DCAS Trauma Management 4 — Questions and Answers
Question 1: Burns are classified by depth; a full-thickness (third-degree) burn is characterised by:
- Destruction of all skin layers, white/brown/black leathery appearance, painless due to nerve destruction (Correct answer)
- Painful, blistering, moist red surface
- Superficial redness without blistering
- Blistering with extreme sensitivity to touch
Correct answer: Destruction of all skin layers, white/brown/black leathery appearance, painless due to nerve destruction
Full-thickness burns destroy the epidermis, dermis, and subcutaneous structures, appearing as dry, leathery, white/brown/black, and painless as the nerve endings are destroyed.
Question 2: The Parkland formula for burn fluid resuscitation is:
- 4ml × weight (kg) × %TBSA burned, of Lactated Ringer's, with half given in first 8 hours (Correct answer)
- 2ml × weight (kg) × %TBSA
- 1 litre per 10% TBSA burned
- Normal saline 250ml/hour regardless of burn size
Correct answer: 4ml × weight (kg) × %TBSA burned, of Lactated Ringer's, with half given in first 8 hours
The Parkland formula calculates the 24-hour fluid requirement for major burns; half is given in the first 8 hours (timed from the injury, not hospital arrival) and half over the subsequent 16 hours.
Question 3: The 'Rule of Nines' estimates total body surface area (TBSA) burned; the head and neck account for:
- 9% in adults (Correct answer)
- 18% in adults
- 4.5% in adults
- 1% in adults
Correct answer: 9% in adults
In adults, the Rule of Nines allocates: head and neck = 9%, each arm = 9%, each leg = 18%, anterior trunk = 18%, posterior trunk = 18%, and perineum = 1%. Children have proportionally larger heads.
Question 4: Inhalation injury is suspected in a burn patient when:
- There are facial burns, singed eyebrows/nasal hair, carbonaceous (sooty) sputum, and hoarse voice (Correct answer)
- Burns cover more than 30% TBSA only
- The patient has hypotension
- Burns are full-thickness only
Correct answer: There are facial burns, singed eyebrows/nasal hair, carbonaceous (sooty) sputum, and hoarse voice
Clinical indicators of inhalation injury include facial burns, singed nasal/facial hair (indicating exposure to flame), carbonaceous sputum (soot in the airway), and hoarseness (glottic oedema) — the last indicating imminent airway compromise.
Question 5: Traumatic asphyxia presents with:
- Petechial haemorrhages to face and neck, cyanosis, conjunctival haemorrhages after severe chest compression (Correct answer)
- Subcutaneous emphysema and tracheal deviation
- Bilateral haemothorax
- Blunt cardiac injury with arrhythmia
Correct answer: Petechial haemorrhages to face and neck, cyanosis, conjunctival haemorrhages after severe chest compression
Traumatic asphyxia results from a sudden massive increase in intrathoracic pressure (e.g., crush injury) forcing blood retrograde through the valveless veins of the head and neck, causing petechiae, cyanosis, and subconjunctival haemorrhages.
Question 6: Near-drowning (submersion injury) pre-hospital management priorities are:
- Removal from water, airway opening, ventilation, CPR if pulseless, warm core temperature (Correct answer)
- Administration of diuretics to remove water from the lungs
- Chest compressions before airway management
- Immediate transport without any field interventions
Correct answer: Removal from water, airway opening, ventilation, CPR if pulseless, warm core temperature
Near-drowning management: safely rescue from water, establish airway and provide rescue breathing, begin CPR if in cardiac arrest, prevent/treat hypothermia, and transport to hospital — all standard ALS priorities.
DCAS Trauma Management 4
Burns are classified by depth; a full-thickness (third-degree) burn is characterised by: