TCRN Burn and Inhalation Injuries Questions and Answers — Questions and Answers
Question 1: A 45-year-old male weighing 70 kg was rescued from a house fire and has full-thickness burns to his entire chest and abdomen, and the entire circumference of his right arm. Using the Rule of Nines, what is the total volume of Lactated Ringer's solution to be administered in the first 8 hours of fluid resuscitation according to the Parkland formula?
- 7,560 mL
- 3,780 mL (Correct answer)
- 15,120 mL
- 5,040 mL
Correct answer: 3,780 mL
First, calculate the Total Body Surface Area (TBSA) burned using the Rule of Nines: Chest (9%) + Abdomen (9%) + Entire Right Arm (9%) = 27% TBSA. Next, use the Parkland formula: 4 mL x Body Weight (kg) x TBSA (%). So, 4 mL x 70 kg x 27% = 7,560 mL. This is the total volume for the first 24 hours. The formula specifies that half of this total volume must be administered in the first 8 hours post-burn. Therefore, 7,560 mL / 2 = 3,780 mL.
Question 2: A trauma nurse is caring for a patient with circumferential, full-thickness burns to the entire left leg. Which of the following assessment findings would be the earliest and most critical indication for an escharotomy?
- Absent distal pulses on palpation
- Delayed capillary refill in the toes
- Deep, aching pain in the affected limb
- Weak or absent signal on Doppler ultrasound (Correct answer)
Correct answer: Weak or absent signal on Doppler ultrasound
While delayed capillary refill and pain are concerning, a weak or absent signal on Doppler ultrasound is a more definitive and critical sign of compromised arterial flow, necessitating immediate intervention with an escharotomy to relieve pressure and restore circulation. Waiting for pulses to be absent by palpation may indicate irreversible damage.
Question 3: A patient is admitted after being trapped in a burning building. They are hoarse, have carbonaceous sputum, and singed nasal hairs. What is the highest priority intervention for this patient?
- Administering 100% oxygen via a non-rebreather mask
- Obtaining a carboxyhemoglobin level
- Preparing for early endotracheal intubation (Correct answer)
- Initiating intravenous fluid resuscitation
Correct answer: Preparing for early endotracheal intubation
The presence of hoarseness, carbonaceous sputum, and singed nasal hairs are strong indicators of a significant inhalation injury. The airway can become edematous and obstructed rapidly. Therefore, the highest priority is to secure the airway with early endotracheal intubation before progressive swelling makes it impossible. While oxygen and fluid resuscitation are crucial, they are secondary to securing a patent airway.
Question 4: Which method for estimating the Total Body Surface Area (TBSA) of a burn is considered the most accurate for pediatric patients because it accounts for the developmental differences in body proportions?
- Rule of Nines
- Palmar method
- Rule of Fives
- Lund-Browder chart (Correct answer)
Correct answer: Lund-Browder chart
The Lund-Browder chart is the most accurate method for estimating TBSA in children because it adjusts the percentage assigned to different body parts based on age. Children have proportionally larger heads and smaller legs than adults, a fact that the standard Rule of Nines does not accurately reflect.
Question 5: A patient rescued from a fire has a cherry-red skin color despite being in respiratory distress. The pulse oximeter reads 99%. The trauma nurse should have the highest suspicion for what condition?
- Cyanide poisoning
- Methemoglobinemia
- Carbon monoxide poisoning (Correct answer)
- Anaphylactic shock
Correct answer: Carbon monoxide poisoning
Carbon monoxide has a much higher affinity for hemoglobin than oxygen. It binds to hemoglobin, creating carboxyhemoglobin, which has a bright, cherry-red color. This can cause the classic cherry-red skin finding. A standard pulse oximeter cannot differentiate between oxyhemoglobin and carboxyhemoglobin, leading to a falsely high oxygen saturation reading. The combination of physical signs, mechanism of injury, and a misleadingly high SpO2 are hallmark signs of carbon monoxide poisoning.
Question 6: A trauma patient has sustained a high-voltage electrical injury. In addition to cutaneous burns at the entrance and exit wounds, for which of the following complications is this patient at highest risk?
- Acute respiratory distress syndrome (ARDS)
- Cardiac dysrhythmias and rhabdomyolysis (Correct answer)
- Acalculous cholecystitis
- Neurogenic shock
Correct answer: Cardiac dysrhythmias and rhabdomyolysis
High-voltage electricity can travel through the body, causing significant internal damage. The electrical current can disrupt the heart's normal conduction system, leading to life-threatening dysrhythmias. Furthermore, the massive muscle damage caused by the current leads to rhabdomyolysis, releasing myoglobin into the bloodstream, which can cause acute kidney injury.
TCRN Burn and Inhalation Injuries Questions and Answers
A 45-year-old male weighing 70 kg was rescued from a house fire and has full-thickness burns to his entire chest and abdomen, and the entire circumference of his right arm.
Using the Rule of Nines, what is the total volume of Lactated Ringer's solution to be administered in the first 8 hours of fluid resuscitation according to the Parkland formula?