PHTLS PHTLS - Prehospital Trauma Life Support Burns and Thermal Injuries 5 — Questions and Answers
Question 1: During the prehospital care of a burn patient in cold weather, which thermoregulation strategy is most appropriate to prevent hypothermia without worsening the burn wound?
- Apply ice packs wrapped in cloth to actively cool the burn wound
- Use warmed IV fluids and cover non-burned areas with blankets while using clean dry dressings on burns (Correct answer)
- Immerse the burned limbs in cold water throughout transport
- Do not apply any covering to burn wounds since occlusion increases infection risk
Correct answer: Use warmed IV fluids and cover non-burned areas with blankets while using clean dry dressings on burns
Burned patients lose thermoregulatory ability through destroyed skin; warm IV fluids and covering non-burned areas prevent hypothermia while clean dressings protect the wound.
Question 2: A patient sustains electrical burns after contact with a high-voltage power line. Beyond the entry and exit wounds, which organ system requires the highest priority monitoring during prehospital care?
- Gastrointestinal system for stress-induced hemorrhage
- Cardiac system for dysrhythmias caused by electrical current traversing the heart (Correct answer)
- Integumentary system for delayed blister formation
- Musculoskeletal system for stress fractures at entry/exit sites
Correct answer: Cardiac system for dysrhythmias caused by electrical current traversing the heart
Electrical current passing through the body can induce ventricular fibrillation and other life-threatening dysrhythmias; continuous cardiac monitoring is essential.
Question 3: Which burn pattern should immediately raise suspicion of non-accidental trauma (child abuse) in a pediatric patient?
- Superficial burns on the dorsum of the hand from touching a hot surface
- Splash-pattern scald burns across the face and anterior trunk
- Symmetric stocking or glove distribution scald burns with sharp demarcation lines (Correct answer)
- Linear burns along the forearm consistent with contact with a hot object
Correct answer: Symmetric stocking or glove distribution scald burns with sharp demarcation lines
Symmetric, sharply demarcated scald burns in a stocking or glove distribution indicate forced immersion injury, a classic pattern of intentional abuse.
Question 4: A patient with 30% TBSA burns is agitated, tachycardic, and has a blood pressure of 88/60 mmHg 2 hours after injury despite IV fluid resuscitation. What is the most likely cause of the hemodynamic instability?
- Septic shock from early wound contamination
- Hypovolemic shock from fluid shifts and increased capillary permeability (Correct answer)
- Neurogenic shock from pain-mediated vasodilation
- Cardiogenic shock from burn-induced myocardial depression
Correct answer: Hypovolemic shock from fluid shifts and increased capillary permeability
Massive fluid shifts due to increased capillary permeability in the early post-burn period cause hypovolemic shock requiring aggressive crystalloid resuscitation.
Question 5: When treating a patient with burns involving the genitalia and perineum, what is the primary prehospital concern beyond wound management?
- Immediate urinary catheter insertion to prevent urethral swelling and obstruction (Correct answer)
- Application of topical antiseptic to prevent fecal contamination
- Careful patient positioning to prevent pressure on burned tissue
- Splinting of the lower extremities to prevent contracture formation
Correct answer: Immediate urinary catheter insertion to prevent urethral swelling and obstruction
Genital and perineal burns cause rapid edema that can occlude the urethra; early catheterization before swelling progresses is necessary to ensure urinary drainage.
Question 6: A patient presents after sustaining radiation burns from an industrial source. After removing contaminated clothing, what additional step unique to radiation exposure must occur before transport?
- Administration of potassium iodide to block radioactive uptake
- Radiation survey and decontamination of the patient to protect rescuers and hospital staff (Correct answer)
- Immediate application of lead shielding over the burn wound
- Hyperventilation to accelerate elimination of inhaled radioactive particles
Correct answer: Radiation survey and decontamination of the patient to protect rescuers and hospital staff
Patients exposed to radioactive contamination must be surveyed with a Geiger counter and decontaminated before transport to prevent exposing EMS personnel and hospital staff.
Question 7: In PHTLS, what is the recommended approach to blisters present on partial-thickness burn wounds during prehospital care?
- Debride and rupture all blisters to assess the underlying wound depth
- Leave blisters intact as they provide a sterile barrier protecting the underlying wound (Correct answer)
- Apply firm circumferential bandaging over blisters to prevent rupture during transport
- Aspirate blisters with a syringe to reduce fluid loss from the wound surface
Correct answer: Leave blisters intact as they provide a sterile barrier protecting the underlying wound
Intact blisters serve as a natural sterile dressing protecting the underlying dermis; prehospital providers should leave them intact and cover with a clean dry dressing.
PHTLS PHTLS - Prehospital Trauma Life Support Burns and Thermal Injuries 5
During the prehospital care of a burn patient in cold weather, which thermoregulation strategy is most appropriate to prevent hypothermia without worsening the burn wound?