CBM Special Populations in Burn Care 2 — Questions and Answers
Question 1: Which factor most contributes to the significantly higher burn mortality seen in elderly patients compared to younger adults with similar burn size?
- Decreased skin thickness increasing burn depth
- Impaired immune response and reduced physiologic reserve (Correct answer)
- Higher incidence of chemical burn exposure in this age group
- Greater pain sensitivity limiting rehabilitation participation
Correct answer: Impaired immune response and reduced physiologic reserve
Elderly patients have diminished immune function, reduced cardiorespiratory reserve, and impaired healing capacity, all of which combine to dramatically increase burn mortality risk.
Question 2: Circumferential burns on an extremity requiring escharotomy are treated this way because:
- Elevation and ice application fail to reduce edema adequately
- Intravenous corticosteroids cannot penetrate burned tissue
- Rigid eschar restricts tissue expansion, causing compartment syndrome (Correct answer)
- Compression wrapping increases circulation in burned limbs
Correct answer: Rigid eschar restricts tissue expansion, causing compartment syndrome
Escharotomy (incision through burned eschar) is performed to relieve compartment pressure caused by the inability of rigid burned tissue to expand as underlying edema develops.
Question 3: Hydrofluoric acid burns cause systemic toxicity primarily by:
- Oxidizing tissue proteins at the burn surface
- Chelating calcium ions and causing severe systemic hypocalcemia (Correct answer)
- Generating toxic inhalation vapors at room temperature
- Alkalinizing blood pH beyond physiologic range
Correct answer: Chelating calcium ions and causing severe systemic hypocalcemia
Fluoride ions from hydrofluoric acid penetrate tissue and bind calcium, causing systemic hypocalcemia that can produce fatal cardiac arrhythmias even from small surface area exposures.
Question 4: The Revised Baux Score (age + %TBSA + 17 if inhalation injury present) is used primarily to:
- Calculate 24-hour fluid resuscitation requirements
- Estimate probability of mortality in burn patients (Correct answer)
- Determine optimal timing of skin graft surgery
- Assess total caloric needs for nutritional support
Correct answer: Estimate probability of mortality in burn patients
The Revised Baux Score is a validated mortality prediction tool; scores above 140 are associated with near-certain mortality and it guides goals-of-care discussions in burn patients.
Question 5: Chemical burns should be initially decontaminated by:
- Applying a pH-neutralizing agent directly to the burn site
- Covering with a dry sterile dressing immediately
- Irrigating with copious running water for at least 20-30 minutes (Correct answer)
- Administering intravenous sodium bicarbonate
Correct answer: Irrigating with copious running water for at least 20-30 minutes
Copious water irrigation for 20-30 minutes dilutes and removes the chemical agent; neutralizing agents are avoided because the exothermic neutralization reaction can worsen tissue damage.
Question 6: Which pre-existing comorbidity most severely impairs burn wound healing in elderly patients?
- Osteoporosis
- Diabetes mellitus (Correct answer)
- Glaucoma
- Hypothyroidism
Correct answer: Diabetes mellitus
Diabetes mellitus causes microvascular dysfunction, impaired neutrophil function, and reduced growth factor activity, all of which significantly compromise burn wound healing.
Question 7: In elderly burn patients, aggressive fluid resuscitation must be carefully monitored because they are at increased risk for:
- Accelerated fluid absorption causing over-hydration rapidly
- Fluid overload and pulmonary edema due to reduced cardiac reserve (Correct answer)
- Renal hyperfiltration leading to electrolyte loss
- Paradoxical dehydration from impaired antidiuretic hormone release
Correct answer: Fluid overload and pulmonary edema due to reduced cardiac reserve
Elderly patients frequently have reduced cardiac reserve and renal function, making them highly susceptible to fluid overload and pulmonary edema with aggressive resuscitation strategies.
CBM Special Populations in Burn Care 2
Which factor most contributes to the significantly higher burn mortality seen in elderly patients compared to younger adults with similar burn size?