CBRN Fluid Resuscitation & Pain Control 4 — Questions and Answers
Question 1: The Modified Brooke formula differs from the Parkland formula in that it uses:
- 3 mL/kg/%TBSA of LR without colloid in the first 24 hours
- 2 mL/kg/%TBSA of LR plus 0.5 mL/kg/%TBSA of colloid in the first 24 hours
- 2 mL/kg/%TBSA of LR for the first 24 hours, then colloid in the second 24 hours (Correct answer)
- 4 mL/kg/%TBSA of normal saline for the first 8 hours
Correct answer: 2 mL/kg/%TBSA of LR for the first 24 hours, then colloid in the second 24 hours
The Modified Brooke formula uses 2 mL/kg/%TBSA of LR in the first 24 hours, then switches to colloid (0.3–0.5 mL/kg/%TBSA) in the second 24 hours.
Question 2: A patient with electrical burns has cola-colored urine. Which intervention is the priority?
- Restrict fluids to prevent further hemolysis
- Increase IV fluid rate to maintain urine output of 1–1.5 mL/kg/hr and consider mannitol (Correct answer)
- Administer sodium bicarbonate to alkalinize serum
- Obtain a renal ultrasound immediately
Correct answer: Increase IV fluid rate to maintain urine output of 1–1.5 mL/kg/hr and consider mannitol
Cola-colored urine indicates myoglobinuria; aggressive fluid resuscitation to flush the renal tubules (target UO 1–1.5 mL/kg/hr) prevents acute tubular necrosis, with mannitol as an adjunct.
Question 3: When calculating TBSA for fluid resuscitation, partial-thickness and full-thickness burns are included but which areas are excluded?
- Burns of the hands and feet
- Superficial (first-degree) burns (Correct answer)
- Burns crossing joints
- Circumferential burns
Correct answer: Superficial (first-degree) burns
Superficial (first-degree) burns such as simple sunburn do not compromise the dermal barrier sufficiently to warrant inclusion in TBSA calculations for resuscitation.
Question 4: Which pharmacological intervention is used to treat opioid-induced pruritus in burn patients?
- Diphenhydramine 50 mg IV
- Nalbuphine (a mixed opioid agonist-antagonist) (Correct answer)
- Ketorolac 30 mg IV
- Lorazepam 1 mg IV
Correct answer: Nalbuphine (a mixed opioid agonist-antagonist)
Nalbuphine acts as a mu-receptor antagonist and kappa-receptor agonist, reducing opioid-induced pruritus while preserving analgesia.
Question 5: A burn patient is receiving patient-controlled analgesia (PCA). Which nursing assessment is most critical for safe PCA management?
- Checking the PCA pump battery every 2 hours
- Assessing respiratory rate and sedation level hourly (Correct answer)
- Documenting total opioid use at end of shift only
- Confirming PCA demand dose with a pharmacist each day
Correct answer: Assessing respiratory rate and sedation level hourly
Respiratory depression and over-sedation are the most serious PCA-related adverse effects; hourly assessment of respiratory rate and sedation level is essential for patient safety.
Question 6: Hypertonic saline resuscitation in burns is thought to offer which advantage over isotonic crystalloids?
- It requires a greater total volume to achieve the same hemodynamic effect
- It reduces total fluid volume needed by drawing interstitial fluid into the vasculature (Correct answer)
- It eliminates the risk of hypernatremia
- It is the standard of care recommended by all burn centers
Correct answer: It reduces total fluid volume needed by drawing interstitial fluid into the vasculature
Hypertonic saline's osmotic effect draws fluid from the interstitium into the intravascular space, potentially reducing the total resuscitation volume and edema.
Question 7: Which statement about methadone use in burn pain management is correct?
- Methadone has a short half-life making it safe for PRN dosing
- Methadone is useful for chronic burn pain due to its long half-life and NMDA antagonism (Correct answer)
- Methadone has no drug-drug interactions relevant to burn care
- Methadone is contraindicated in patients with inhalation injuries
Correct answer: Methadone is useful for chronic burn pain due to its long half-life and NMDA antagonism
Methadone's long half-life provides sustained analgesia and its NMDA receptor antagonism helps combat opioid tolerance, making it useful in chronic burn pain management.
CBRN Fluid Resuscitation & Pain Control 4
The Modified Brooke formula differs from the Parkland formula in that it uses: