PHTLS PHTLS - Prehospital Trauma Life Support Burns and Thermal Injuries 2 — Questions and Answers
Question 1: When calculating fluid resuscitation using the Parkland formula (4 mL × kg × %TBSA), what proportion of the total 24-hour volume should be given in the first 8 hours?
- 25%
- 33%
- 50% (Correct answer)
- 75%
Correct answer: 50%
The Parkland formula calls for 50% of the calculated 24-hour volume to be infused in the first 8 hours from the time of burn, with the remaining 50% over the next 16 hours.
Question 2: Which circumferential burn complication requires escharotomy and presents with absent distal pulses and a tight, pale extremity?
- Deep vein thrombosis
- Compartment syndrome from eschar constriction (Correct answer)
- Arterial vasospasm
- Rhabdomyolysis
Correct answer: Compartment syndrome from eschar constriction
Circumferential full-thickness burns create rigid eschar that constricts swelling tissue, causing compartment syndrome that requires escharotomy to restore circulation.
Question 3: A patient has burns to both anterior forearms and the anterior chest. Using the Rule of Nines, what is the approximate TBSA burned?
- 13.5%
- 18%
- 22.5% (Correct answer)
- 27%
Correct answer: 22.5%
Anterior chest = 18%, each anterior forearm = 4.5% (half of 9% per arm); total = 18 + 4.5 + 4.5 = approximately 22.5% TBSA.
Question 4: What is the primary danger of applying ice directly to a burn wound?
- It increases the risk of infection
- It causes frostbite and worsens tissue injury while accelerating hypothermia (Correct answer)
- It prevents proper wound assessment
- It causes the eschar to harden prematurely
Correct answer: It causes frostbite and worsens tissue injury while accelerating hypothermia
Ice causes vasoconstriction that worsens burn depth, can cause frostbite of injured tissue, and significantly contributes to systemic hypothermia.
Question 5: Which burn characteristic classifies a burn as a 'critical burn' requiring transfer to a burn center per ABA guidelines?
- Any burn on the dorsum of the hand
- Partial thickness burns greater than 10% TBSA in a healthy adult (Correct answer)
- Superficial burns covering both lower extremities
- Any burn requiring IV access for pain management
Correct answer: Partial thickness burns greater than 10% TBSA in a healthy adult
The American Burn Association criteria for burn center referral include partial thickness burns >10% TBSA, burns involving face/hands/feet/genitalia/perineum, full thickness burns, and chemical or electrical burns.
Question 6: In an electrical burn patient, which systemic injury not visible on the skin surface must be assumed and monitored for?
- Pulmonary contusion from current path
- Rhabdomyolysis and myoglobinuria causing renal failure (Correct answer)
- Hepatic necrosis from current passage
- Splenic rupture from electrical surge
Correct answer: Rhabdomyolysis and myoglobinuria causing renal failure
Electrical current causes deep muscle destruction; myoglobin released from damaged muscle precipitates in renal tubules, causing acute kidney injury.
PHTLS PHTLS - Prehospital Trauma Life Support Burns and Thermal Injuries 2
When calculating fluid resuscitation using the Parkland formula (4 mL × kg × %TBSA), what proportion of the total 24-hour volume should be given in the first 8 hours?