TCRN TCRN Burn and Inhalation Injuries 5 — Questions and Answers
Question 1: A patient has burns to both hands, genitalia, and face. In addition to TBSA percentage, why is this patient's burn classified as a major burn requiring burn center transfer?
- Because of increased fluid resuscitation requirements for these areas
- Because burns to functionally critical and cosmetically sensitive areas require specialized care (Correct answer)
- Because these areas have higher infection rates due to constant moisture
- Because pain management for these areas requires specialized equipment
Correct answer: Because burns to functionally critical and cosmetically sensitive areas require specialized care
Burns to the face, hands, feet, genitalia, perineum, and major joints are ABA criteria for burn center referral due to functional and cosmetic significance requiring specialized rehabilitation.
Question 2: Which assessment finding suggests a chemical burn is still actively progressing despite copious irrigation?
- Blister formation at the wound margins
- Continued pain or worsening erythema despite 30 minutes of irrigation (Correct answer)
- Brown discoloration of the wound surface
- Absence of wound exudate
Correct answer: Continued pain or worsening erythema despite 30 minutes of irrigation
Persistent or worsening pain and erythema after prolonged irrigation indicates ongoing chemical reaction, requiring continued decontamination and possible pH testing of irrigation effluent.
Question 3: A burn patient on day 3 develops hypotension, fever of 39.8°C, confusion, and a white blood cell count of 18,000. Which condition must be differentiated from the normal post-burn inflammatory response?
- Burn shock due to inadequate resuscitation
- Systemic inflammatory response syndrome (SIRS) from burns alone
- Sepsis from burn wound or line infection (Correct answer)
- Abdominal compartment syndrome
Correct answer: Sepsis from burn wound or line infection
While SIRS is expected after major burns, the addition of a suspected source, organ dysfunction, and clinical deterioration requires urgent evaluation for sepsis and appropriate cultures.
Question 4: What is the significance of the 'zone of stasis' in burn wound pathophysiology?
- It represents the central necrotic core of the burn wound that requires debridement
- It is viable tissue that may convert to necrosis without optimal resuscitation and care (Correct answer)
- It is the area of hyperemia surrounding the burn that always recovers completely
- It defines the boundary for skin grafting decisions
Correct answer: It is viable tissue that may convert to necrosis without optimal resuscitation and care
Jackson's zone of stasis surrounds the central zone of coagulation; it has reduced perfusion and can convert to full-thickness necrosis if edema and ischemia are not addressed with adequate resuscitation.
Question 5: Which intervention is indicated for a patient with suspected hydrofluoric acid (HF) burns to the hand with systemic symptoms?
- Silver sulfadiazine dressing and wound elevation
- Intravenous calcium gluconate infusion (Correct answer)
- Immediate surgical debridement of affected tissue
- Sodium bicarbonate soaks to neutralize the acid
Correct answer: Intravenous calcium gluconate infusion
HF penetrates tissue and binds calcium, causing life-threatening hypocalcemia and dysrhythmias; systemic involvement requires IV calcium gluconate in addition to topical calcium gel.
Question 6: A nurse is assessing a patient's pain 2 hours after dressing change for partial-thickness burns. The patient rates pain 8/10 and is tachycardic. Which analgesic approach is most appropriate for procedural burn pain?
- Scheduled oral acetaminophen alone
- IV opioids titrated to effect before and during procedures (Correct answer)
- Topical lidocaine applied to wound surface
- NSAIDs as primary analgesic to reduce inflammation
Correct answer: IV opioids titrated to effect before and during procedures
Procedural burn pain requires preemptive IV opioid analgesics titrated to effect, often combined with anxiolytics, as topical agents are insufficient and oral medications have delayed onset.
Question 7: When caring for a burned patient, the TCRN notes that carbon monoxide levels correlate poorly with clinical symptoms. Which patient population is MOST at risk for severe CO poisoning symptoms at lower carboxyhemoglobin levels?
- Young adults with athletic conditioning
- Elderly patients and those with cardiopulmonary disease (Correct answer)
- Patients with sickle cell trait
- Patients taking anticoagulant therapy
Correct answer: Elderly patients and those with cardiopulmonary disease
Elderly patients and those with pre-existing cardiopulmonary disease have diminished physiologic reserve and may develop severe neurologic or cardiac symptoms at lower carboxyhemoglobin levels than healthy adults.
TCRN TCRN Burn and Inhalation Injuries 5
A patient has burns to both hands, genitalia, and face.
In addition to TBSA percentage, why is this patient's burn classified as a major burn requiring burn center transfer?