CBRN Inhalation Injury & Airway Management

Question 1

Which finding in a patient with facial burns from a house fire most strongly indicates the need for early endotracheal intubation?

Accepted Answer

Progressive hoarseness with stridor

Answer

Hoarseness and stridor signal evolving upper-airway edema, which can progress to complete obstruction as fluid resuscitation proceeds. Early intubation is safer than waiting. Singed nasal hairs and soot are risk indicators but do not by themselves show airway compromise.

Question 2

A patient rescued from an enclosed-space fire has a headache and confusion, and the pulse oximeter reads 99%. What is the best interpretation and first intervention?

Accepted Answer

The reading may be falsely normal because of carboxyhemoglobin, so give 100% oxygen

Answer

Standard pulse oximetry cannot tell carboxyhemoglobin from oxyhemoglobin, so SpO2 can look normal during carbon monoxide poisoning. Treatment is 100% oxygen by non-rebreather or ventilator, which shortens the carboxyhemoglobin half-life from about 4–6 hours to about 60–90 minutes.

Question 3

Which test is the standard for confirming inhalation injury below the glottis?

Accepted Answer

Fiberoptic bronchoscopy

Answer

Bronchoscopy lets the clinician see airway erythema, soot, edema, and mucosal sloughing directly. Initial chest x-rays are often normal in inhalation injury, and ABGs are nonspecific.

Question 4

A burn patient from a closed-space fire has unexplained severe lactic acidosis (lactate above 10 mmol/L) and hypotension despite resuscitation. Which antidote should the nurse anticipate?

Accepted Answer

Hydroxocobalamin

Answer

Burning plastics and synthetic materials release hydrogen cyanide. Cyanide blocks cellular respiration and causes lactic acidosis. Hydroxocobalamin binds cyanide to form cyanocobalamin (vitamin B12), which is excreted in urine.

Question 5

Which ventilator strategy is recommended for a burn patient with inhalation injury and ARDS physiology?

Accepted Answer

Tidal volume about 6 mL/kg ideal body weight, with plateau pressure kept below 30 cm H2O

Answer

A lung-protective strategy with low tidal volumes based on ideal body weight and limited plateau pressure reduces ventilator-induced lung injury. This approach is used for inhalation injury and ARDS.

(CBRN) Certified Burn Registered Nurse Practice Test

(CBRN) Certified Burn Registered Nurse Practice Test

CBRN Inhalation Injury & Airway Management