CBRN Fluid Resuscitation & Pain Control 2 — Questions and Answers
Question 1: A 70 kg adult has 40% TBSA burns. Using the Parkland formula, how much Lactated Ringer's should be given in the first 8 hours?
- 2,800 mL
- 5,600 mL (Correct answer)
- 11,200 mL
- 4,200 mL
Correct answer: 5,600 mL
Parkland formula is 4 mL × kg × %TBSA; half is given in the first 8 hours post-injury, so (4 × 70 × 40) / 2 = 5,600 mL.
Question 2: Which urine output target best indicates adequate fluid resuscitation in an adult burn patient?
- 0.25–0.5 mL/kg/hr
- 0.5–1 mL/kg/hr (Correct answer)
- 1–2 mL/kg/hr
- 2–3 mL/kg/hr
Correct answer: 0.5–1 mL/kg/hr
A urine output of 0.5–1 mL/kg/hr is the standard goal in adult burn resuscitation, reflecting adequate renal perfusion without over-resuscitation.
Question 3: A burn patient develops abdominal compartment syndrome during resuscitation. Which intervention is most appropriate?
- Increase IV fluid rate by 25%
- Switch from LR to normal saline
- Reduce fluid rate and consider adding colloid or vasopressors (Correct answer)
- Administer a bolus of albumin 25%
Correct answer: Reduce fluid rate and consider adding colloid or vasopressors
Abdominal compartment syndrome signals over-resuscitation; decreasing crystalloid and adding colloid or vasopressors reduces total volume while maintaining perfusion.
Question 4: Which opioid route is preferred for moderate-to-severe burn pain during the acute phase when IV access is established?
- Oral
- Intramuscular
- Subcutaneous
- Intravenous (Correct answer)
Correct answer: Intravenous
IV administration provides reliable, titratable analgesia; IM and subcutaneous routes are unreliable due to altered perfusion in burned tissue.
Question 5: Ketamine is used as an analgesic-anesthetic adjunct in burn care primarily because it:
- Has no cardiovascular effects
- Preserves airway reflexes and provides dissociative analgesia (Correct answer)
- Suppresses emergence reactions in all patients
- Reduces opioid-induced hyperalgesia when used alone
Correct answer: Preserves airway reflexes and provides dissociative analgesia
Ketamine's dissociative properties provide effective analgesia while maintaining airway protective reflexes, making it valuable for procedural pain in burn patients.
Question 6: During dressing changes, which non-pharmacological intervention has the strongest evidence for reducing burn pain and anxiety?
- Guided imagery only
- Virtual reality distraction therapy (Correct answer)
- Music therapy alone
- TENS (transcutaneous electrical nerve stimulation)
Correct answer: Virtual reality distraction therapy
Virtual reality distraction has robust evidence in burn populations for significantly reducing procedural pain scores during dressing changes.
Question 7: Colloid administration is typically delayed until after 24 hours post-burn injury because:
- Colloids increase the risk of acute kidney injury in the first 24 hours
- Capillary leak allows colloids to extravasate and worsen edema early on (Correct answer)
- Albumin is contraindicated in burn patients
- Colloids cause hyponatremia when given early
Correct answer: Capillary leak allows colloids to extravasate and worsen edema early on
Increased capillary permeability in the first 24 hours causes colloids to leak into the interstitium, potentially worsening edema rather than expanding intravascular volume.
CBRN Fluid Resuscitation & Pain Control 2
A 70 kg adult has 40% TBSA burns.
Using the Parkland formula, how much Lactated Ringer's should be given in the first 8 hours?