TNCC Burn and Thermal Trauma 2 — Questions and Answers
Question 1: Electrical burns are often more severe than they appear externally because:
- The skin is a poor conductor and limits surface injury
- Current travels through the body causing extensive internal tissue destruction along its path (Correct answer)
- Delayed symptom onset masks the true depth
- Exit wounds are always larger than entry wounds
Correct answer: Current travels through the body causing extensive internal tissue destruction along its path
Electrical burns cause extensive internal tissue destruction along the current path through the body, while external entry and exit wounds may appear deceptively small.
Question 2: Which finding is most directly indicative of inhalation injury in a burn patient?
- Tachycardia greater than 120 beats per minute
- Carbonaceous (soot-tinged) sputum (Correct answer)
- Full-thickness burns covering the face
- Blood pressure of 90/60 mmHg
Correct answer: Carbonaceous (soot-tinged) sputum
Carbonaceous sputum containing sooty particles is direct evidence that combustion byproducts were inhaled into the airway, confirming inhalation injury.
Question 3: When monitoring fluid resuscitation in a burn patient, which parameter best indicates adequate tissue perfusion?
- Resolution of facial and periorbital edema
- Urine output of 0.5–1 mL/kg/hour (Correct answer)
- Reduction of pain score to below 3 out of 10
- Heart rate decreasing to below 100 beats per minute
Correct answer: Urine output of 0.5–1 mL/kg/hour
Urine output of 0.5–1 mL/kg/hour reflects adequate renal perfusion and is the primary endpoint for titrating fluid resuscitation in burn patients.
Question 4: What is the preferred route for opioid analgesic administration during the acute phase of major burn injury?
- Subcutaneous injection
- Oral administration
- Intramuscular injection
- Intravenous administration (Correct answer)
Correct answer: Intravenous administration
IV administration is essential in burn patients because impaired peripheral circulation makes subcutaneous and intramuscular routes unreliable for medication absorption.
Question 5: According to American Burn Association guidelines, which patient should be referred to a burn center?
- Adult with superficial burns covering 5% TBSA
- Patient with partial-thickness burns greater than 10% TBSA (Correct answer)
- Patient with minor chemical exposure and no blistering
- Adult with a sunburn and localized pain
Correct answer: Patient with partial-thickness burns greater than 10% TBSA
The American Burn Association criteria for burn center referral include partial-thickness burns exceeding 10% TBSA due to the complexity of care required.
Question 6: Why must a patient with a high-voltage electrical injury be placed on continuous cardiac monitoring immediately?
- Electrical burns cause predictable hypertension
- Current traversing the heart can precipitate ventricular fibrillation and life-threatening dysrhythmias (Correct answer)
- Monitoring detects early signs of hyperglycemia
- Electrical injuries uniformly cause bradycardia
Correct answer: Current traversing the heart can precipitate ventricular fibrillation and life-threatening dysrhythmias
Electrical current passing through the heart can depolarize myocardial tissue and trigger ventricular fibrillation or other fatal dysrhythmias at the time of injury.
Question 7: Why is hypothermia a major risk in patients with major burn injuries?
- Burns dramatically increase the body's basal metabolic rate, causing hyperthermia
- Loss of the skin barrier causes massive evaporative heat loss and eliminates thermoregulatory function (Correct answer)
- IV fluid administration produces vasodilation and heat dissipation
- Opioid analgesics suppress thermoregulatory centers in the brain
Correct answer: Loss of the skin barrier causes massive evaporative heat loss and eliminates thermoregulatory function
Burned skin loses its thermoregulatory function, resulting in massive evaporative heat loss from the wound surface and an inability to maintain body temperature.
TNCC Burn and Thermal Trauma 2
Electrical burns are often more severe than they appear externally because: