CBRN Fluid Resuscitation & Pain Control 3 — Questions and Answers
Question 1: A pediatric burn patient weighing 20 kg has 30% TBSA burns. Using the Galveston formula, what is the 24-hour fluid volume?
- 1,800 mL
- 3,500 mL
- 5,300 mL (Correct answer)
- 6,000 mL
Correct 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.
Question 2: Which electrolyte abnormality is most commonly seen in the first 48–72 hours post-major burn due to tissue destruction?
- Hypokalemia
- Hyperkalemia (Correct answer)
- Hypernatremia
- Hypercalcemia
Correct answer: Hyperkalemia
Massive cell destruction releases intracellular potassium, causing hyperkalemia in the early post-burn period.
Question 3: A burn nurse notes the patient's urine output is 150 mL/hr. The most appropriate next action is to:
- Continue current fluid rate and reassess in 4 hours
- Decrease the fluid infusion rate (Correct answer)
- Administer a 500 mL fluid bolus
- Insert a second IV line and increase rate
Correct 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.
Question 4: Which assessment finding best indicates that a burn patient's pain is being under-treated during procedural care?
- Heart rate 68 bpm
- Grimacing and guarding with dressing removal (Correct answer)
- Respiratory rate 14 breaths/min
- Blood pressure 118/74 mmHg
Correct 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.
Question 5: Gabapentinoids (e.g., gabapentin) are used in burn pain management primarily to target:
- Nociceptive pain from tissue damage
- Neuropathic pain and itching (pruritus) (Correct answer)
- Acute procedural pain
- Opioid-induced constipation
Correct 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.
Question 6: Burn resuscitation 'fluid creep' refers to:
- Gradual slowing of IV fluid rate over 24 hours
- Administration of volumes exceeding formula recommendations, leading to complications (Correct answer)
- Leakage of IV fluid from the catheter site
- The slow shift of edema fluid back into the vasculature
Correct 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.
Question 7: Which analgesic adjunct is most appropriate for reducing background burn pain while minimizing opioid requirements?
- Meperidine scheduled every 6 hours
- Acetaminophen scheduled around the clock (Correct answer)
- Codeine PRN as needed
- Hydromorphone bolus every 2 hours
Correct 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.
CBRN Fluid Resuscitation & Pain Control 3
A pediatric burn patient weighing 20 kg has 30% TBSA burns.
Using the Galveston formula, what is the 24-hour fluid volume?