Burn Management Flashcards

A patient with 25% TBSA partial-thickness burns develops decreased breath sounds on the right with tracheal deviation to the left after needle decompression for suspected tension pneumothorax from a blast injury. The next step is:

Answer: Insert a chest tube (tube thoracostomy) on the right

Persistent findings after needle decompression indicate failure of needle relief and require definitive chest tube placement for effective pneumothorax management.

In pediatric burn patients, the Rule of Nines is modified because:

Answer: The head represents a proportionally larger surface area than in adults

A child's head represents up to 18% TBSA (versus 9% in adults), and the legs are proportionally smaller; the Lund and Browder chart accounts for age-related differences.

Which laboratory finding is most specific for rhabdomyolysis in an electrical burn patient requiring increased urine output targets?

Answer: Myoglobinuria (dark, tea-colored urine with positive dipstick for blood but no RBCs)

Myoglobinuria causes dark urine that tests positive for blood on dipstick without microscopic RBCs, indicating muscle breakdown requiring urine output of 1–1.5 mL/kg/hr.

A patient with significant burns to both hands should have dressings applied in which configuration to preserve function?

Answer: Individual digit wrapping with the hand in a position of function

Each digit is dressed individually and the hand is positioned in the intrinsic-plus (position of function) to prevent contracture formation.

A nurse is caring for a patient 72 hours post-burn who suddenly develops decreasing urine output, increasing edema, and rising CVP. This constellation most likely represents:

Answer: Fluid remobilization causing volume overload

Around 48–72 hours post-burn, capillary integrity is restored and mobilized third-space fluid returns to the vascular compartment, potentially causing volume overload.

Which burn location automatically qualifies a patient for transfer to a burn center regardless of burn size?

Answer: Burns involving the face, hands, feet, genitalia, perineum, or major joints

ABA burn center referral criteria include burns to functionally and cosmetically critical areas: face, hands, feet, genitalia, perineum, and major joints.

When evaluating for inhalation injury, which diagnostic tool provides direct visualization of supraglottic airway injury and is considered the gold standard?

Answer: Bronchoscopy

Bronchoscopy provides direct visualization of soot, mucosal edema, and carbonaceous deposits in the supraglottic and tracheobronchial airways, confirming inhalation injury.