ITLS - International Trauma Life Support Burns and Environmental Trauma Questions and Answers 1 — Questions and Answers
Question 1: An electrician is found unconscious after contact with a high-voltage wire. He has small entry and exit burns on his hands and feet. What is the most critical and immediate concern for this patient beyond the surface burns?
- Severe internal tissue damage and potential cardiac dysrhythmias. (Correct answer)
- Rapid development of hypothermia due to skin damage.
- Infection of the small entry and exit wounds.
- Fluid loss calculated solely based on the visible burn surface area.
Correct answer: Severe internal tissue damage and potential cardiac dysrhythmias.
High-voltage electricity travels through the body, causing extensive internal damage to muscles and organs (rhabdomyolysis) that is not visible externally. The current can also disrupt the heart's electrical conduction system, leading to life-threatening dysrhythmias like ventricular fibrillation. Therefore, cardiac monitoring and aggressive fluid resuscitation are paramount, as the visible burns are a poor indicator of the true injury severity.
Question 2: A patient is rescued from a structural fire. They have no significant cutaneous burns but are coughing, have a hoarse voice, and possess soot around their nose and mouth. Which finding is the most reliable indicator of a significant inhalation injury requiring aggressive airway management?
- Presence of soot on the face.
- A carboxyhemoglobin level of 5%.
- A progressively worsening hoarse voice. (Correct answer)
- A respiratory rate of 24 breaths per minute.
Correct answer: A progressively worsening hoarse voice.
A hoarse voice, stridor, or brassy cough indicates laryngeal edema from direct thermal injury to the upper airway. This swelling can rapidly progress to complete airway obstruction. While soot and tachypnea are clues, the change in voice is a more direct and ominous sign of impending airway compromise that necessitates early and definitive airway control.
Question 3: An 80 kg adult patient has full-thickness burns to his entire chest and abdomen. According to the Parkland formula, what is the total amount of fluid to be administered over the first 8 hours from the time of the burn?
- 5760 mL
- 1440 mL
- 720 mL
- 2880 mL (Correct answer)
Correct answer: 2880 mL
The Parkland formula is 4 mL x patient's weight in kg x percentage of Total Body Surface Area (%TBSA) burned. Using the Rule of Nines, the entire anterior torso (chest + abdomen) is 18% TBSA. The total 24-hour fluid is 4 mL x 80 kg x 18 = 5760 mL. Half of this amount (5760 / 2 = 2880 mL) must be infused over the first 8 hours from the time of the injury.
Question 4: On a hot, humid day, you are called to a construction site for a worker who collapsed. He has hot, dry skin, a respiratory rate of 28, a heart rate of 130, and is confused and combative. These findings are most consistent with which heat-related emergency, and what is the priority intervention?
- Heat exhaustion; administer oral salt solutions.
- Heat stroke; initiate immediate and aggressive active cooling. (Correct answer)
- Heat cramps; gently stretch the affected muscles.
- Heat stroke; administer an IV fluid bolus as the sole treatment.
Correct answer: Heat stroke; initiate immediate and aggressive active cooling.
The combination of altered mental status (confusion, combativeness) and hot, dry skin (due to failure of the thermoregulatory system) are the classic signs of exertional heat stroke. This is a true medical emergency, and the priority is to rapidly lower the core body temperature with the principle of "cool first, transport second." While fluids are important, cooling is the most critical life-saving intervention.
Question 5: Which of the following is a critical principle when managing a patient with severe hypothermia (core temperature < 30°C / 86°F)?
- Vigorously rubbing the extremities to stimulate circulation.
- Handling the patient gently to avoid precipitating ventricular fibrillation. (Correct answer)
- Administering a warm fluid bolus as rapidly as possible.
- Focusing solely on active external rewarming with heat packs to the extremities.
Correct answer: Handling the patient gently to avoid precipitating ventricular fibrillation.
The cold myocardium is extremely irritable in severely hypothermic patients. Rough handling or movement can easily trigger lethal dysrhythmias, particularly ventricular fibrillation. Therefore, all interventions must be performed gently. Active rewarming should focus on the core (axilla, groin, trunk), not the periphery, to avoid "afterdrop," where cold blood from the extremities returns to the core and further lowers the core temperature.
Question 6: A factory worker has been splashed in the face and on the chest with a large amount of an unknown liquid chemical. He is complaining of intense burning pain. What is the most appropriate and immediate action after ensuring scene safety?
- Apply a neutralizing agent like vinegar or baking soda.
- Immediately begin copious irrigation with large amounts of water. (Correct answer)
- Cover the affected area with a dry, sterile dressing.
- Attempt to identify the chemical before initiating any treatment.
Correct answer: Immediately begin copious irrigation with large amounts of water.
The immediate priority for most liquid chemical burns is to stop the burning process by removing contaminated clothing and flushing the area with copious amounts of water for an extended period (at least 20 minutes). Attempting to neutralize a chemical without knowing its identity can worsen the injury by creating an exothermic reaction. Identification can occur concurrently with irrigation but should not delay it.
ITLS - International Trauma Life Support Burns and Environmental Trauma Questions and Answers 1
An electrician is found unconscious after contact with a high-voltage wire.
He has small entry and exit burns on his hands and feet.
What is the most critical and immediate concern for this patient beyond the surface burns?