A child has third-degree burns of the hand, chest, and face.

Explanation

Core Concept: Airway comes before everything. Burns to the face and chest carry a high probability of inhalation injury, and airway oedema after a burn develops over hours — so ineffective airway clearance is the priority diagnosis, even in a child who is talking normally right now.

Clinical Presentation:

• Inhalation injury signs: facial burns, singed nasal hair, soot in the mouth or sputum, hoarseness, stridor, brassy cough, drooling.
• Circumferential full-thickness chest burns restrict chest wall expansion mechanically, independently of the airway.
• Third-degree burns are painless and leathery in the burnt area because the nerve endings are destroyed.

Diagnosis:

• First-line: continuous airway and respiratory assessment, oxygen saturation, carboxyhaemoglobin level and arterial blood gas.
• Estimate burn surface area with a paediatric (Lund-Browder) chart — a child's head is proportionally larger than an adult's, so the adult rule of nines misestimates.

Management:

• Acute: high-flow humidified oxygen and early intubation before oedema closes the airway; then fluid resuscitation by a weight-based formula, analgesia and temperature control.
• Long-term: infection prevention, nutritional support, escharotomy for circumferential burns, and later attention to body image, mobility and scar management — all of which matter, but only after the airway is secured.