ATLS thermal injuries

Question 1

Burns inside or around the mouth mean you should take what action

Answer 1

Intubation

Question 2

What are the clinical indications of inhalation injury? (5)

Answer 2

• Burns or soot around mouth and face
• Inflammation of the nose/pharynx
• Hoarseness
• H/o confinement in a burning building
• Carboxyhemoglobin level over 10%

Question 3

True or false: if the patient has an inhalational injury, they should be intubated and shipped to the nearest burn center

Answer 3

True

Question 4

When in the course of the disease does stridor occur with inhalational injuries?

Answer 4

Late–intubate NOW

Question 5

Circumferential burns to the neck indicate the need for what?

Answer 5

Intubation now

Question 6

Should you remove clothing from a burn victim?

Answer 6

Yes, but do not peel off adherent clothing

Question 7

What temperature water should be used to clean burn patients?

Answer 7

Warm

Question 8

Any patient with burns over more than (__) of the

body surface requires fluid resuscitation.

Answer 8

Any patient with burns over more than 20% of the

body surface requires fluid resuscitation.

Question 9

If the extent of the burn precludes placement of the catheter through unburned skin, what should be done?

Answer 9

Place IV through the burned skin into an accessible vein

Question 10

Why are upper extremity veins better for establishing IVs than lower ones?

Answer 10

Lower risk of phelbitis

Question 11

The palmar surface (including the fingers) of the patient’s hand represents approximately (__) of the patient’s body surface

Answer 11

1%

Question 12

What defines second degree burns?

Answer 12

Erythema, Blisters and edema, painful, wet

Question 13

What defines third degree burns?

Answer 13

Dead, insensate tissue, that does not blanch with pressure

Question 14

What percent of the body surface area does the head represent in an adult?

Answer 14

9%

Question 15

What percent of the body surface area do the arms represent in an adult?

Answer 15

9% apiece

Question 16

What percent of the body surface area does the anterior torso and back (respectively) represent in an adult?

Answer 16

18% apiece

Question 17

What percent of the body surface area do the legs represent in an adult?

Answer 17

9% apiece

Question 18

What percent of the body surface area does the genital area represent in an adult?

Answer 18

1%

Question 19

What percent of the body surface area does the head represent in an infant?

Answer 19

18%

Question 20

What percent of the body surface area do the arms represent in an infant?

Answer 20

9% apiece

Question 21

What percent of the body surface area do the legs represent in an infant?

Answer 21

14% apiece

Question 22

What percent of the body surface area does the anterior torso represent in an infant?

Answer 22

18%

Question 23

What percent of the body surface area does the back (excluding the buttocks) represent in an infant?

Answer 23

13%

Question 24

What percent of the body surface area do the buttocks represent in an infant?

Answer 24

2.5% apiece for a total of 5% for the entire butt

Question 25

The clinical manifestations of inhalation injury may be subtle and frequently do not appear in the first (__) hours

Answer 25

The clinical manifestations of inhalation injury may be subtle and frequently do not appear in the first 24 hours

Question 26

What are the three major breathing concerns (not airway) with inhalational injuries?

Answer 26

Hypoxia CO poisoning Smoke inhalation

Question 27

Circumferential chest burns may induce (__) indicating the need for (__)

Answer 27

hypoxia from constriction, indicating the need for intubation

Question 28

CO levels under what % usually cause no s/sx?

Answer 28

20%

Question 29

What should all patients suspected of CO poisoning get?

Answer 29

CO levels | Non-rebreather mask with high flow O2

Question 30

Why do you need a bigger sized ET tube when intubating a burn patient?

Answer 30

Will need for bronchoscopy later

Question 31

Why is there an increased risk of pneumonia in inhalational injuries?

Answer 31

Edema and sloughing of cells in the airways leads to plugging

Question 32

What are the two factors needed to diagnose inhalational injury?

Answer 32

Exposure to a combustible agent | Signs of exposure to smoke in the lower airways

Question 33

What is the treatment for smoke inhalation injury?

Answer 33

good supportive care

Question 34

Why, if appropriate, should an inhalational injury victim be sit up at 30 degrees in bed? What needs to be excluded before doing this?

Answer 34

Reduced neck and chest wall edema--but make sure no spinal injury or hemodynamic compromise

Question 35

What is the goal urine output in an adult burn victim? Children?

Answer 35

``` Adult = 0.5 mL/kg/hr Children = 1 mL/kg/hr if under 30 kg ```

Question 36

Why is ECG monitoring necessary for fluid resuscitation of burn victims?

Answer 36

Electrolyte abnormalities can occur

Question 37

What is the parkland formula (mathematically)?

Answer 37

V = 4*m*(A*100) | m = kg, A = surface area and V is mL

Question 38

What is the parkland formula used for? How is it applied?

Answer 38

To calculate fluids needs in first 24 hours | First half of fluids given over 8 hours, rest given over 16

Question 39

What are the orders to be placed for burn/smoke inhalation victims? (5)

Answer 39

``` CBC BMP ABG Type and cross Pregnancy test ```

Question 40

How is compartment syndrome 2/2 circumferential burns treated?

Answer 40

Escharotomy

Question 41

Circumferential abdominal burns + aggressive IVFs = ?

Answer 41

Abdominal compartment syndrome

Question 42

Why should all jewelry be removed from burn patients?

Answer 42

Resulting edema can cause compartment syndrome

Question 43

When is an NG tube indicated for burn pts?

Answer 43

n/v or more than 20% burned surface area

Question 44

Severely burned patients may be restless and anxious from hypoxemia or hypovolemia rather than pain. What is the significance of this?

Answer 44

Hypoxemia and inadequate fluid resuscitation should be managed before administration of narcotic analgesics or sedatives, which can mask the signs of hypoxemia and hypovolemia

Question 45

Why should you not apply cold compresses to burns over 10% BSA?

Answer 45

Hypothermia

Question 46

What is the role of Abx prophylactically in burn pts

Answer 46

Not given--only for infx

Question 47

Which are more serious and why: alkali or acid burns?

Answer 47

Alkali because it penetrates deeper

Question 48

Why is water preferred over neutralizing acid/bases in chemical burns?

Answer 48

Neutralizing agents will produce heat and further damage tissue

Question 49

Alkali burns to the eye require continuous irrigation during the first (__) hours after the burn.

Answer 49

8 hours

Question 50

Why are electrical burns more serious than they appear?

Answer 50

can burn inside due to rapid cooling of outer skin, but no so deeper

Question 51

True or false: electrical burn patients frequently need fasicotomies

Answer 51

True

Question 52

True or false: If there are no arrhythmias in an electrical burn patient within the first few hours of injury, prolonged monitoring is not necessary.

Answer 52

True

Question 53

Why is rhabdo a major concern with electrical injuries?

Answer 53

Compartment syndrome and severe muscle contraction from electrocution

Question 54

What is the rate of IVF administration for rhabdo in children and adults respectively?

Answer 54

100 mL/hr in adults or 2 mL/kg in children

Question 55

Partial-thickness and full-thickness burns on greater than (__) of the BSA in any patient require transfer to a burn center

Answer 55

10%

Question 56

Partial-thickness and full-thickness burns involving what areas of the body require transfer to a burn center? (4)

Answer 56

head hands feet genitals/perineum

Question 57

True or false: full thickness burns in anyone require burn center eval

Answer 57

True

Question 58

True or false: any significant chemical or electrical burns needs to be transferred to a burn center

Answer 58

True

Question 59

True or false; inhalational injuries always transfer to a burn center

Answer 59

True

Question 60

What is the treatment for frostnip?

Answer 60

Supportive

Question 61

What is frostnip?

Answer 61

White or red skin that is reversible with warming

Question 62

What is first degree frostbite?

Answer 62

Hyperemia and edema without skin necrosis

Question 63

What is second degree frostbite?

Answer 63

Large, clear vesciles formation + hyperemia and partial skin necrosis

Question 64

What is third degree frostbite?

Answer 64

Full thickness an SQ tissue necrosis, with vesicle formation

Question 65

What is fourth degree frostbite?

Answer 65

Full thickness skin necrosis, including muscles and bone with gangrene

Question 66

When is the only time rewarming is not indicated for the treatment of frostbite?

Answer 66

If there is a chance of refreezing

Question 67

What is the treatment for all forms of frostbite?

Answer 67

Rewarm and give analgesics

Question 68

True or false: cardiac monitoring is not needed when rewarming frostbite

Answer 68

False-is needed

Question 69

Does a pt need to stop smoking with frostbite

Answer 69

Yes--vasoconstriction

Question 70

When can the patient bear weight on a frost bitten extremity?

Answer 70

When edema is resolved

Question 71

What temp defines hypothermia and severe hypothermia?

Answer 71

36 C = hypothermia | 32 C = severe hypothermia

Question 72

Why is hypothermia in the trauma patient particularly bad?

Answer 72

Worsens coagulopathy