story.append(section('BURN CENTER REFERRAL AND SAFEGUARDING',ref,RED)) story.append(PageBreak()) story += [P('Frostbite in Children','Title2'),P('Freezing injury: treat associated hypothermia and prevent refreezing before focusing on the limb.','Sub')] frost=[P('<b>1. Remove cold exposure:</b> remove wet clothing and constricting jewelry. Protect tissue. Do <b>not</b> rub, massage, walk on a frozen foot, or apply direct dry heat/hot air.','B'),P('<b>2. Prioritize core rewarming:</b> moderate/severe hypothermia or serious trauma takes precedence. Give warm fluids only if awake and safe to swallow; manage hypothermia per protocol.','B'),P('<b>3. Prevent refreezing:</b> if thawed tissue could refreeze, protect it and defer active thawing until durable warmth is available.','B'),P('<b>4. Rapid rewarming when safe:</b> immerse in circulating clean water <b>37-40°C</b> (thermometer monitored) until soft/pliable and flushed, usually <b>30-60 min</b>. This is painful: provide analgesia.','B'),P('<b>5. After thawing:</b> gently air-dry, elevate, separate digits with clean dry gauze, and use loose bulky sterile dressings. Do not apply constricting wraps.','B')] story.append(section('FROSTBITE: FIRST-LINE MANAGEMENT',frost,TEAL)) clin_data=[ [P('<b>Feature</b>','Small'),P('<b>Interpretation and action</b>','Small')], [P('Frostnip','Small'),P('Numbness/pain and erythema, no edema or blisters. Reversible: passive warming and protection may be sufficient, but reassess.','Small')], [P('Superficial frostbite','Small'),P('Waxy skin with deeper tissue still soft; clear blisters, edema, erythema after thawing. Prompt medical review.','Small')], [P('Deep frostbite','Small'),P('Hard/wooden tissue before thawing, persistent cyanosis, hemorrhagic blisters, absent distal perfusion, extensive tissue involvement. Urgent specialist/burn/plastic/vascular input.','Small')], [P('Blisters','Small'),P('For first aid providers: do not debride. In hospital, follow specialist protocol. Clear blisters may be selectively aspirated by trained clinicians; leave hemorrhagic blisters intact unless directed otherwise.','Small')], [P('Meds','Small'),P('Give weight-based analgesia. Ibuprofen may be used if no contraindication, per local pediatric formulary. Consider tetanus prophylaxis based on routine immunization and wound assessment.','Small')], ] t=Table(clin_data,colWidths=[1.3*inch,5.85*inch],repeatRows=1) t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,0),PALE),('GRID',(0,0),(-1,-1),.3,HexColor('#C9D8DF')),('VALIGN',(0,0),(-1,-1),'TOP'),('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5),('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4)])) story.append(section('FROSTBITE: SEVERITY AND CLINICAL ACTIONS',t,TEAL)) story.append(section('FROSTBITE: ESCALATE / CONSULT URGENTLY',[P('<b>Urgent specialist assessment</b> for deep frostbite, hemorrhagic blisters, persistent cyanosis after rewarming, large surface area involvement, altered sensation/perfusion, compartment concern, delayed presentation, or significant comorbidity. Deep injuries may be candidates for imaging-guided thrombolysis/iloprost under specialist protocol and time-sensitive pathways. <b>Defer definitive debridement/amputation</b> unless infection or another urgent indication: tissue demarcation evolves.','B')],RED)) avoid=[P('<b>Burns:</b> no ice/direct cold; no adhesive dressings on wound; no circumferential wrapping; do not delay referral for airway risk; no routine systemic antibiotic prophylaxis.','B'),P('<b>Frostbite:</b> no rubbing/massage; no dry heat/open flame; no thawing if refreezing risk; no routine field blister debridement; do not allow ambulation on a frozen foot if avoidable.','B')] story.append(section('HIGH-RISK ERRORS TO AVOID',avoid,RED)) sources=[P('<b>Evidence and source notes</b>','Small'),P('American Heart Association and American Red Cross. <i>2024 Guidelines for First Aid</i>: thermal burn cooling; frostbite rewarming, dressings, hypothermia priority and blister precautions.','Tiny'),P('Update on the management of burns in paediatrics. <i>BJA Education</i>. 2021;21:103-110. Pediatric fluid principles and specialist transfer criteria.','Tiny'),P('Tintinalli’s Emergency Medicine: A Comprehensive Study, Burn Size/Depth and Burn Center Transfer sections. Pediatric TBSA estimation uses Lund-Browder.','Tiny'),P('Harrison’s Principles of Internal Medicine, 22e (2025), Peripheral Cold Injuries section. Frostbite rewarming and deep injury management.','Tiny'),P('Wilderness Medical Society Frostbite Practice Guidelines. Rewarming 37-39°C and specialist treatment pathways.','Tiny'),P('<b>Scope:</b> This sheet supports, not replaces, local burn-center, emergency, hypothermia, child protection, medication, and transfer protocols. Doses and treatment eligibility must be verified locally.','Tiny')] story.append(section('SOURCES, LIMITS, AND LOCAL ADAPTATION',sources,NAVY)) doc.build(story,canvasmaker=NumberedCanvas) print(out) PY python - <<'PY' from pypdf import PdfReader p='/tmp/workspace/pediatric-burn-frostbite-reference/output/Pediatric_Thermal_Burn_and_Frostbite_Quick_Reference.pdf' r=PdfReader(p) print('pages',len(r.pages),'bytes',__import__('os').path.getsize(p)) for i,page in enumerate(r.pages): print('PAGE',i+1,'chars',len(page.extract_text() or ''), (page.extract_text() or '')[:100]) PY

python - <<'PY' import fitz from pathlib import Path pdf=Path('/tmp/workspace/pediatric-burn-frostbite-reference/output/Pediatric_Thermal_Burn_and_Frostbite_Quick_Reference.pdf') doc=fitz.open(pdf) out=Path('/tmp/workspace/pediatric-burn-frostbite-reference/output/preview_page1.png') pix=doc[0].get_pixmap(matrix=fitz.Matrix(1.25,1.25),alpha=False) pix.save(out) print(out, out.stat().st_size) PY