ITLS - International Trauma Life Support Burns and Environmental Trauma Questions and Answers

Question 1

An electrician is found unconscious after contact with a high-voltage wire. He has small entry and exit burns on his hands and feet. What is the most critical and immediate concern for this patient beyond the surface burns?

Accepted Answer

Severe internal tissue damage and potential cardiac dysrhythmias.

Answer

High-voltage electricity travels through the body, causing extensive internal damage to muscles and organs (rhabdomyolysis) that is not visible externally. The current can also disrupt the heart's electrical conduction system, leading to life-threatening dysrhythmias like ventricular fibrillation. Therefore, cardiac monitoring and aggressive fluid resuscitation are paramount, as the visible burns are a poor indicator of the true injury severity.

Question 2

A patient is rescued from a structural fire. They have no significant cutaneous burns but are coughing, have a hoarse voice, and possess soot around their nose and mouth. Which finding is the most reliable indicator of a significant inhalation injury requiring aggressive airway management?

Accepted Answer

A progressively worsening hoarse voice.

Answer

A hoarse voice, stridor, or brassy cough indicates laryngeal edema from direct thermal injury to the upper airway. This swelling can rapidly progress to complete airway obstruction. While soot and tachypnea are clues, the change in voice is a more direct and ominous sign of impending airway compromise that necessitates early and definitive airway control.

Question 3

An 80 kg adult patient has full-thickness burns to his entire chest and abdomen. According to the Parkland formula, what is the total amount of fluid to be administered over the first 8 hours from the time of the burn?

Accepted Answer

2880 mL

Answer

The Parkland formula is 4 mL x patient's weight in kg x percentage of Total Body Surface Area (%TBSA) burned. Using the Rule of Nines, the entire anterior torso (chest + abdomen) is 18% TBSA. The total 24-hour fluid is 4 mL x 80 kg x 18 = 5760 mL. Half of this amount (5760 / 2 = 2880 mL) must be infused over the first 8 hours from the time of the injury.

Question 4

On a hot, humid day, you are called to a construction site for a worker who collapsed. He has hot, dry skin, a respiratory rate of 28, a heart rate of 130, and is confused and combative. These findings are most consistent with which heat-related emergency, and what is the priority intervention?

Accepted Answer

Heat stroke; initiate immediate and aggressive active cooling.

Answer

The combination of altered mental status (confusion, combativeness) and hot, dry skin (due to failure of the thermoregulatory system) are the classic signs of exertional heat stroke. This is a true medical emergency, and the priority is to rapidly lower the core body temperature with the principle of "cool first, transport second." While fluids are important, cooling is the most critical life-saving intervention.

Question 5

Which of the following is a critical principle when managing a patient with severe hypothermia (core temperature < 30°C / 86°F)?

Accepted Answer

Handling the patient gently to avoid precipitating ventricular fibrillation.

Answer

The cold myocardium is extremely irritable in severely hypothermic patients. Rough handling or movement can easily trigger lethal dysrhythmias, particularly ventricular fibrillation. Therefore, all interventions must be performed gently. Active rewarming should focus on the core (axilla, groin, trunk), not the periphery, to avoid "afterdrop," where cold blood from the extremities returns to the core and further lowers the core temperature.

ITLS - International Trauma Life Support Practice Test

ITLS - International Trauma Life Support Practice Test

ITLS - International Trauma Life Support Burns and Environmental Trauma Questions and Answers