CBRN Burn Pathophysiology & Wound Care Management 5 — Questions and Answers
Question 1: Which formula is used to estimate TBSA burned in adults using the palm of the patient's hand?
- The Rule of Nines
- The Lund and Browder chart
- The 1% palm method (Correct answer)
- The Baux score
Correct answer: The 1% palm method
The patient's palm (including fingers) represents approximately 1% of TBSA and is useful for estimating scattered or irregular burn patterns.
Question 2: A patient has circumferential full-thickness burns to both lower extremities with absent distal pulses and paresthesias. What intervention is indicated?
- Elevation of extremities and warm compresses
- Emergent escharotomy (Correct answer)
- Immediate fasciotomy without escharotomy
- Doppler monitoring only
Correct answer: Emergent escharotomy
Circumferential full-thickness burns create constrictive eschar that impairs circulation; escharotomy releases the constriction and restores distal perfusion.
Question 3: Which nutritional route is preferred for burn patients who have a functioning gastrointestinal tract?
- Total parenteral nutrition (TPN) via central line
- Peripheral parenteral nutrition
- Early enteral nutrition via nasogastric tube (Correct answer)
- Oral diet only when fully awake
Correct answer: Early enteral nutrition via nasogastric tube
Early enteral nutrition is preferred as it maintains gut integrity, reduces bacterial translocation, and supports the hypermetabolic response.
Question 4: Burn patients who receive prolonged silver nitrate 0.5% dressing treatment are at risk for which electrolyte complication?
- Hyperchloremia and hypernatremia
- Hyponatremia and hypochloremia (Correct answer)
- Hyperkalemia and metabolic acidosis
- Hypercalcemia and hypermagnesemia
Correct answer: Hyponatremia and hypochloremia
Silver nitrate leaches sodium and chloride from the wound, causing hyponatremia and hypochloremia that requires close electrolyte monitoring.
Question 5: A burn patient is receiving split-thickness skin grafts. Which post-operative assessment finding at the graft site would indicate graft failure?
- Mild wound edge erythema at 48 hours
- Fluid collection (seroma or hematoma) beneath the graft (Correct answer)
- Slight adherence of graft at 72 hours
- Minimal pain at donor site
Correct answer: Fluid collection (seroma or hematoma) beneath the graft
Seroma or hematoma beneath a graft prevents the graft from adhering to the wound bed, leading to graft failure due to impaired nutrient diffusion.
Question 6: Which scoring system estimates burn mortality risk by adding the patient's age to the percentage of TBSA burned?
- The Lund-Browder score
- The Baux score (Correct answer)
- The ABSI (Abbreviated Burn Severity Index)
- The APACHE II score
Correct answer: The Baux score
The Baux score (Age + %TBSA) provides a quick mortality estimate; a score above 140 typically indicates a very high mortality risk.
Question 7: During the flow phase of the burn stress response, which metabolic change is most characteristic?
- Decreased oxygen consumption
- Decreased core body temperature
- Hyperdynamic circulation with increased metabolic rate (Correct answer)
- Reduced protein catabolism
Correct answer: Hyperdynamic circulation with increased metabolic rate
The flow phase begins after 48 hours and is characterized by hyperdynamic circulation, elevated metabolic rate, and significant protein catabolism.
CBRN Burn Pathophysiology & Wound Care Management 5
Which formula is used to estimate TBSA burned in adults using the palm of the patient's hand?