ATLS Thermal and Electrical Injuries 3 — Questions and Answers
Question 1: What is the initial treatment for carbon monoxide poisoning in a burn patient?
- Hyperbaric oxygen immediately
- 100% oxygen via non-rebreather mask (Correct answer)
- Room air and observation
- Intubation with 50% FiO2
Correct answer: 100% oxygen via non-rebreather mask
100% O2 reduces COHb half-life from 4-6 hours to 60-90 minutes. Start before COHb levels are available.
Standard pulse oximetry is UNRELIABLE (reads COHb as oxyhemoglobin). COHb must be measured by co-oximetry. Hyperbaric oxygen considered for COHb >25%, LOC, neurological symptoms, pregnancy.
Question 2: Which burn patients meet criteria for transfer to a burn center?
- All burns >5% TBSA
- Partial-thickness >10%, full-thickness, face/hands/feet/genitalia/joints, electrical/chemical, inhalation injury (Correct answer)
- Only full-thickness >20%
- All burn patients
Correct answer: Partial-thickness >10%, full-thickness, face/hands/feet/genitalia/joints, electrical/chemical, inhalation injury
ABA transfer criteria include multiple specific criteria covering size, depth, location, mechanism, and patient factors.
Also includes burns with comorbidities, concomitant trauma, and patients needing special rehabilitation. Initial stabilization should begin before transfer.
Question 3: Hydrofluoric acid burns require what specific treatment beyond water irrigation?
- Sodium bicarbonate neutralization
- Topical and/or subcutaneous calcium gluconate (Correct answer)
- Silver sulfadiazine
- Immediate surgical excision
Correct answer: Topical and/or subcutaneous calcium gluconate
Fluoride ions bind calcium causing progressive destruction and potentially fatal hypocalcemia requiring calcium gluconate.
Even small HF burns (<1% TBSA) can cause fatal hypocalcemia and cardiac arrhythmias. Monitor serum calcium, magnesium, and ECG. Intra-arterial calcium gluconate for digital burns.
Question 4: In pediatric burn patients, the Rule of Nines is modified because of which anatomical difference?
- Proportionally smaller arms
- Proportionally larger heads and smaller legs (Correct answer)
- Proportionally larger trunks
- Thinner skin
Correct answer: Proportionally larger heads and smaller legs
Infants' heads are ~18% TBSA (vs. 9% adults), legs ~14% (vs. 18%). Use Lund-Browder chart.
With each year of age, ~1% transfers from head to legs until adult proportions at age 15. Children are also more susceptible to hypothermia and hypoglycemia.
Question 5: Which finding on fiberoptic bronchoscopy confirms inhalation injury?
- Normal mucosa with clear secretions
- Erythema, edema, and carbonaceous deposits in the airway (Correct answer)
- Isolated nasal mucosal irritation
- Pleural effusion
Correct answer: Erythema, edema, and carbonaceous deposits in the airway
Bronchoscopy revealing mucosal erythema, edema, ulceration, and soot deposits confirms inhalation injury.
Graded 0-4 by severity. Bronchoscopy should be performed within 24 hours. Inhalation injury increases fluid requirements 30-50% above Parkland calculations.
Question 6: What is the most common cause of death in hospitalized burn patients?
- Hypovolemic shock
- Sepsis and multi-organ failure (Correct answer)
- Carbon monoxide poisoning
- Renal failure
Correct answer: Sepsis and multi-organ failure
Sepsis is the leading cause due to loss of the skin barrier, immune suppression, and prolonged ICU stay.
Prevention: early wound excision/grafting, infection control, nutritional support (enteral feeding within 24 hours). Common organisms: Pseudomonas, S. aureus, Candida.
ATLS Thermal and Electrical Injuries 3
What is the initial treatment for carbon monoxide poisoning in a burn patient?