CBM Pain Management & Sedation 2 — Questions and Answers
Question 1: Which opioid is preferred for procedural pain in burn patients due to its rapid onset and short duration?
- Morphine
- Fentanyl (Correct answer)
- Hydromorphone
- Methadone
Correct answer: Fentanyl
Fentanyl's rapid onset (1-2 min IV) and short duration (30-60 min) make it ideal for burn dressing changes and procedures.
Question 2: Ketamine is frequently used in burn patients primarily because it:
- Suppresses respiratory drive
- Provides analgesia while maintaining airway reflexes (Correct answer)
- Requires no monitoring
- Eliminates opioid requirements entirely
Correct answer: Provides analgesia while maintaining airway reflexes
Ketamine is a dissociative anesthetic that provides potent analgesia and sedation while largely preserving protective airway reflexes and spontaneous breathing.
Question 3: A burn patient develops tolerance to opioids after 2 weeks of continuous infusion. The BEST next step is to:
- Discontinue opioids immediately
- Rotate to a different opioid class or agent (Correct answer)
- Double the current dose indefinitely
- Switch exclusively to NSAIDs
Correct answer: Rotate to a different opioid class or agent
Opioid rotation exploits incomplete cross-tolerance, allowing effective pain control at lower equianalgesic doses of the new agent.
Question 4: Which non-opioid adjuvant has shown benefit in reducing opioid consumption in burn patients by acting on alpha-2 receptors?
- Gabapentin
- Dexmedetomidine (Correct answer)
- Ketorolac
- Ondansetron
Correct answer: Dexmedetomidine
Dexmedetomidine, a selective alpha-2 agonist, provides sedation and opioid-sparing analgesia without respiratory depression.
Question 5: During a dressing change, a burn patient's NRS pain score is 9/10 despite background opioid infusion. The MOST appropriate intervention is:
- Delay the dressing change until the score drops
- Administer a procedural bolus dose 20-30 minutes before the procedure (Correct answer)
- Increase the background infusion rate and proceed immediately
- Switch to oral analgesics only
Correct answer: Administer a procedural bolus dose 20-30 minutes before the procedure
Pre-procedural bolus dosing timed to peak effect (20-30 min for IV morphine) ensures adequate analgesia before the painful stimulus begins.
Question 6: Which statement best describes neuropathic pain in burn survivors?
- It resolves completely within 2 weeks of wound closure
- It may persist for months to years and requires adjuvants like gabapentinoids (Correct answer)
- It responds exclusively to opioids
- It only occurs with full-thickness burns
Correct answer: It may persist for months to years and requires adjuvants like gabapentinoids
Neuropathic pain from nerve damage in burn injuries can persist long after wound healing and often requires gabapentinoids, TCAs, or SNRIs in addition to standard analgesics.
Question 7: Propofol infusion syndrome (PRIS) is a rare but life-threatening complication characterized by:
- Hyperthermia and diarrhea
- Metabolic acidosis, rhabdomyolysis, and cardiac failure (Correct answer)
- Respiratory alkalosis and seizures
- Hyponatremia and bronchospasm
Correct answer: Metabolic acidosis, rhabdomyolysis, and cardiac failure
PRIS presents with metabolic acidosis, rhabdomyolysis, lipemia, hepatomegaly, and cardiac failure, typically with high-dose or prolonged propofol infusion.
CBM Pain Management & Sedation 2
Which opioid is preferred for procedural pain in burn patients due to its rapid onset and short duration?