Trauma and Burns

Question 1

Describe Newton’s First Law.

Answer 1

A body at rest or a body in motion will remain in that state until acted upon by an outside force.

Question 2

What is the highest possible Revised Trauma Score that a patient can achieve?

Answer 2

4

Question 3

T/F: A negative F.A.S.T. exam successfully rules out the potential for abdominal trauma.

Answer 3

False

Question 4

Which of the following best describes the Le Fort II fracture?

a) The palate is separated from the maxilla
b) Craniofacial dysjunction is present
c) The orbits are free-floating
d) The maxilla separates from the face

Answer 4

d) The maxilla separates from the face

Question 5

What is the most immediate concern for a patient with a Le Fort fracture?

Answer 5

airway patency

Question 6

T/F: Patients with neurogenic shock present with hypotension and paradoxical tachycardia due to loss of sympathetic tone.

Answer 6

False

Question 7

This spinal cord injury is characterized by weakness, which is greater in the upper extremities than the lower extremities, and more pronounced in the distal aspect of the extremities.

Answer 7

Central spinal cord syndrome

Question 8

This spinal cord injury involves complete motor paralysis and is caused by compression of the anterior spinal artery.

Answer 8

Anterior spinal cord syndrome

Question 9

You are transport a patient with a C2 fracture. What should be your primary concern?

Answer 9

Airway management caused by diaphragmatic paralysis

Question 10

Major pelvic fracture hemorrhage is defined as bleeding in excess of _______ mL.

Answer 10

2000

Question 11

Blood loss of ______ mL or greater upon chest tube insertion is an indication for immediate surgical intervention.

Answer 11

1500

Question 12

How can a tension pneumothorax result in death?

Answer 12

Death can be caused by compression of the heart, decreasing preload and afterload.

Question 13

T/F: A patient may “hide” a tension pneumothorax, and signs and symptoms may not become evident until the patient is receiving positive pressure ventilation.

Answer 13

True

Question 14

You are treating a patient who has a Swan-Ganz catheter in place and currently has a tension pneumothorax. You would expect to see ___________ pulmonary artery pressure and _________ cardiac output.

Answer 14

increased, decreased

Question 15

What are the three parts of Beck’s Triad associated with acute cardiac tamponade?

Answer 15

Hypotension, increased venous pressure, and muffled heart sounds

Question 16

T/F: Most patients with aortic injuries will have numerous fractures and may present with massive hemorrhage.

Answer 16

True

Question 17

You are transporting a ventilated patient on pressure control ventilation. Your patient has a sudden drop in tidal volume. What should you suspect?

Answer 17

Tension pneumothorax

Question 18

You are treating a blunt trauma patient who presents with severe dyspnea, severe epigastric pain, and bowel sounds in the chest and up into the shoulder. What should you suspect?

Answer 18

Diaphragm injury

Question 19

T/F: The clinical diagnosis of rhabdomyolysis is made based on urinary output and creatine kinase.

Answer 19

True

Question 20

T/F: In rhabdomyolysis, extracellular contents become intracellular and intracellular contents become extracellular leading to hyperkalemia.

Answer 20

True

Question 21

What is the leading cause of crush injuries?

Answer 21

Natural disasters including earthquakes

Question 22

After ____ hours without perfusion, a limb is considered non-viable.

Answer 22

6

Question 23

Why is D50 and insulin given to patients with a crush injury?

Answer 23

The insulin and glucose helps to active the sodium/potassium pump, and drive potassium back into the cell.

Question 24

You are treating a 58-year-old male patient with a severe crush injury. He has a foley catheter in place. What is the target urine output for this patient?

Answer 24

50 mL per hour

Question 25

You are treating a 14-year-old male patient who was helping his grandfather on a farm. The patient present with severe GI cramps, diarrhea, tearing of the eye, vomiting, wheezing, and is bradycardic. What toxic exposures should you suspect?

Answer 25

Cholinergic (muscarinic) from agricultural pesticides

Question 26

You are transporting an 8-year-old male who was found unconscious at the bottom of a swimming pool. He was resuscitated on the scene by a lifeguard. This patient should be observed in the hospital for a minimum of _____ hours.

Answer 26

24

Question 27

T/F: CPAP should not be used on near-drowning patients due to the extreme risk of further alveolar damage.

Answer 27

False

Question 28

This burn is characterized by blanching of the wound, or mottled cherry red color that doesn’t blanch.

Answer 28

2nd degree burn

Question 29

T/F: When compared to a deep 2nd degree burn, a 3rd degree burn can often be mistaken for unburnt skin.

Answer 29

True

Question 30

You are treating a 38-year-old female who tried to commit suicide by dousing herself in gasoline and then lighting herself on fire. She is burnt on her head, neck, left arm (circumferentially), anterior trunk, and left leg (circumferentially). What is her TBSA according to the Rule of Nines?

Answer 30

54%

Question 31

The Rule of Palm is not considered accurate for burns greater than ___% TBSA.

Answer 31

10

Question 32

As it relates to carbon monoxide poisoning, what is the normal COHb (Carboxyhemoglobin) percentage?

Answer 32

<10%

Question 33

T/F: Oxygen should be administered to all pregnant patients with suspected carbon monoxide exposure.

Answer 33

True

Question 34

A nasogastric tube should be placed in all patients with a TBSA greater than ____%.

Answer 34

20

Question 35

During the body’s burn response, fluid shifts rapidly from the ____________ into the ____________ space.

Answer 35

intravascular, interstitial

Question 36

You are transporting a patient with 70% second degree burns. He was burned approximately five hours earlier. Would you expect for this patient to be hemodiluted or hemoconcentrated?

Answer 36

Hemoconcentrated due to the loss of plasma.

Question 37

T/F: Oxygen consumption increased up to 150% above normal after a major burn.

Answer 37

True

Question 38

Burns <____% TBSA can be cooled with cool water / moist dressings.

Answer 38

20

Question 39

Care should be used when administering succinylcholine in patients who are greater than _____ hours post-burn because of the potential for hyperkalemia.

Answer 39

24

Question 40

You are treating a 180 pound patient with 55% 2nd and 3rd degree burns. According to the Parkland formula, how much fluid should this patient receive in the first eight hours?

Answer 40

9000 mL
Parkland Formula: (4 mL) x (TBSA%) x (weight in kg)
Half of this amount is given in the first eight hours, while the 2nd half is given in the following 16 hours

Question 41

You are monitoring the urinary output of a 5-year-old child with a severe burn injury. What is the ideal urinary output for this patient?

Answer 41

1 cc/kg/hour

Question 42

Which of the following burn patients will typically require greater fluid resuscitation volumes when compared to standard burns?

a) chemical burns
b) burns in the elderly
c) electrical burns
d) radiation burns

Answer 42

c) electrical burns

Question 43

You are on an ambulance transporting a serious burn patient. The driver asks you what you would like the temperature set in the ambulance. What is the appropriate ambient temperature range for this patient?

Answer 43

28 - 33°C (82.4 - 91.4°F)
Formula for converting °F to °C = [(°F - 32) x 5] / 9

Question 44

Secondary to airway management, what is the next most immediate concern in a burn patient?

Answer 44

Pain management. Burns are documented as being one of the most painful injuries one can experience.

Question 45

T/F: Fasciotomies differ from escharotomies in that a fasciotomy only divides burnt tissue and does not divide living tissue.

Answer 45

False, escharotomies only cuts the skin, whereas fasciotomies separate the burnt tissue from the living tissue.

Question 46

What is the most important treatment in stopping the progression of Stevens Johnson / Toxic Epidermal Necrolysis (SJS/TEN)?

Answer 46

Locating the source and immediately stopping it

Question 47

T/F: Prompt surgical debridement can significantly increase survival in patients with necrotizing fasciitis.

Answer 47

True