PHTLS PHTLS - Prehospital Trauma Life Support Burns and Thermal Injuries 1 — Questions and Answers
Question 1: Using the Rule of Nines in an adult patient, what percentage of total body surface area (TBSA) does the entire lower extremity represent?
- 9%
- 18% (Correct answer)
- 27%
- 36%
Correct answer: 18%
Each entire lower extremity accounts for 18% of TBSA in an adult using the Rule of Nines (9% anterior + 9% posterior).
Question 2: Which burn depth classification is characterized by dry, leathery, insensate skin that does not blanch with pressure?
- Superficial (first-degree)
- Partial thickness superficial
- Partial thickness deep
- Full thickness (third-degree) (Correct answer)
Correct answer: Full thickness (third-degree)
Full-thickness burns destroy all layers of the dermis, producing dry, leathery, insensate skin that does not blanch because dermal capillaries are destroyed.
Question 3: A patient with major burns over 30% TBSA requires IV fluid resuscitation. What is the preferred initial fluid per PHTLS guidelines?
- Hypertonic saline
- Dextrose 5% in water
- Lactated Ringer's solution (Correct answer)
- Albumin
Correct answer: Lactated Ringer's solution
Lactated Ringer's solution is the preferred isotonic crystalloid for initial burn resuscitation because its electrolyte composition most closely matches plasma.
Question 4: In prehospital burn care, when should you stop the burning process by cooling a wound with water?
- Only if transport time exceeds 60 minutes
- Immediately, with cool (not cold) water for 10–20 minutes (Correct answer)
- Only for chemical burns, not thermal burns
- After covering with dry sterile dressings first
Correct answer: Immediately, with cool (not cold) water for 10–20 minutes
Cool (15–25°C) water applied within 3 hours of injury for 10–20 minutes reduces burn depth and pain, but ice or cold water should be avoided to prevent hypothermia.
Question 5: A patient is found unconscious in a burning building. Which inhalation injury concern takes highest priority in management?
- Upper airway thermal burns causing edema
- Carbon monoxide poisoning (Correct answer)
- Lower airway chemical burns from combustion products
- Cyanide toxicity from synthetic materials
Correct answer: Carbon monoxide poisoning
Carbon monoxide poisoning is the most immediately life-threatening inhalation injury; it binds hemoglobin with 240Ă— the affinity of oxygen and is treated with high-flow 100% oxygen.
Question 6: Which finding is the most reliable early sign of inhalation injury requiring airway intervention?
- Carbonaceous sputum only
- Singed nasal hairs only
- Hoarseness or stridor (Correct answer)
- Facial burns with erythema
Correct answer: Hoarseness or stridor
Hoarseness or stridor indicates upper airway edema from thermal injury, signaling impending obstruction and the need for early definitive airway management.
PHTLS PHTLS - Prehospital Trauma Life Support Burns and Thermal Injuries 1
Using the Rule of Nines in an adult patient, what percentage of total body surface area (TBSA) does the entire lower extremity represent?