CBRN Fluid Resuscitation & Pain Control 5 — Questions and Answers
Question 1: A 55 kg patient with 25% TBSA burns arrives 3 hours post-injury. How much fluid should be infused over the remaining 5 hours of the first 8-hour period?
- 1,375 mL (Correct answer)
- 2,750 mL
- 5,500 mL
- 3,437 mL
Correct answer: 1,375 mL
Total 24h = 4×55×25 = 5,500 mL; first 8h share = 2,750 mL; 3 hours already elapsed leaves 5 hours, so infuse 2,750 mL over those 5 hours at 550 mL/hr, totaling 1,375 mL in the next ~2.5h — the rate is 550 mL/hr over the remaining 5 hours delivering 2,750 mL, so the remaining volume is the full 2,750 mL.
Question 2: Which sign most strongly suggests compartment syndrome in a circumferentially burned extremity?
- Mild pitting edema distal to the burn
- Pain with passive stretch of muscles in the affected compartment (Correct answer)
- Skin temperature equal to the contralateral limb
- Capillary refill of 3 seconds
Correct answer: Pain with passive stretch of muscles in the affected compartment
Pain out of proportion with passive muscle stretch is the most sensitive early indicator of compartment syndrome requiring urgent escharotomy or fasciotomy.
Question 3: Alpha-2 agonists (e.g., dexmedetomidine) are used in burn ICU patients primarily to:
- Replace all opioids for pain management
- Provide sedation and opioid-sparing analgesia while maintaining arousability (Correct answer)
- Treat opioid withdrawal symptoms exclusively
- Reverse respiratory depression from morphine
Correct answer: Provide sedation and opioid-sparing analgesia while maintaining arousability
Dexmedetomidine provides sedation and reduces opioid requirements while allowing the patient to remain arousable, which is beneficial for neurologic monitoring.
Question 4: Inhalation injury is present in a burn patient. How does this affect fluid resuscitation?
- It reduces total fluid requirements by 25%
- It increases fluid requirements beyond standard formula predictions (Correct answer)
- It has no effect on fluid resuscitation volumes
- It necessitates switching to normal saline instead of LR
Correct answer: It increases fluid requirements beyond standard formula predictions
Inhalation injury increases systemic inflammation and pulmonary edema risk, typically increasing actual fluid requirements above formula-predicted volumes.
Question 5: The FLACC scale is used in burn patients who are:
- Alert adults able to use a numeric rating scale
- Critically ill, preverbal, or cognitively impaired and cannot self-report pain (Correct answer)
- Only pediatric patients under 2 years of age
- Sedated and paralyzed on mechanical ventilation
Correct answer: Critically ill, preverbal, or cognitively impaired and cannot self-report pain
FLACC (Face, Legs, Activity, Cry, Consolability) assesses pain via behavioral observation and is validated for patients unable to self-report, including preverbal children and cognitively impaired adults.
Question 6: Which statement about anxiolytics in burn pain management is accurate?
- Benzodiazepines alone provide sufficient analgesia for dressing changes
- Anxiolytics reduce the anxiety component of pain but should be combined with analgesics (Correct answer)
- Midazolam is preferred over opioids as a first-line analgesic
- Anxiolytics eliminate the need for opioids during wound care
Correct answer: Anxiolytics reduce the anxiety component of pain but should be combined with analgesics
Anxiolytics address the emotional distress component of procedural pain but do not provide analgesia; they must be combined with analgesics for comprehensive pain management.
Question 7: Which hemodynamic parameter is preferred over CVP for guiding fluid resuscitation in major burn patients in the ICU?
- Mean arterial pressure alone
- Pulse pressure variation (PPV) or stroke volume variation (SVV) (Correct answer)
- Central venous pressure (CVP)
- Systolic blood pressure
Correct answer: Pulse pressure variation (PPV) or stroke volume variation (SVV)
Dynamic parameters such as PPV and SVV are more accurate predictors of fluid responsiveness than static CVP measurements in mechanically ventilated burn patients.
CBRN Fluid Resuscitation & Pain Control 5
A 55 kg patient with 25% TBSA burns arrives 3 hours post-injury.
How much fluid should be infused over the remaining 5 hours of the first 8-hour period?