Burns

Question 1

Main causes of early death (<48 hrs):

Answer 1

Shock and/or

inhalation injury

Question 2

Main causes death After 48 hours

Answer 2

Multi-organ failure &

sepsis

Question 3

rule of 9s adultf

Answer 3

head = 9
back = 18
chest = 18
arms = 9
perineum = 1
legs = 18

Question 4

rule of 9s for children

Answer 4

head = 18
back = 18
chest = 18
arms = 9
perineum = 1
legs = 13.5

Question 5

what is classified as Major Burn

Answer 5

2° or 3° burn, >10% TBSA
Electrical burn
Inhalation injury (regardless of

Question 6

If patient age + %TBSA is >115 then

Answer 6

> 80% mortality

Question 7

4 types of burn injury

Answer 7

chemical
electrical
thermal
inhalation

Question 8

protective phenomenon with inhalation injuries

Answer 8

Heat in upper a/w is

dissipated - will see reflex laryngospasm to protect lower a/w

Question 9

warning signs of inhalation injury

Answer 9

Hoarseness, sore throat, dysphagia,
hemoptysis, tachypnea, respiratory distress, elevated
carbon monoxide levels

Question 10

If upper a/w damage present,

Answer 10

EARLY intubation is indicated

even when asymptomatic

Question 11

why AVOID SUCCINYLCHOLINE IF > 24 HRS POST-INJURY

Answer 11

Burn = receptor up-regulation (increased acetylcholine 
receptors) = massive hyperkalemia = cardiac arrest/death

Question 12

best choice of intubation if swelling/obstruction present

Answer 12

awake intubation

Question 13

what does progressive air leak around ETT indicate

Answer 13

a/w swelling subsiding

Question 14

what does CO poisoning cause

Answer 14

decreased SaO2 & metabolic acidosis

pt will present “drunk”

Question 15

cyanide poisoning causes

Answer 15

metabolic acidosis from blocking intracellular o2 use

Question 16

symptoms of cyanide poisoning

Answer 16

Changes in LOC, seizures, dilated pupils, hypotension,
apnea, high lactate levels

Question 17

rx for cyanide poisoning

Answer 17

vit b12a

Question 18

next step in rx burn pt after securing a/w?

Answer 18

aggressive fluid resuscitation to prevent hypovolemic shock from leaking fluid and edema

Question 19

parkland formula?

Answer 19

4ml x BSA% x weight (kg)

give half amount of 8 hours, other half over 16

Question 20

what fluids to use with burn patients for resuscitation?

Answer 20

heavy isotonic crystalloid with no colloid or blood

Question 21

what do children require during fluid rescus that adults do not

Answer 21

maintenance glucose

Question 22

trend to minimize baratrauma

Answer 22

low TV and low PIP

Question 23

common guidelines for debridement and grafting

Answer 23

• no more than 20% of body surface at a time
• stop surgery at core temp <35%
• stop when 10 units (3500 mL) of prbc given

Question 24

what med must be avoided?

Answer 24

succ unless it is used on admit

Question 25

consideration with regional anesth of burn pt?

Answer 25

never pass needle through burned tissue