TCRN TCRN Burn and Inhalation Injuries 3 — Questions and Answers
Question 1: A patient with inhalation injury has a PaO2 of 55 mmHg on 100% non-rebreather mask. Which intervention should be initiated?
- Increase PEEP on the ventilator (Correct answer)
- Administer IV methylprednisolone
- Perform bronchoscopy for airway clearance
- Initiate prone positioning immediately
Correct answer: Increase PEEP on the ventilator
Refractory hypoxemia in intubated inhalation injury patients is treated with increased PEEP to recruit collapsed alveoli and improve oxygenation.
Question 2: Which wound characteristic distinguishes a deep partial-thickness burn from a full-thickness burn?
- Presence of blisters on the wound surface
- Ivory or leathery appearance with firm texture
- Painful response to pinprick testing (Correct answer)
- Red, moist appearance with blanching
Correct answer: Painful response to pinprick testing
Deep partial-thickness burns are painful to pinprick because sensory nerve endings in the dermis remain intact, whereas full-thickness burns destroy nerves and are insensate.
Question 3: Hydrogen cyanide (HCN) toxicity is suspected in a burn patient from a structure fire. What is the antidote of choice?
- Sodium thiosulfate alone
- Hydroxocobalamin (Cyanokit) (Correct answer)
- Amyl nitrite inhalation
- High-flow oxygen only
Correct answer: Hydroxocobalamin (Cyanokit)
Hydroxocobalamin binds cyanide to form cyanocobalamin (vitamin B12), is the preferred antidote, and does not cause methemoglobinemia unlike nitrite-based regimens.
Question 4: A patient with 30% TBSA burns develops fever, tachycardia, and wound purulence on day 5. Which organism is the most common cause of early burn wound infection?
- Candida albicans
- Pseudomonas aeruginosa
- Staphylococcus aureus (Correct answer)
- Klebsiella pneumoniae
Correct answer: Staphylococcus aureus
Staphylococcus aureus (including MRSA) predominates in early burn wound infections during the first week, while Pseudomonas aeruginosa becomes more common later.
Question 5: When calculating fluid resuscitation using the Parkland formula for a 70 kg patient with 30% TBSA burns, what is the total 24-hour lactated Ringer's volume?
- 4,200 mL
- 8,400 mL (Correct answer)
- 12,000 mL
- 2,100 mL
Correct answer: 8,400 mL
Parkland formula: 4 mL × 70 kg × 30% TBSA = 8,400 mL total over 24 hours.
Question 6: A child with burns to the entire right leg is evaluated using the Lund and Browder chart. How does this differ from adult calculation for the same area?
- Children's legs account for a larger percentage of TBSA than adults
- Children's legs account for a smaller percentage of TBSA than adults (Correct answer)
- The Lund and Browder chart applies the same percentages as the Rule of Nines
- Children's head and legs are calculated identically to adults
Correct answer: Children's legs account for a smaller percentage of TBSA than adults
In children, the head is proportionally larger and each leg proportionally smaller than in adults; the Lund and Browder chart accounts for these age-based anatomical differences.
Question 7: Which topical antimicrobial agent is contraindicated in patients with sulfonamide allergy?
- Silver nitrate solution
- Mafenide acetate (Sulfamylon)
- Silver sulfadiazine (Silvadene) (Correct answer)
- Bacitracin ointment
Correct answer: Silver sulfadiazine (Silvadene)
Silver sulfadiazine (Silvadene) is a sulfonamide compound and is contraindicated in patients with sulfa allergy due to risk of allergic reaction.
TCRN TCRN Burn and Inhalation Injuries 3
A patient with inhalation injury has a PaO2 of 55 mmHg on 100% non-rebreather mask.
Which intervention should be initiated?