ATLS Thermal and Electrical Injuries 2 — Questions and Answers
Question 1: Using the Parkland formula, what is the 24-hour fluid requirement for a 70 kg patient with 40% TBSA burns?
- 5,600 mL
- 8,400 mL
- 11,200 mL (Correct answer)
- 14,000 mL
Correct answer: 11,200 mL
Parkland formula: 4 mL x 70 kg x 40% = 11,200 mL LR over 24 hours, half in first 8 hours.
First half in 8 hours from TIME OF INJURY. Titrate to urine output 0.5-1 mL/kg/hr. Use LR not NS. Over-resuscitation causes compartment syndrome and pulmonary edema.
Question 2: A patient with circumferential full-thickness burns of both legs develops tense compartments and diminished pulses. Treatment?
- Increase IV fluid rate
- Perform escharotomy (Correct answer)
- Apply compression bandages
- Elevate and observe
Correct answer: Perform escharotomy
Circumferential full-thickness burns create rigid eschar acting as a tourniquet; escharotomy restores perfusion.
Incisions through eschar along medial and lateral midaxial lines, extending across joints. Full-thickness eschar has no sensation. Fasciotomy may additionally be needed.
Question 3: What percentage of TBSA does one patient palm (including fingers) represent?
- 0.5%
- 1% (Correct answer)
- 2%
- 3%
Correct answer: 1%
The patient's palm plus fingers equals approximately 1% TBSA.
Useful for small/scattered burns. Rule of Nines for larger burns: head 9%, each arm 9%, anterior trunk 18%, each leg 18%. Lund-Browder chart is most accurate for children.
Question 4: An electrician sustains high-voltage (>1000V) electrical injury with minimal skin burns. What internal injuries should be suspected?
- Only superficial damage
- Deep muscle necrosis, cardiac arrhythmias, and rhabdomyolysis (Correct answer)
- Isolated nerve damage
- Thermal injury at entry/exit points only
Correct answer: Deep muscle necrosis, cardiac arrhythmias, and rhabdomyolysis
High-voltage injuries cause extensive deep tissue damage disproportionate to visible burns.
Current follows least resistance through nerves, blood vessels, and muscles. ECG monitoring for 24+ hours, aggressive hydration for rhabdomyolysis (UO 1-2 mL/kg/hr), watch for compartment syndrome and fractures from tetanic contractions.
Question 5: Which burn type is characterized by white/waxy appearance, no pain, and no capillary refill?
- Superficial (first-degree)
- Superficial partial-thickness
- Deep partial-thickness
- Full-thickness (third-degree) (Correct answer)
Correct answer: Full-thickness (third-degree)
Full-thickness burns destroy all skin layers including nerve endings, resulting in insensate, white/waxy wounds requiring grafting.
Full-thickness burns will NOT heal spontaneously; they require excision and grafting. Depth assessment may need 48-72 hour reassessment as burns can convert deeper.
Question 6: A burn patient develops hoarseness, stridor, and carbonaceous sputum 2 hours after a house fire. Most critical concern?
- Carbon monoxide poisoning
- Impending upper airway obstruction from inhalation injury (Correct answer)
- Circumferential chest restriction
- Cyanide poisoning
Correct answer: Impending upper airway obstruction from inhalation injury
These signs indicate supraglottic thermal injury with progressive edema that will worsen over 12-24 hours.
EARLY INTUBATION is critical. Once edema progresses, intubation becomes impossible. Inhalation injury has three components: supraglottic thermal, tracheobronchial chemical, and systemic toxicity.
ATLS Thermal and Electrical Injuries 2
Using the Parkland formula, what is the 24-hour fluid requirement for a 70 kg patient with 40% TBSA burns?