Burns Flashcards
A 22 yo man was brought to the ER after a house fire. He has burns around his mouth and his voice is hoarse, but breathing is unlabored. What most appropriate next step in management?
A. Immediate endotracheal intubation
B. Examination of oral cavity and pharynx, with fiberoptic laryngoscope if available.
C. Place on supplemental oxygen.
D. Placement of two large-bore intravenous (IV) catheters with fluid resuscitation.
B. Examination of oral cavity and pharynx, with fiberoptic laryngoscope if available.
Burns to one leg (circumferential), one arm (circumferential), and anterior trunk. Percentage of burn?
A. 18%
B. 27%
C. 36%
D. 45%
D. 45%
A 40-year- old woman is admitted to the burn unit after an industrial fire at a plastics manufacturing plant with burns to the face and arms. Her ECG shows S-T elevation, and initial chemistry panel and arterial blood gas reveal an anion gap metabolic acidosis with normal arterial carboxyhemoglobin. What is the most appropriate next step?
A. Correction of acidosis by adding sodium bicarbonate to IV fluids
B. Administration of 100% oxygen and hydroxocobalamin
C. Transthoracic echocardiogram
D. Blood culture with IV antibiotics
B. Administration of 100% oxygen and hydroxocobalamin
Which of the following is a common sequelae of electrical injury
A. Cardiac arrhythmias
B. Paralysis
C. Brain damage
D. Cataracts
D. Cataracts
An 8-year-old boy is brought to the ER after accidentally touching a hot iron with his forearm. On examination, the burned area has weeping blisters and is very tender to the touch. What is the burn depth?
A. First degree
B. Second degree
C. Third degree
D. Fourth degree
B. Second degree
Three hours after a burn injury that consisted of circumferential, third degree burns at the wrist and elbow of the right arm, a patient loses sensation to light touch in his fingers. Motor function of his digits, however, remains intact. The most appropriate treatment for this patient now would consist of
A. Elevation of the extremity, doppler ultrasonography every 4 hours, and if distal pulses are absent 8 hours later, immediate escharotomy
B. Palpation for distal pulses and immediate escharotomy if pulses are absent
C. Doppler ultrasonography for assessment of peripheral flow and immediate escharotomy if flow is decreased
D. Immediate escharotomy under general anesthesia from above the elbow to below the wrist on both medial and lateral aspects of the arm
C. Doppler ultrasonography for assessment of peripheral flow and immediate escharotomy if flow is decreased
What is the fluid requirement of a 50-kg man with first degree burns to his left arm and leg, circumferential second degree burn to his right arm, and third degree burns to his torso and right leg. What is the rate of initial fluid resuscitation
A. 4.5 L over 8 hours, followed by 4.5 L over 16 hours
B. 4.5 L over 8 hours, followed by 6 L over 16 hours
C. 6 L over 8 hours, followed by 6 L over 16 hours
D. 6 L over 8 hours, followed by 9 L over 16 hours
A. 4.5 L over 8 hours, followed by 4.5 L over 16 hours
A patient with a 90% burn encompassing the entire torso develops an increasing Pco2 and peak inspiratory pressure. Which of the following is most likely to resolve this problem
A. Increase the delivered tidal volume
B. Increase the respiratory rate
C. Increase the Fio2
D. Perform a thoracic escharotomy
D. Perform a thoracic escharotomy
FALSE regarding silver sulfadiazine
A. Used as prophylaxis against burn wound infections with a wide range of antimicrobial activity
B. Safe to use on full and partial thickness burn wounds, as well as skin grafts
C. Has limited systemic absorption
D. May inhibit epithelial migration in partial thickness wound healing
B. Safe to use on full and partial thickness burn wounds, as well as skin grafts
Successful antibiotic penetration of a burn eschar can be achieved with
A. Mafenide acetate
B. Neomycin
C. Silver nitrate
D. Silber sulfadiazine
A. Mafenide acetate
True regarding nutritional needs of burn patients
A. The hypermetabolic response to burn wounds typically raises the basic metabolic rate by 120%
B. Oxandrolone, an anabolic steroid, can improve lean body mass but can be associated with hyperglycemia and clinically significant rise in hepatic transaminitis
C. Early enteral feeding is safe when burns are less than 20% of TBSA, otherwise enteral feeding should await return of bowel function to avoid feeding a patient with gastric ileus
D. For patients with greater than 40% TBSA, caloric needs are estimated to be 25 kcal/kg/day plus 40 kcal/%TBSA/day
D. For patients with greater than 40% TBSA, caloric needs are estimated to be 25 kcal/kg/day plus 40 kcal/%TBSA/day
A 14 yo girl sustains a steam burn measuring 6 by 7 inches over the ulnar aspect of her right forearm. Blisters develop over the entire area of the burn wound, and by the time the patient is seen 6 hours after the injury, some of the blisters have ruptured spontaneously. NOT considered appropriate therapeutic regimen
A. Application of silver sulfadiazine cream and daily washes, but no dressing
B. Application of mafenide acetate cream but no daily washes or dressing
C. Homograft application without sutures to secure it in place, but no daily washes or dressing
D. Heterograft (pigskin) application with sutures to secure it in place and daily washes, but no dressing.
D. Heterograft (pigskin) application with sutures to secure it in place and daily washes, but no dressing.
FALSE concerning surgical treatment of burn wounds
A. Tangential excision consists of tangential slices of burn tissue until bleeding tissue is encountered. Thus, excision can be associated with potentially significant blood loss.
B. Human cadaveric allograft is a permanent alternative to split-thickness skin grafts when there are insufficient donor sites
C. Bleeding from tangential excision can be helped with injection of epinephrine tumescence solution, pneumatic tourniquets, epinephrine soaked compresses, and fibrinogen and thrombin spray sealant
D. Meshed split thickness skin grafts allow serosanguinous drainage to prevent graft loss and provide a greater area of wound coverage
B. Human cadaveric allograft is a permanent alternative to split-thickness skin grafts when there are insufficient donor sites
A 45 yo woman is admitted to a hospital because of a third degree burn to 40% of her TBSA, and her wounds are treated with topical silver sulfadiazine cream. Three days after admission, a burn wound biopsy semiquantitative culture shows 10^4 Pseudomonas organisms per gram of tissue. The patient’s condition is stable at this time. The most appropriate management for this patient would be to
A. Repeat the biopsy and culture in 24 hours
B. Start subeschar clysis with antibiotics
C. Administer systemic antibiotics
D. Surgically excise the burn wounds
B. Start subeschar clysis with antibiotics
Fourteen days after admission to the hospital for a 30% partial thickness burn and hemodynamic instability requiring central venous access, a patient develops a spiking temperature curve. On PE, the central venous catheter site was red, tender, and warm. Best treatment:
A. Exchange of central venous catheter over guidewire, culture tip of previous catheter.
B. Treat patient with IV antibiotics until blood cultures drawn from catheter are negative
C. Removal of central venous catheter, culture tip, and placement of new catheter on contralateral site
D. Removal of catheter and treat patient with oral antibiotics and pain medication as needed
C. Removal of central venous catheter, culture tip, and placement of new catheter on contralateral site
