Thermal and Electrical Injuries Flashcards

A 45-year-old male is rescued from a house fire. He has full-thickness burns to his face, singed nasal hairs, a hoarse voice, and carbonaceous sputum. His initial oxygen saturation is 98% on a non-rebreather mask. What is the most appropriate next step in management?

Answer: Perform immediate endotracheal intubation.

The presence of facial burns, singed nasal hairs, hoarseness, and carbonaceous sputum are strong predictors of a significant inhalation injury and impending airway obstruction from edema. Despite a normal oxygen saturation, which can be falsely reassuring, ATLS guidelines recommend early prophylactic intubation before swelling makes the airway impossible to manage.

A 70 kg adult has sustained full-thickness burns to his entire right arm and the entire anterior trunk. According to the Parkland formula, what is the total volume of lactated Ringer's solution that should be administered in the first 8 hours after the injury occurred?

Answer: 3780 mL

Using the Rule of Nines, the entire right arm is 9% TBSA and the anterior trunk is 18% TBSA, for a total of 27% TBSA. The Parkland formula is 4 mL x body weight (kg) x %TBSA. The total 24-hour fluid requirement is 4 mL x 70 kg x 27 = 7560 mL. Half of this total volume must be administered in the first 8 hours from the time of the burn, which is 7560 mL / 2 = 3780 mL.

A patient presents with a circumferential, full-thickness burn to the right lower leg. The limb is tense and swollen. Which of the following is the most definitive indication for an immediate escharotomy?

Answer: Loss of a previously audible distal pulse signal on Doppler ultrasound.

The primary purpose of an escharotomy is to relieve the constricting effect of a circumferential burn eschar, which can cause compartment syndrome and compromise distal blood flow. The most critical and definitive sign of severe vascular compromise necessitating immediate intervention is the loss of distal pulses, confirmed by Doppler if not palpable. While delayed capillary refill is a concerning sign, the absence of a pulse indicates that limb-threatening ischemia is already occurring.

A 30-year-old lineman sustains a high-voltage electrical injury with entry and exit wounds on his hand and foot. He is alert and hemodynamically stable. Besides cardiac monitoring, which of the following is a critical management priority to prevent a common, severe complication?

Answer: Aggressive fluid resuscitation to maintain urine output at 75-100 mL/hr.

High-voltage electrical injuries cause extensive deep tissue and muscle necrosis, which is often far greater than the surface wounds suggest. This leads to rhabdomyolysis and the release of myoglobin, which can precipitate in the renal tubules and cause acute kidney injury. Aggressive fluid resuscitation is crucial to maintain a high urine output (target 75-100 mL/hr in adults) to flush the myoglobin and help prevent renal failure.

A patient is brought to the emergency department after being found confused in a garage with a running car. The patient complains of a headache and nausea. A standard pulse oximeter shows an oxygen saturation of 99%. Which of the following is the most appropriate and immediate action?

Answer: Administer 100% high-flow oxygen via a non-rebreather mask.

The clinical scenario is highly suggestive of carbon monoxide (CO) poisoning. Standard pulse oximeters cannot differentiate between oxyhemoglobin and carboxyhemoglobin, leading to a falsely elevated SpO2 reading. The critical first step is to administer 100% oxygen to displace CO from hemoglobin and significantly reduce its half-life. Diagnostic tests like an ABG with co-oximetry should be performed, but treatment should not be delayed.

Which of the following patients with thermal burns requires initiation of formal intravenous fluid resuscitation according to ATLS guidelines?

Answer: An 8-year-old with partial-thickness burns covering the entire back.

Formal fluid resuscitation is generally indicated for adults with burns >20% TBSA and children with burns >10-15% TBSA. The 8-year-old with burns to the entire back (18% TBSA) meets the pediatric criteria. The adult with burns to the anterior arms has a 9% TBSA burn (4.5% for each anterior arm), which is below the threshold. Superficial burns are not included in TBSA calculations for resuscitation. Isolated hand burns, while serious, do not typically meet the TBSA requirement for formal resuscitation.