TNCC Burn Management 2 — Questions and Answers
Question 1: A burn patient arrives with singed nasal hairs, hoarseness, and carbonaceous sputum. What is the priority intervention?
- Administer high-flow oxygen via non-rebreather mask
- Prepare for immediate endotracheal intubation (Correct answer)
- Obtain IV access and begin fluid resuscitation
- Apply cool water to facial burns
Correct answer: Prepare for immediate endotracheal intubation
Signs of inhalation injury with impending airway compromise require immediate intubation before progressive edema makes the airway inaccessible.
Question 2: Using the Parkland formula, how much lactated Ringer's should be given in the first 8 hours to a 70 kg patient with 40% TBSA burns?
- 2,800 mL
- 5,600 mL (Correct answer)
- 11,200 mL
- 4,480 mL
Correct answer: 5,600 mL
Parkland formula: 4 mL × kg × %TBSA = 4 × 70 × 40 = 11,200 mL total, with half (5,600 mL) given in the first 8 hours.
Question 3: Which burn depth classification is characterized by blisters, moist wound surface, extreme pain, and blanching with pressure?
- Superficial (first-degree)
- Superficial partial-thickness (second-degree) (Correct answer)
- Deep partial-thickness (second-degree)
- Full-thickness (third-degree)
Correct answer: Superficial partial-thickness (second-degree)
Superficial partial-thickness burns involve the epidermis and superficial dermis, causing blisters, moisture, intense pain, and preserved capillary refill.
Question 4: A patient with circumferential full-thickness burns to the right arm has absent radial pulse and paresthesias. The priority intervention is:
- Elevation of the extremity above heart level
- Emergent escharotomy (Correct answer)
- Fasciotomy of the forearm
- IV heparin to prevent thrombosis
Correct answer: Emergent escharotomy
Circumferential eschar causes compartment syndrome; escharotomy releases constricting eschar to restore perfusion before nerve and muscle damage occur.
Question 5: Carbon monoxide poisoning should be suspected in a burn patient found in an enclosed space. Which finding is most consistent with CO poisoning?
- Cyanosis and low SpO2 on pulse oximetry
- Normal SpO2 with altered mental status (Correct answer)
- Bradycardia and hypotension
- Cherry-red skin and elevated SpO2
Correct answer: Normal SpO2 with altered mental status
Pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin, so SpO2 may appear normal despite significant CO poisoning causing AMS.
Question 6: When calculating TBSA in an adult using the Rule of Nines, which value is assigned to the entire head and neck?
- 18%
- 9% (Correct answer)
- 4.5%
- 1%
Correct answer: 9%
In adults, the head and neck together account for 9% of TBSA using the Rule of Nines.
Question 7: Which type of burn is most likely to cause deep tissue injury with minimal external skin findings and poses risk of myoglobinuria?
- Chemical burn
- Radiation burn
- Electrical burn (Correct answer)
- Scald burn
Correct answer: Electrical burn
Electrical burns cause current to travel through deep tissues, destroying muscle and releasing myoglobin with little surface evidence of injury.
TNCC Burn Management 2
A burn patient arrives with singed nasal hairs, hoarseness, and carbonaceous sputum.
What is the priority intervention?