Chapter 11, Surface & Burn Trauma

Question 1

How long before compartment syndrome results in permanent damage?
How long before compartment syndrome results in possible amputation?

Answer 1

6 hours
12 hours

Question 2

What is the difference between a contusion and a hematoma?

Answer 2

Contusion (bruise): a closed wound in which a ruptured blood vessel or capillary bed hemorrhages into the surrounding tissue as a result of blunt trauma.

Hematoma: occurs when blood leaks under the skin surface and often forms a palpable mass (blood clot) under the skin.

Question 3

Where should lidocaine with epinephrine be avoided?

Answer 3

Fingers
Toes
Areas where vasoconstriction could cause impaired distal blood circulation

Question 4

What are patients that present with thermal burns from an enclosed space at risk for?

Answer 4

Inhalation injury
Carbon monoxide poisoning

Question 5

When should a patient be intubated based on body surface area burned?

Answer 5

40-50% TBSA

Question 6

How should a patient with CO poisoning be treated?

Answer 6

Treat with oxygen until carboxyhemoglobin levels drop to less than 10%.

Question 7

What type of poisoning can result from incomplete combustion of synthetic products such as carpeting, upholstered furniture, plastics, or draperies?

Answer 7

Cyanide
Treat with hydroxocobalamin cyanide antidote kit.

Question 8

Burns with what TBSA are most commonly vulnerable to capillary leak?

Answer 8

> 20% TBSA

Question 9

Burns are divided into what three zones?

Answer 9

Zone of coagulation
Zone of stasis
Zone of hyperemia

Question 10

Why does hypothermia and a core temperature of 95 degrees F worsen the burn?

Answer 10

It causes vasoconstriction.

Question 11

What are the hydration guidelines for burns > 20% TBSA prior to calculation?

Answer 11

5 yrs and under: 125 mL of LR per hour
6-13 yrs: 250 mL of LR per hour
14 yrs and over: 500 mL of LR per hour

Question 12

For burns > 20% TBSA, how should fluids be calculated in the adult?

Answer 12

Thermal burns: 2 mL/kg per percentage of TBSA
Electrical burns: 4 mL/kg per percentage of TBSA

Half of the fluid should be given in the first 8 hrs.

Question 13

How should urinary output be maintained in the adult burn patient?

Answer 13

0.5 mL/kg/hour (~30-50 mL/hour)

Question 14

How should urinary output be maintained for patients with electrical burns and evidence of myoaglobinuria?

Answer 14

1-1.5 mL/kg/hour (~75-100 mL/hour)

Question 15

What is the fluid of choice for burn patients?

Answer 15

LR

Question 16

What are the fluid replacement guidelines for children under the age of 14?

Answer 16

3 mL/kg/TBSA
Half given in the first 8 hours
Infants/young children 30 kg or less should be placed on maintenance fluids of D5LR

Question 17

What is a common HR associated with adult burn patients who have received adequate resuscitation?

Answer 17

110-120 BPM
HR of 140 or greater should be investigated

Question 18

What are two monitoring considerations for burn patients?

Answer 18

Cardiac monitoring
Urinary catheter

Question 19

How should burns be covered?

Answer 19

With clean dry dressings or sheets.

Question 20

How should the burn patient be positioned?

Answer 20

Head of bed 45 degrees
Extremities above the level of the heart

Question 21

What finding is a sign of severe injury in the patient who has an electrical burn?

Answer 21

Contractures

Question 22

How should an electrical burn be labeled?

Answer 22

“Contact point”