TCRN TCRN Burn and Inhalation Injuries 2 — Questions and Answers
Question 1: A patient with burns over 40% TBSA is 8 hours post-injury. According to the Parkland formula, what percentage of the 24-hour fluid total should have been infused by this point?
- 25%
- 50% (Correct answer)
- 75%
- 100%
Correct answer: 50%
The Parkland formula calls for half (50%) of the 24-hour total (4 mL × kg × %TBSA) to be given in the first 8 hours post-injury.
Question 2: Which finding is most characteristic of carbon monoxide poisoning in a burn patient?
- SpO2 of 85% on pulse oximetry
- Cherry-red skin color (Correct answer)
- Cyanotic mucous membranes
- Hemoptysis with carbonaceous sputum
Correct answer: Cherry-red skin color
Cherry-red skin (carboxyhemoglobin-bound blood) is a classic sign of CO poisoning, though it is not always present; pulse oximetry is unreliable in CO poisoning as it reads falsely normal.
Question 3: A burn patient develops hoarseness, stridor, and oropharyngeal edema 2 hours after a house fire. What is the priority intervention?
- Administer nebulized racemic epinephrine
- Apply a non-rebreather mask at 15 L/min
- Perform early endotracheal intubation (Correct answer)
- Obtain ABG and reassess in 30 minutes
Correct answer: Perform early endotracheal intubation
Progressive upper airway edema from inhalation injury mandates early endotracheal intubation before complete obstruction renders intubation impossible.
Question 4: Which parameter best guides fluid resuscitation adequacy in a major burn patient?
- Mean arterial pressure > 70 mmHg
- Urine output of 0.5–1 mL/kg/hr (Correct answer)
- Central venous pressure of 8–12 mmHg
- Heart rate < 100 beats/min
Correct answer: Urine output of 0.5–1 mL/kg/hr
Urine output of 0.5–1 mL/kg/hr is the most reliable indicator of adequate end-organ perfusion and guides burn resuscitation.
Question 5: A patient sustains burns to the anterior trunk, both arms, and the head. Using the Rule of Nines, what is the estimated TBSA burned?
- 36%
- 45% (Correct answer)
- 54%
- 63%
Correct answer: 45%
Anterior trunk = 18%, each arm = 9% (×2 = 18%), head = 9%, totaling 45% TBSA.
Question 6: Circumferential full-thickness burns of the lower extremity require escharotomy primarily to prevent which complication?
- Systemic sepsis from eschar colonization
- Compartment syndrome with vascular compromise (Correct answer)
- Deep vein thrombosis from immobility
- Contracture formation during healing
Correct answer: Compartment syndrome with vascular compromise
Circumferential eschar restricts tissue expansion, causing compartment syndrome and limb-threatening vascular compromise that requires escharotomy.
Question 7: What is the primary reason high-voltage electrical burns often cause more extensive internal injury than surface appearance suggests?
- Electrical current generates intense visible flame causing deeper burns
- Current follows neurovascular bundles causing internal tissue destruction (Correct answer)
- High voltage causes immediate respiratory arrest masking injury extent
- Electricity destroys pain receptors, underreporting injury severity
Correct answer: Current follows neurovascular bundles causing internal tissue destruction
Electrical current travels through paths of least resistance—nerves and blood vessels—causing extensive internal tissue necrosis far beyond visible entry/exit wounds.
TCRN TCRN Burn and Inhalation Injuries 2
A patient with burns over 40% TBSA is 8 hours post-injury.
According to the Parkland formula, what percentage of the 24-hour fluid total should have been infused by this point?