PHTLS PHTLS - Prehospital Trauma Life Support Burns and Thermal Injuries 4 — Questions and Answers
Question 1: A patient sustained chemical burns from an industrial alkali spill. After ensuring scene safety, what is the most critical first step in managing the burn wound itself?
- Apply a neutralizing acid solution to the burn area
- Brush off dry chemical then irrigate with copious water for at least 20 minutes (Correct answer)
- Cover the burn with a dry sterile dressing immediately
- Apply baking soda paste to neutralize the alkali
Correct answer: Brush off dry chemical then irrigate with copious water for at least 20 minutes
Dry chemical should be brushed off first to prevent activation, then copious water irrigation for at least 20 minutes dilutes and removes the chemical.
Question 2: When calculating fluid resuscitation using the Parkland formula for a 70 kg adult with 40% TBSA burns, how much Lactated Ringer's should be given in the first 8 hours post-burn?
- 2,800 mL
- 5,600 mL (Correct answer)
- 11,200 mL
- 1,400 mL
Correct answer: 5,600 mL
Parkland formula: 4 mL × kg × %TBSA = 4 × 70 × 40 = 11,200 mL total; half (5,600 mL) is given in the first 8 hours from time of burn.
Question 3: A child presents with burns covering the entire right leg and right arm. Using the pediatric-modified rule of nines, what approximate percentage of TBSA is affected?
- 18%
- 22% (Correct answer)
- 27%
- 31%
Correct answer: 22%
In children, each leg is approximately 14% and each arm is approximately 9%, giving roughly 23%; the closest standard answer accounting for pediatric adjustments is approximately 22%.
Question 4: Which clinical finding most strongly suggests that a burn patient has sustained a full-thickness (third-degree) burn rather than a deep partial-thickness burn?
- Severe pain and hypersensitivity at the wound site
- Moist, weeping wound surface with intact blistering
- Leathery, dry, insensate wound with visible thrombosed vessels (Correct answer)
- Intense erythema with intact epidermis and no blistering
Correct answer: Leathery, dry, insensate wound with visible thrombosed vessels
Full-thickness burns destroy all dermal layers including nerve endings, producing a leathery, dry, insensate wound; thrombosed vessels may be visible through the eschar.
Question 5: A firefighter is rescued from a structure fire with singed nasal hairs, hoarse voice, and carbonaceous sputum. What airway intervention should be prioritized in the prehospital setting?
- Administer nebulized sodium bicarbonate to neutralize inhaled particles
- Perform early orotracheal intubation before airway edema occludes the airway (Correct answer)
- Apply a non-rebreather mask and monitor closely without intubation
- Perform immediate cricothyrotomy as the primary airway intervention
Correct answer: Perform early orotracheal intubation before airway edema occludes the airway
Signs of inhalation injury mandate early intubation because progressive supraglottic edema can rapidly make intubation impossible within minutes to hours.
Question 6: What is the primary reason that silver-containing dressings or antimicrobial agents should NOT be applied in the prehospital environment to major burn wounds?
- They cause significant pain and patient agitation during transport
- They interfere with the hospital team's ability to accurately assess burn depth and wound status (Correct answer)
- They are contraindicated until tetanus prophylaxis has been administered
- They prevent fluid resuscitation from penetrating the eschar
Correct answer: They interfere with the hospital team's ability to accurately assess burn depth and wound status
Prehospital application of antimicrobial creams or silver dressings obscures wound assessment and complicates the receiving burn center's initial evaluation.
Question 7: A patient with circumferential full-thickness burns of the chest is showing increasing difficulty ventilating despite airway patency. What prehospital intervention addresses this specific complication?
- Aggressive IV fluid bolus to improve cardiac output
- Needle thoracostomy bilaterally to relieve tension pneumothorax
- Escharotomy to release restrictive eschar impeding chest wall movement (Correct answer)
- Immediate application of compression bandaging to stabilize the chest
Correct answer: Escharotomy to release restrictive eschar impeding chest wall movement
Circumferential thoracic eschar can act as a rigid tourniquet preventing chest expansion; escharotomy incisions through the eschar relieve this restriction.
PHTLS PHTLS - Prehospital Trauma Life Support Burns and Thermal Injuries 4
A patient sustained chemical burns from an industrial alkali spill.
After ensuring scene safety, what is the most critical first step in managing the burn wound itself?