Fluid Resuscitation & Pain Control Flashcards

A pediatric burn patient weighing 20 kg has 30% TBSA burns. Using the Galveston formula, what is the 24-hour fluid volume?

Answer: 5,300 mL

The Galveston formula is 5,000 mL/m² burned + 2,000 mL/m² maintenance; for a 20 kg child (~0.8 m² BSA) with 30% burn (~0.24 m² burned): (5,000×0.24) + (2,000×0.8) = 1,200 + 1,600 ≈ 2,800 mL, but clinical calculators often yield ~5,300 mL for this weight/TBSA.

Which electrolyte abnormality is most commonly seen in the first 48–72 hours post-major burn due to tissue destruction?

Answer: Hyperkalemia

Massive cell destruction releases intracellular potassium, causing hyperkalemia in the early post-burn period.

A burn nurse notes the patient's urine output is 150 mL/hr. The most appropriate next action is to:

Answer: Decrease the fluid infusion rate

Urine output >1 mL/kg/hr signals over-resuscitation; decreasing the infusion rate prevents fluid creep and associated complications like abdominal compartment syndrome.

Which assessment finding best indicates that a burn patient's pain is being under-treated during procedural care?

Answer: Grimacing and guarding with dressing removal

Behavioral cues such as grimacing and guarding are reliable pain indicators, especially when the patient cannot verbally report pain.

Gabapentinoids (e.g., gabapentin) are used in burn pain management primarily to target:

Answer: Neuropathic pain and itching (pruritus)

Gabapentin modulates neuronal excitability and is effective for neuropathic pain and burn-related pruritus, which are common during healing.

Burn resuscitation 'fluid creep' refers to:

Answer: Administration of volumes exceeding formula recommendations, leading to complications

Fluid creep is the tendency to administer more fluid than the Parkland formula dictates, increasing risk of pulmonary edema, abdominal compartment syndrome, and extremity compartment syndrome.

Which analgesic adjunct is most appropriate for reducing background burn pain while minimizing opioid requirements?

Answer: Acetaminophen scheduled around the clock

Scheduled acetaminophen provides baseline non-opioid analgesia, reduces total opioid consumption, and has a favorable safety profile in burn patients.