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Emergency Care Quiz Answers: Burns

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Emergency Care Quiz: Burns Answer Key
By Nancy Caroline

Answer: D. Inhalation burns cause rapid and serious airway compromise. The vast majority of deaths from fires are not from burns but from upper airway compromise, pulmonary injury, or inhalation of toxic gases.

Answer: A. Anyone exposed to smoke from a fire may have thermal burns, hypoxia, tissue damage, and toxic effects caused by chemicals in the smoke.

Answer: B. Lower airway damage is more often associated with the inhalation of steam or hot particulate matter, whereas upper airway damage is more often associated with the inhalation of superheated gases.

Answer: C. In the lower airway, laryngospasm and bronchospasm may result from heat inhalation. Patients sometimes experience pulmonary damage from direct thermal injury. Pulmonary involvement may be from toxic inhalation injury.

Answer: B. False. Your impression should be that the patient has a potential airway and/or breathing problem. In the absence of hypoxia or other trauma, it is not uncommon for the severely burned patient to be conscious and able to hold a conversation.

Answer: D. Combative patients should be considered hypoxic until proven otherwise. Isolated burns do not cause unconsciousness (although toxic inhalations can).

Answer: A. Early endotracheal intubation — before the airway has closed off — could be lifesaving in such cases and should be performed by the most experienced paramedic on your team. To intervene early, you need to spot the problem early.

Answer: B. People with preexisting lung disease may have bronchospasm after relatively minor exposure to smoke. Anyone suspected of having burns to the upper airway may benefit from humidified, cool oxygen.

Answer: D. All of these are categories of burn patients. A fourth category includes patients whose airways are currently patent but who have a history consistent with risk factors for eventual airway compromise. Many burn patients ultimately require intubation, even though they were talking to you and in no distress in the field. Although it is preferable to intubate in a controlled environment with a full complement of anesthesia agents, a few patients absolutely require an emergency airway in the field.

Answer: A. Cooking fires represent a distinct hazard to older people, who may be less able to smell a gas leak or a fire in the kitchen. Older patients are particularly sensitive to respiratory insults.

Challenging Questions

11. Definitive burn care can be divided into four phases. Although paramedics will be most involved in the first phase (initial evaluation and resuscitation), it is important to recognize all phases of care the patient will receive. Your management begins with the steps taken during the scene size-up and initial assessment to extinguishing the fire and ensuring adequate ABCs. Only when the ABCs are under control should you turn your attention to the burn itself.


12. The universal mechanism of calculating the area burned is the rule of nines, which divides the body into 9% segments. The provider adds the portions of the body to calculate the total of the body area affected by the burn injury. Because our proportions change as we grow, there are different rules of nines for infants, children, and adults.

13. An IV line may be inserted in the field to administer fluids and/or pain medication. A large-bore IV catheter should be inserted as early as possible in any patient who has been severely burned. You can use the burned extremity if you cannot located another site. Approximate the amount of fluid the burned patient will need by using the Parkland formula, which states that during the first 24 hours, the burned patient will need
4 mL  x  kg  x  percentage of body surface burned:
4 mL  x  70 kg  x  30 = 8,400 mL
Half of the 8,400 mL — that is, 4,200 mL — needs to be administered during the first 8 hours.

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