Chapter 32

According to the rule of nines, an adult with partial- and full-thickness burns to his or her head, face, and anterior chest has burns to ____% of his total body surface area. Select one: A. 18 B. 27 C. 36 D. 45

18

A superficial burn is: Select one: A. usually painless because the nerve endings are not exposed. B. characterized by reddened skin with varying degrees of pain. C. painful, but will heal spontaneously, often with scar formation. D. a second-degree burn that is characterized by blister formation.

characterized by reddened skin with varying degrees of pain.

What medication may be administered to a patient with a severe electrical burn in order to facilitate osmotic diuresis? Select one: A. Furosemide B. Mannitol C. Calcium D. Albuterol

Mannitol

Most lightning-related injuries occur when the victim: Select one: A. experiences a direct hit while standing in a large open area. B. is talking on a phone and a utility pole is struck by lightning. C. is attempting to escape an oncoming thunderstorm by running. D. receives a "splash" effect after lightning strikes a nearby object.

receives a "splash" effect after lightning strikes a nearby object.

You are transporting a conscious but confused 29-year-old man after he was electrocuted. The patient is on high-flow oxygen, has an IV line of normal saline in place, is on a cardiac monitor, and has his spine fully immobilized. During transport, it is especially important for you to: Select one: A. remain alert for lethal cardiac dysrhythmias and be prepared to defibrillate. B. administer at least 2 L of normal saline solution to prevent renal failure. C. thoroughly assess and clean the entry and exit wounds to prevent an infection. D. reassess his vital signs every 15 minutes and treat any fractures or dislocations.

remain alert for lethal cardiac dysrhythmias and be prepared to defibrillate.

You respond to an industrial plant for a 42-year-old man with a chemical burn. Upon arrival at the scene, you find the patient to be ambulatory. He tells you that he was moving some bags of dry lime when one of the bags broke and spilled lime all over him. After donning the appropriate personal protective equipment, you should: Select one: A. remove his clothing, brush as much of the lime off of him as possible, and flush the affected areas with copious amounts of water. B. avoid brushing any of the lime from his skin, as doing so may cause additional injury, and flush his entire body with water for 30 minutes. C. remove his clothing, carefully brush the lime away from his skin, but avoid flushing with water, as doing so will likely increase burn severity. D. remove all of his clothing, apply baking powder to neutralize the lime, and begin flushing his body with copious amounts of sterile saline.

remove his clothing, brush as much of the lime off of him as possible, and flush the affected areas with copious amounts of water.

The peripheral area surrounding the zone of coagulation, which has decreased blood flow and inflammation, is called the zone of: Select one: A. stasis. B. coagulation. C. hyperemia. D. liquefaction.

stasis.

Question text Supraglottic damage following a burn is MOST often caused by: Select one: A. the inhalation of superheated gases. B. exposure to carbon monoxide or cyanide. C. the inhalation of hot particulate steam. D. direct flame exposure to the oropharynx.

the inhalation of superheated gases.

The onset of ___________ soon after exposure to radiation is a predictor of poor outcomes. Select one: A. hair loss B. tachycardia C. confusion D. vomiting

vomiting

The degree of absorption of a corrosive chemical determines: Select one: A. the type of liquid used to irrigate the burn. B. whether the burn should be flushed. C. whether toxicity is local or systemic. D. the antidote required to reverse the effects.

whether toxicity is local or systemic.

You are caring for a 41-year-old man who was trapped in his burning house before being rescued by fire fighters. He has full-thickness burns to his head and anterior trunk, and mixed partial- and full-thickness burns to both anterior upper extremities. What percentage of his total body surface area has been burned? Select one: A. 18% B. 27% C. 36% D. 45%

36%

Which of the following locations would provide the BEST protection from a lightning strike? Select one: A. An open shed or lean-to B. A spot at least 5 miles away from the storm C. Curled up in a ball in an open area D. A car with the windows rolled up

A car with the windows rolled up

What type of thermal burn is MOST commonly associated with inhalation injury? Select one: A. Steam burns B. Flame burns C. Scald burns D. Arc burns

Steam burns

Which of the following burn injuries would MOST likely require transport to a burn specialty center? Select one: A. Superficial burns to more than 40% of the body B. Burns that involve the hands, feet, or genitalia C. Partial-thickness burns to more than 5% of the body D. Any burn that occurs in a child under 5 years of age

Burns that involve the hands, feet, or genitalia

Which of the following statements regarding sodium metal chemical burns is correct? Select one: A. Do not flush with water as doing so may produce heat and cause an explosion. B. Sodium metal burns should be covered with oil after irrigating with water. C. They react violently with oil and should only be flushed with sterile water. D. Applying baking soda to the wound effectively neutralizes sodium metals.

Do not flush with water as doing so may produce heat and cause an explosion.

A patient has partial-thickness burns to both lower extremities and blisters have formed. What should you do? Select one: A. Elevate the extremities to reduce edema. B. Administer 2 liters of fluid within 45 minutes. C. Administer half the usual dose of IV analgesia. D. Carefully rupture the blisters and irrigate the burn.

Elevate the extremities to reduce edema.

________ radiation is very penetrating and easily passes through the body and solid materials. Select one: A. Alpha B. Beta C. Gamma D. Ionizing

Gamma

Which of the following statements regarding carbon monoxide (CO) poisoning is correct? Select one: A. Never rule out CO poisoning in the absence of cherry red skin. B. The most common symptom of CO poisoning is chest pressure. C. CO results in systemic hypoxia by disintegrating red blood cells. D. Hyperbaric therapy is beneficial only if CO levels are above 40%.

Never rule out CO poisoning in the absence of cherry red skin.

Which of the following statements regarding partial-thickness burns is correct? Select one: A. Partial-thickness burns are usually extremely painful for the patient. B. Partial-thickness burns are difficult to distinguish from superficial burns in the field. C. The majority of partial-thickness burns are caused by an open flame. D. Partial-thickness burns typically heal spontaneously without scarring.

Partial-thickness burns are usually extremely painful for the patient.

Which of the following chemicals causes a painless burn and can result in significant damage before it is identified? Select one: A. Phenol B. Sulfur mustard C. Sulfuric acid D. Potassium hydroxide

Phenol

What medication should be administered if significant tissue damage is suspected following an electrical burn injury? Select one: A. Albuterol B. Furosemide C. Sodium bicarbonate

Sodium bicarbonate

Which of the following statements regarding the rule of palms is correct? Select one: A. The patient's palm, excluding the fingers, represents 1% of his or her total body surface area. B. The rule of palms is not an accurate estimator of total body surface area burned in pediatric patients. C. The patient's palm, including the fingers, represents 1% of his or her total body surface area. D. The rule of palms is most accurate when a patient has experienced burns to less than 20% of his or her total body surface area.

The patient's palm, excluding the fingers, represents 1% of his or her total body surface area.

Specific treatment for a hydrofluoric acid burn is: Select one: A. calcium chloride. B. sodium bicarbonate. C. magnesium sulfate. D. viscous lidocaine gel.

calcium chloride.

A 33-year-old man was burned when the hot water heater on which he was working exploded. The patient has superficial and partial-thickness burns to his face, neck, and arms. Your primary assessment reveals that he is restless and tachypneic. His BP is 80/54 mm Hg and his heart rate is 120 beats/min and weak. You should: Select one: A. conclude that he is experiencing burn shock, start two large-bore IV lines of normal saline, and administer fluids based on the Parkland formula. B. assist his ventilations with a bag-mask device, cover him with a blanket, and start a large-bore IV of normal saline set at a keep vein open rate. C. apply oxygen via nonrebreathing mask, cover his burns with cold moist dressings, start an IV with normal saline, and give up to 4 mg of morphine for pain. D. administer high-flow oxygen, keep him warm, start at least one large-bore IV of normal saline, and administer fluid boluses to maintain adequate perfusion.

administer high-flow oxygen, keep him warm, start at least one large-bore IV of normal saline, and administer fluid boluses to maintain adequate perfusion.

Narcotic analgesia could cause the MOST acutely significant problems in a patient with: Select one: A. diabetes. B. cirrhosis. C. renal disease. D. airway burns.

airway burns.

A 52-year-old man sustained superficial and partial-thickness burns to his left arm approximately 15 minutes ago when he opened the radiator cap on his car. He is conscious, alert, and in severe pain. His BP is 138/76 mm Hg, pulse is 110 beats/min and strong, respirations are 22 breaths/min and regular, and oxygen saturation is 97% on room air. He denies any other injuries. Initial management for this patient involves: Select one: A. applying ice to the burn to provide immediate pain relief. B. applying cool, wet dressings to the burn and elevating his arm. C. starting an IV of normal saline and administering 2 mg of morphine. D. administering oxygen and applying an anesthetic cream to the burn.

applying cool, wet dressings to the burn and elevating his arm.

Flash burns: Select one: A. are usually relatively minor compared with the potential for trauma from whatever caused the flash. B. are caused by prolonged exposure to intense heat, usually resulting in burns that extend deep into the dermis. C. are a common source of burn injury and are most often the result of hot liquids, such as radiator fluid. D. are generally confined to a very small area of the body, but cause extensive damage to the dermis.

are usually relatively minor compared with the potential for trauma from whatever caused the flash.

The two MOST common causes of death from an electrical injury are: Select one: A. asphyxia and cardiopulmonary arrest. B. full-thickness burns and respiratory arrest. C. nervous system damage and massive sepsis. D. myoglobinuria and diaphragmatic paralysis.

asphyxia and cardiopulmonary arrest.

assessment of a 21-year-old woman with a suspected inhalation injury, you note that she is combative and her respirations are profoundly labored and stridorous. The closest appropriate medical facility is approximately 25 miles by ground, and the local air transport service is unavailable. You should: Select one: A. provide supplemental oxygen via nonrebreathing mask, insert an intraosseous catheter, and administer a sedative medication. B. assist ventilations with a bag-mask device, start an IV, administer a sedative and a neuromuscular blocker, and intubate her trachea. C. administer humidified oxygen, start at least one large-bore IV, and visualize her upper airway to assess the severity of soft-tissue swelling. D. insert an oropharyngeal airway, ventilate her with a bag-mask device at 20 breaths/min, and prepare to nasotracheally intubate her.

assist ventilations with a bag-mask device, start an IV, administer a sedative and a neuromuscular blocker, and intubate her trachea.

When assessing a burn patient, it is MOST important to: Select one: A. accurately calculate the extent of body surface area burned. B. be alert for occult trauma that could affect patient outcome. C. apprise medical control of the situation as soon as possible. D. rapidly determine if the patient will require an escharotomy.

be alert for occult trauma that could affect patient outcome.

A 24-year-old woman was struck by lightning. Bystanders moved the patient to an area of safety but did not provide any other care before your arrival. Your primary assessment reveals that the patient is pulseless and apneic. You begin CPR and apply the cardiac monitor, which reveals asystole. After requesting a backup paramedic unit, the MOST appropriate treatment for this patient involves: Select one: A. instructing your partner to resume one-rescuer CPR, establishing an IV of normal saline, and reassessing her cardiac rhythm in 5 minutes. B. continuing CPR, providing full spinal precautions, intubating her trachea, and ventilating her at a rate of 20 to 24 breaths per minute. C. performing adequate BLS, following standard ACLS protocol, and considering terminating your efforts if asystole persists after 10 minutes. D. continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessary.

continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessary.

A burn caused by a sodium metal should be treated by: Select one: A. administering calcium chloride. B. covering the burn wound with oil. C. applying a moist, sterile dressing. D. irrigating the wound with water.

covering the burn wound with oil.

Unlike partial-thickness burns, full-thickness burns: Select one: A. extend completely through the epidermis and produce severe pain. B. are characterized by reddened, moist skin and large fluid-filled blisters. C. destroy the base membrane of the dermis that produces new skin cells. D. often heal spontaneously over a long period of time with massive scarring.

destroy the base membrane of the dermis that produces new skin cells.

Assessment of a patient who may have been exposed to radiation begins by: Select one: A. determining if the scene is safe to enter. B. thoroughly decontaminating the patient. C. quickly moving the patient to a safe area. D. evaluating airway, breathing, and circulation.

determining if the scene is safe to enter.

Upon initial contact with a severely burned patient, you must: Select one: A. assess airway and breathing adequacy. B. cover the patient to prevent hypothermia. C. ensure that the patient is not still burning. D. quickly establish the extent of the burns.

ensure that the patient is not still burning.

Compared to beta radiation particles, alpha radiation particles: Select one: A. have minimal penetrating energy. B. easily pass through solid materials. C. are able to travel much farther in air. D. are not dangerous if they are ingested.

have minimal penetrating energy.

The purpose of estimating a patient's total body surface area burns in the prehospital setting is to: Select one: A. obtain an accurate calculation of how severe the patient's burns are. B. determine whether the patient should be transported via a helicopter. C. ascertain how much IV fluid the patient should receive during transport. D. help the paramedic determine the most appropriate destination hospital.

help the paramedic determine the most appropriate destination hospital.

After an adult victim is struck by lightning and experiences cardiac arrest: Select one: A. 5 minutes of CPR generally restores a pulse. B. perform a compression to ventilation ratio of 15:2. C. his or her heart may resume beating spontaneously. D. the ECG usually shows an organized cardiac rhythm.

his or her heart may resume beating spontaneously.

The secondary assessment of a severely burned patient is intended to: Select one: A. provide for a rapid means of assessing the patient for occult injuries. B. identify other injuries that may have a higher priority for treatment. C. focus on areas of the body that have sustained the most serious burns. D. locate and treat minor injuries after all serious injuries have been treated.

identify other injuries that may have a higher priority for treatment.

Exposure to hydrofluoric acid causes: Select one: A. little pain and coagulation necrosis. B. immediate pain and liquefaction necrosis. C. little pain and liquefaction necrosis. D. immediate pain and coagulation necrosis.

immediate pain and coagulation necrosis.

If a burn patient presents with a hoarse voice and states, "I'm cold," your MOST immediate concern should be: Select one: A. hypothermia. B. burn shock. C. inhalation injury. D. cyanide toxicity.

inhalation injury.

A partial-thickness burn is considered to be a major burn in a 40-year-old person if it: Select one: A. occurs in any patient over the age of 45 years. B. is located to the proximal aspect of an extremity. C. is rated as at least a 5 on a pain scale of 0 to 10. D. involves more than 25% of the body surface area.

involves more than 25% of the body surface area.

With regard to a thermal burn injury, the zone of coagulation: Select one: A. may undergo necrosis within 24 to 48 hours after the burn. B. surrounds the central part of the burn and is often inflamed. C. is the area least affected by the burn and will likely recover. D. is the central part of the burn and suffers the most damage.

is the central part of the burn and suffers the most damage.

Unlike chemical burns, radiation burns: Select one: A. generally extend into the dermal layer. B. may appear hours or days after exposure. C. are typically confined to the epidermis. D. are immediately apparent after exposure.

may appear hours or days after exposure.

A burn patient with a history of chronic obstructive pulmonary disease: Select one: A. is at a higher risk for infection than a patient without any medical problems. B. often requires prophylactic beta-2 agonist drugs to prevent respiratory arrest. C. should only be given high-flow oxygen if signs of hypoxia are grossly present. D. may be triaged as a critically burned patient, even if the burn injury is small.

may be triaged as a critically burned patient, even if the burn injury is small.

Full-thickness circumferential burns to the chest: Select one: A. require the paramedic to incise the burn to decompress it. B. may cause significant restriction of respiratory excursion. C. are generally not significant unless the skin is unyielding. D. necessitate immediate intubation and ventilatory support.

may cause significant restriction of respiratory excursion.

A person who is exposed to cement: Select one: A. typically only experiences burns to the epidermal layer because calcium oxide is a weak chemical. B. often does not experience a burn unless he or she is exposed to the cement for longer than 2 hours. C. may not notice a skin burn for hours because cement penetrates through clothing and reacts with sweat. D. experiences immediate pain and inflammation to the area because of the calcium oxide in the cement.

may not notice a skin burn for hours because cement penetrates through clothing and reacts with sweat.

A patient with full-thickness burns surrounded by areas of superficial and partial-thickness burns should be treated with all of the following, EXCEPT: Select one: A. analgesia. B. high-flow oxygen. C. moist dressings. D. sterile burn pads.

moist dressings.

Many of the physiologic changes caused by acute radiation syndrome: Select one: A. can be reversed if chemotherapy is administered within 24 hours. B. occur over time and will not be apparent in the prehospital setting. C. are a direct result of beta particles and are usually life threatening. D. manifest with lethal cardiac dysrhythmias and sudden cardiac arrest.

occur over time and will not be apparent in the prehospital setting.

Damage to the kidneys following an electrical injury: Select one: A. is caused by excess serum potassium levels. B. occurs when damaged muscle produces myoglobin. C. can be prevented with boluses of lactated Ringer's. D. is the result of electricity passing through the kidneys.

occurs when damaged muscle produces myoglobin.