ATLS QUIZ TEST

ATLS QUIZ TEST What characterizes a full-thickness burn? How will the surface look? dry or wet? redness? degree of swelling? - Answer- Appear dark and leathery, or skin can appear translucent or waxy white. Surface is usually PAINLESS and generally dry though may be red but does NOT blanch white with pressure. There is little swelling, though surrounding tissue may have dignificant amount. What is the distribution of TBSA for the adult body per the rule of 9s? - Answer- Head = 4.5% front and back = 9% total Arms = 4.5% each fron and back = total 18% Chest/ab = 18% front and back = 36% Genitals = 1% Legs = 9% each front and back = 36 total How long does it take for the clinical manifestations of inhalation injury to appear? - Answer- Frequently do not appear in the first 24hrs What should the clinician NOT wait for when assessing a patient for airway inhalation injury? - Answer- Provider should not wait for x-ray evidence of pulmonary injury or change in blood gas determinations since by that time airway edema can preclude intubation thus requiring a surgical airway. What are the three breathing concerns in a burn injury? - Answer- 1. hypoxia 2. CO poisoning 3. smoke inhalation What should the provider always assume in patient who were burned in enclosed areas? - Answer- CO exposure = measure HbCO. Above what percentage of HbCO is a patient likely to have symptoms? What are common symptoms? - Answer- Patients with levels of CO 20% will have symptoms. At lower levels usually HA and nausea then confusion and at higer levels ie 40-60%, coma then 60% death. What is the initial treatment for any patient in whom CO exposure could have occured? Why? - Answer- All patients should recieve high-flow O2 via non-rebreathing mask which shortens HbCO time to dissociation from 4hrs to 40 minutes. Per the American Burn Association, what are the two defined requirements for the diagnosis of smoke inhalation injury? - Answer- 2. exposure to a combustible agent 3. signs of exposure to smoke in lower airway, below vocal cords, bronchoscopy. What can help reduce neck and chest wall edema in a patient with smoke inhalation injury? - Answer- elevation of the head and chest by 30 degrees = must have excluded spinal injury! How many mL of fluid does a patient with burns require? - Answer- 2-4mL of LR per kilogram of body weight per percentage BSA of deep partial thickness and fullthickness burns during first 24hrs. After starting at target rate of fluid administration for a burn patient, what guides adjustement in fluid rates? - Answer- What to adjust based on urine output target of 0.5mL/kg/hr for an adult and 1mL/kg/hr for children. For a burn patient, within what time frame should the recieve half of their calculated fluids? - Answer- With in the first 8hrs. Why should you avoid appying cold water to extensive burn injuries? - Answer- Cold compresses can cause hypothermia. When does a patient in the post burn period require antibiotics? - Answer- There is NO indication for prophylactic abd and are reserved for established infection. What is the advantage of using neutralizing agents over water lavage in the presence of a chemical burn? - Answer- There is NO advantage because reaction with neutralizing agent itselft can produce heath and cause further tissue damage. Why are electrical burns so dangerous? - Answer- Because there are different rates of heat loss from superficial and deep tissues which means that with a electrical burn a patient can have relatively normal overlying skin with deep muscle necrosis beneath. Do all patients with electrical burns require long term cardiac monitoring? - Answer- No, if there are no arrhythmias within the first few hours of injury than prolonged monitoring is not necessary. A patient is BIBA with an electrical burn with dark urine, what should be done? - Answer- Should assume that thabdomyolysis occured that that urine has hemochoromogens. Should initiate increased fluid administration to ensure urinary output of 100mL/hr in adults or 2ml/kg/hr in children 30kg. Correct metabolic acidosis by maintaining adequate perfusion Partial-thickness and full-thickness burns than what percentage require transfer to burn center? - Answer- 10% Partial and full thickness burns involving what areas of the body require transfer to burn center? - Answer- burns involving face, eyes, ears, hands, feet, genitalia, and perineum as well as those involving skin overlying major joints.