CHAPTER 29

The palm of your​ patient's hand is approximately what percentage of her total body surface​ area?

1%

A burn patient has​ full-thickness burns to the fronts of both legs and the entire left arm. The front of the​ patient's right arm has superficial burns. Using the rule of​ nines, the EMT should estimate what percentage of the​ patient's body has been​ burned?

27%

A​ 51-year-old male was burned in the face after a steam valve was accidentally opened. His face is red and​ swollen, and he is screaming in pain. He also states that he is having a hard time seeing. What is the​ EMT's priority concern in caring for this​ patient?

Airway compromise

You are treating a patient with a severe electrical burn on the hand. For what other injury will you NEXT assess on this​ patient?

An exit burn

Firefighters have pulled a​ middle-aged male from a burning bedroom. The patient is unresponsive and has obvious deformity of his left ankle. His respirations are​ rapid, stridorous, and shallow. Your partner inserts an oropharyngeal airway and begins ventilating the patient with a​ bag-valve mask. Which action would you perform​ next?

Assess the​ patient's carotid pulse.

Of the actions that​ follow, which one indicates proper care of a patient who has suffered a​ partial-thickness burn to the​ hand?

Carefully removal rings prior to applying a dry sterile dressing.

An awake but confused patient with a diabetic history spilled a pot of hot water on himself while cooking. He has a​ partial-thickness burn on his right anterior leg. Following an unremarkable primary​ assessment, which action is your highest​ priority?

Check the​ patient's blood glucose level.

What term is used for a burn that wraps around an entire body​ surface?

Circumferential

You are assessing an elderly male patient who was trapped in a burning trailer. What finding would be most indicative that he has suffered an inhalation​ injury?

Coughing of black sputum

The swelling of the upper airway as a result of inhalation of hot gases would be considered what type of burn​ mechanism?

Gas burn

What is the waste product in the blood from extensive burns that causes renal​ failure?

Myoglobin

After stopping the burning​ process, providing airway and oxygenation​ support, and immobilizing if​ needed, what other aspect of care should you try to provide for the patient with​ burns?

Pain management

A patient was burned when he accidentally ignited gasoline while working on his car. When performing the secondary​ assessment, what finding would indicate that the patient has suffered a​ partial-thickness burn?

Painful skin that is moist and contains blisters to the abdomen

You are transporting a patient who was shocked by an electrical current while repairing a residential electrical service panel. He has​ partial-thickness burns to the hand and foot where the electricity entered and exited his body respectively. When reassessing the​ patient, what sign or symptom would be of most​ concern?

Palpation of an irregular heartbeat

Which statement is accurate in applying the rule of nines to a​ 10-month-old child?

The head of a child is considered to be​ 18% of the total body.

What is the primary result of the tissue degeneration that results from electrical​ burns?

The tissue releases toxins into the body.

You are caring for a thermal burn patient. To stop the burning​ process, you​ should:

cool the burn with water.

A​ 20-year-old waitress spilled hot coffee and burned her right forearm. When assessing the​ burn, you note a​ full-thickness burn surrounded by​ partial-thickness burns. She complains of pain in the surrounding​ partial-thickness burn, but not in the center where the​ full-thickness burn is located. As an​ EMT, you recognize that the patient does not localize pain to the center of the burn because​ of:

damage to pain receptors located in the dermis.

A​ fair-skinned patient was exposed to the sun and has a painful superficial burn to her upper back. As a knowledgeable​ EMT, you would recognize that the​ ________ layer(s) of the skin has​ (have) been affected.

epidermal

A young​ female, rescued from a burning​ apartment, has sustained​ partial- and​ full-thickness burns from her chest down to her feet. As​ such, the EMT would recognize the potential for the onset​ of:

hypothermia.

Continual use of a wet dressing in a burn patient may​ cause:

hypothermia.

When a person experiences a severe electrical shock caused by directly touching the electrical​ source, the entrance wound is often on the​ hand, and the exit​ wound:

may be difficult to find.

Guidelines for the treatment of chemical burns​ include:

minimizing further wound contamination when flushing with water by making sure the fluid runs away from the injury and not toward uninjured areas.

Burns to the face are considered critical​ because:

of the potential for respiratory compromise.

Which statement made by an EMT shows that he understands the major cause of death in the prehospital setting for a burn​ patient?

"Most burn patients who die before getting to the hospital die of airway or bleeding​ problems, not the burn​ itself."

A​ patient, who is​ coughing, has suffered a superficial burn to the​ chest, arms, and face after pouring gasoline on a smoldering campfire. Which statement indicates that the EMT is properly caring for​ him?

"Throughout transport, I am going to listen to your lungs quite​ frequently."

For which patient would the palm method be best to estimate the body surface area affected by a​ burn?

49-year-old with a​ partial-thickness burn to the inner thigh

What should you place on a burn that covers more than 10 percent of your​ patient's body?

A burn sheet

A male patient who works in a steel fabricating plant has suffered a flash burn to his right arm and hand. What assessment finding would assist the EMT in determining that the burn is superficial and not partial​ thickness?

Absence of blisters

You are assessing a​ 36-year-old male who was injured in a house fire. He made it out just before the entire house flashed over. He has burns to his entire right arm and soot marks around his face and nose. What care should you give this​ patient?

Administer​ oxygen, place a dry dressing on the​ arm, and transport him to the burn center.

Which statement about electrical burns is​ TRUE?

All tissue between the entrance and exit wounds may be injured.

In accordance with the rule of​ nines, how does the head of an infant compare with the head of an​ adult?

An​ infant's head and neck account for twice the total body surface area of an​ adult's.

A female in her late 20s is lying unconscious in a work area with exposed electrical wiring. The supervisor on scene has turned off and locked out the power source on which the patient was working. As you​ approach, you see burn wounds on both hands. The​ patient's breathing is slow and​ irregular, and her distal pulse is slow and weak. What action should you take​ FIRST?

Assess the​ airway, and assist breathing.

Another way of identifying the seriousness of a burn is by degrees. Which statement is​ TRUE?

A​ full-thickness burn is also known as a​ third-degree burn.

Emergency medical care of a burn patient includes which​ treatment?

Brushing dry chemicals away and then flushing with water

Your patient is a​ 27-year-old male who fell down a full flight of stairs while escaping his burning apartment. What assessment finding should demand your immediate​ attention?

Burns on the face

You are treating a​ 57-year-old female victim of​ partial-thickness thermal burns of the​ hands, arms,​ feet, legs,​ genitalia, and anterior torso. After you have brought her airway under​ control, administered​ high-flow oxygen via a nonrebreather​ mask, and cooled the burned area with​ saline, she is still complaining of being in severe pain. After using cool saline to stop the​ burning, which of the additional steps can you take to relieve some of her​ pain?

Cover the burn with a sterile burn sheet.

What assessment finding would best indicate that a patient has suffered a​ full-thickness burn to his​ leg?

Dry skin with little pain

What type of burn occurs when the patient comes into contact with fire or​ flames?

Flame burn

What is the resulting injury called when the burn penetrates all the way to the bottom layer of​ skin?

Full thickness

When an oral burn can cause swelling of the airway​ structures, what is the pulmonary​ result?

Hypoxemia

Which body system is generally NOT harmed by extensive​ burns?

Skeletal

Burns can result in what effect on the integumentary​ system?

Swelling

Which consideration could be a concern to your safety when doing a standby at a motor vehicle accident in which a​ tractor-trailer carrying fuel has overturned and the fire department is still extricating the​ driver?

The tanker may​ explode, causing burn injuries.

What is the cause of a majority of deaths that are seen prehospitally secondary to a burning​ mechanism?

Toxic inhalation and occluded airway

A​ 44-year-old electrician has been shocked and responds to verbal stimuli with garbled speech. His airway is open and he is breathing poorly at a rate of 8 times per minute. His pulse is slow and irregular. What action would the EMT perform​ next?

Ventilate with a​ bag-valve mask at 12 breaths per minute.

You have been called for an intoxicated male who sustained a​ full-thickness burn to his leg after passing out against a kerosene heater. After ensuring that his​ airway, breathing, and circulation are​ intact, you cool the burn with water and​ then:

carefully wrap the burn with a dry sterile dressing.

When classifying a burn as either​ superficial, partial​ thickness, or full​ thickness, the EMT would need to determine​ the:

depth of the burn.

White and waxy to dark brown or black coloration and charred skin are the signs of​ a:

full-thickness burn.

A patient was trapped in a burning apartment before being rescued by firefighters. As you approach​ him, you note that his legs and arms are burned. He is screaming in pain and​ coughing, but no longer actively burning. Given this​ information, what intervention would you perform​ first?

Decide whether to administer oxygen with a nonrebreather face mask or with a​ bag-valve mask

Which group of patients are more apt to develop infections secondary to​ burns?

Elderly

You have been called for a​ 44-year-old male who was burned on the right hand and arm after falling against the hot door of an industrial incinerator. As you arrive on the​ scene, a nurse employed by the company informs you that he sustained a​ partial-thickness burn. Based on this​ information, the EMT should expect what characteristics at the burn​ site?

Intense pain and blister formation

Which burn injury in an adult patient would be considered critical in terms of​ severity?

Partial-thickness burns of the right hand and arm

Upon your arrival for a burn​ patient, the scene​ size-up reveals that the patient is a child. Why do pediatric patients have more difficulty dealing with burns than​ adults?

Pediatric patients have a high body surface area to body weight ratio.

Why would an EMT be concerned about a​ partial-thickness burn circumferentially to the​ chest?

Restriction of breathing

You have been called for a patient who had a large bag of lime powder tear as he was unloading it from a truck. On arrival he is complaining of burning to both legs and you note that aside from the shorts he is​ wearing, lime dust covers both legs. Your immediate action would be​ to:

brush as much of the lime off his legs as possible.

The condition that occurs after a burn when fluid and proteins move out of the vasculature and into surrounding tissue is​ called:

burn shock.

A patient has a burn that completely encircles his right forearm and upper arm. After performing the primary​ assessment, the​ EMT's next action would be​ to:

check for​ motor, sensory, and a pulse in the right upper extremity.

The primary care for a liquid chemical burn is​ to:

continually flood the affected area with a large amount of water.

A​ 51-year-old female patient tripped in the kitchen and fell against a deep​ fryer, splashing hot oil onto her right arm. Assessment reveals​ partial- and deep​ partial-thickness burns to her arm. You estimate that the burn covers​ 2% of her body. Which​ statement, made by the​ patient, reveals the most important information when determining the overall severity of the​ burn?

​"I have been a diabetic for several​ years."

Which one of the following statements shows that the EMT understands the palm method of estimating the BSA​ burned?

​"I use the​ patient's palm to estimate the size of the burn​ area."

A male patient was injured when a steam valve​ opened, causing hot steam to contact his face. Which​ statement, made by the​ patient, would be of MOST concern to the EMT and require immediate assessment or​ treatment?

​"It is sort of hard to​ breathe."

A student in a science lab has had an unknown chemical splashed into her eye. After assessing the​ airway, breathing, and​ circulation, the EMT would​ immediately:

flush the eye with copious amounts of tap water.

A​ person's FIRST reaction when startled by a flash fire or explosion is normally​ to:

inhale deeply.

If the patient sustains burns to the​ hands, the EMT should​ remove:

jewelry.

Severe burns often lead​ to:

kidney failure.

You are assessing a patient and notice red discoloration with blisters on her legs. This type of burn would be classified​ as:

partial thickness.

Treatment of the superficial burn may​ include:

pouring cool saline over the injury.

A standardized way to quickly determine the amount of skin surface that is burned is called​ the:

rule of nines.

Burned toes should be separated​ with:

sterile gauze pads.

Continued use of a wet burn sheet​ increases:

the risk of hypothermia.

You are assessing a patient who was burned when she dropped a hot iron on her bare foot. Her foot is red and has a small​ partial-thickness burn near the ankle. When completing the prehospital care​ report, what mechanism would you​ document?

Contact burn

You are caring for adult male patient who has a critical burn to the hand after attempting to pick up a piece of hot metal after it was cut with a set of torches. What type of burn mechanism would this​ be?

Contact burn

You are treating a​ 57-year-old female victim of​ partial-thickness thermal burns of the​ hands, arms,​ feet, legs,​ genitalia, and anterior torso. After you have brought her airway under control and administered​ high-flow oxygen via a nonrebreather​ mask, she is complaining of being in severe pain. Which step should you take next to relieve some of her​ pain?

Cool the burn for 1 to 2 minutes with saline.

Firefighters have just pulled a young woman from a house fire and have laid her down on the lawn. She is conscious and badly burned on the​ chest, abdomen, and legs. Her clothes are smoldering. Which action should the EMT take​ immediately?

Cool the burn with water.

A patient has suffered​ partial- and​ full-thickness thermal burns to the anterior​ chest, abdomen, and arms in an industrial accident. What action would be appropriate in the care of this​ patient?

Cool the burns with water for 90 seconds and cover the burns with a​ sterile, dry burn sheet.

An intoxicated​ 28-year-old female has suffered burns to both legs after passing out next to a space​ heater, which ignited her pants. Emergency Medical Responders have removed her clothing and cooled the burns. Which action is most appropriate in the continued care of this​ patient?

Cover the burns with a​ clean, white, dry sheet.

A patient has​ partial-thickness burns over 18 percent of his​ body, including both feet. Which classification does this patient fall​ under?

Critical

A patient has​ partial-thickness burns over 35 percent of his​ body, including both feet. Which classification does this patient fall​ under?

Critical

Your patient suffered a severe electrical burn injury. In your emergency​ care, you should​ always:

assess for an entrance wound and an exit wound.

The layers of the skin are​ the:

epidermis, the​ dermis, and the subcutaneous layer.

This type of burn mechanism is the result of a flammable gas or liquid that ignites​ rapidly, and often the burn damage is to skin surfaces NOT covered by​ clothing:

flash burn.

You are caring for a victim who was rescued from a burning building by the fire department. The patient presents alert and oriented with burns to the​ arms, chest,​ neck, and face. The patient complains that he cannot breathe well. What is this​ patient's MOST critical​ injury?

Possible airway burns

An industrial worker has sustained a​ partial- and​ full-thickness burn to his right hand after accidentally touching an electric furnace used to incinerate medical waste. Assessment reveals no threats to the​ airway, breathing, or circulation. Which action would the EMT perform​ next?

Pour cool saline water on the hand.

A patient has been pulled from a house fire. Assessment reveals him to be lethargic with stridorous respirations and a rapid but strong radial pulse. Firefighters are dousing his body with water to cool him. What action would the EMT perform​ immediately?

Provide positive pressure ventilation with a​ bag-valve mask.

Regarding the severity of the​ burn, chemical burns are generally limited by which​ process?

The chemical burn generally destroys the tissue with which it is in contact.

What is the MOST ominous finding indicating a​ patient's airway is about to swell shut from an inhalation​ injury?

Stridor

You are called by the owner of a restaurant for a female patron who spilled hot tea onto her right thigh. The secondary assessment reveals the burn area to be​ soft, red, and painful. The skin is intact with no blister formation​ noted, although some edema is present. Based on these assessment​ findings, you would recognize what category of​ burn?

Superficial

Your​ 22-year-old male patient has sustained thermal burns involving the entire front of both legs. These burns are dry and​ "leather-like." How severe are these​ burns, and how should you care for​ them?

The burns are​ critical, since they are over 10 percent full thickness. Wrap them in a dry dressing.

An intoxicated patient has suffered a burn to his left lateral thigh after passing out with his leg touching the side of a kerosene heater. Close examination of the burn reveals tough leathery tissue in the center of the burn with red skin with blisters surrounding it. Regarding the​ burn, which statement is​ TRUE?

The inner portion of the burn is full thickness and the outer portion partial thickness.

If you arrive on scene and find a burned patient with​ hypoperfusion, what does that tell you about the status of the​ patient's circulatory​ system?

The patient has blood loss from elsewhere in the body.

You are called to the scene of a patient who was burned in an electrical mishap. Upon​ arrival, you find the patient lying beside some wiring that he was working on. What should be your first​ consideration?

The wires may still be live.

A male patient has just been burned with hot water and has blisters on his left arm. The EMT would recognize​ that:

fluid has collected between the layers of skin.

You are treating a​ 20-year-old male patient with a​ partial-thickness burn of his right arm. He is conscious and well oriented with stable vitals and SpO2 of 100 percent on room air. You have removed clothing and jewelry that was in contact with the affected area and have placed a clean sheet over the burns. The NEXT step in your treatment plan should​ include:

the use of local cooling.

Burns caused by hot water or steam​ are:

thermal burns.

Your patient was involved in a serious industrial accident in which she sustained a critical electrical burn to both her hands when she accidentally grabbed a live wire. This patient will need to​ be:

transported with ALS as she may experience a cardiac dysrhythmia.

You have arrived on the scene of a large structure fire. Emergency Medical Responders​ (EMRs) are by the side of a patient who is responsive to verbal stimuli and has suffered significant burns to his body. They report that the patient fell down a flight of stairs while trying to escape the fire and was trapped for several minutes. Their assessment findings include​ partial- and​ full-thickness burns to his right​ arm, right​ leg, and right side of the face. The EMRs also report that the​ patient's unburned skin is​ cool, clammy, and​ pale, with a delayed capillary refill. His pulse is​ 144, respirations are​ 22, and blood pressure is​ 88/50 mmHg. Which instruction would be MOST​ appropriate?

​"After reassessing the​ ABCs, let's do a secondary assessment and look for signs of injuries that are causing​ shock."

Which statement made by the EMT indicates an understanding of calculating the body surface area​ (BSA) burned?

​"Determining the BSA is an estimation and should never delay transport of the burn patient to the​ hospital."

A​ 24-year-old man was shocked while working on his​ house's electrical system. Assessment reveals a minor burn to the fingers on his left hand. Aside from being slightly​ shaky, he states he feels fine and does not see the need to be treated further or transported to the hospital. What statement would you make before allowing him to refuse additional care and​ transport?

​"It would be best to let the emergency physician check you out. Electrical shocks can damage the​ heart."

A female who had hot coffee thrown at her has a superficial burn to the right side of her face. After transferring the patient to the hospital emergency department for continued​ care, a new EMT asks you whether the patient will have a permanent scar on her face. What is your BEST​ reply?

​"Since only the outer layer of skin was​ burned, there is little chance of​ scarring."

According to the rule of​ nines, what would the involved surface area be for an adult victim who has received burns to her right arm and right anterior​ chest?

​13.50%

When triaging multiple burn​ patients, the EMT would recognize which as suffering the most critical​ burn?

​22-year-old with a​ partial-thickness burn to the right hand

Part of the assessment of a thermal burn is to calculate the percentage of the body surface area that has been burned. Your patient has burns to his anterior torso and the anterior surface of his right arm. What is the estimated percentage of body surface​ burned?

​22.5%

A​ 21-year-old male has sustained a severe burn to his left leg while working on an industrial furnace. Coworkers immediately doused his flaming pants and removed them. Your primary assessment reveals no threats to the​ airway, breathing, or circulation. While performing the secondary assessment on his​ leg, what finding would be most​ critical?

​Partial-thickness burn completely encircling the knee