Chapter 32- Burns

69. You and your partner are transferring a severely burned patient from a community hospital to a burn specialty center. The patient, a 110-pound woman, has partial- and full-thickness burns that cover approximately 55% of her body. She has two large-bore IV lines in place, is intubated, and is on a cardiac monitor. According to the Parkland formula, how much normal saline should she receive in 30 minutes? A) 340 mL B) 355 mL C) 370 mL D) 395 mL

Ans: A Page: 1588-1589

14. The progression of a chemical burn is MOSTLY dependent on: A) the length of time the corrosive chemical remains on the skin. B) the surface area of the body exposed to a corrosive chemical. C) whether the corrosive substance is a strong acid or alkali. D) the patient's general health and the thickness of his or her skin.

Ans: A Page: 1590

17. Phosphorus is found in _____________ and burns when exposed to _____________. A) fireworks, air B) oven cleaner, water C) drain cleaner, air D) battery acid, water

Ans: A Page: 1591

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

Ans: A Page: 1591

62. Which of the following statements regarding sodium metal chemical burns is correct? 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.

Ans: A Page: 1592

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

Ans: A Page: 1592

32. The majority of victims struck by lightning: A) die within the first 24 hours following the injury. B) experience confusion and some degree of amnesia. C) require only short periods of ventilatory support. D) are permanently paralyzed due to a spinal cord injury.

Ans: B Page: 1598

35. Many of the physiologic changes caused by acute radiation syndrome: 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.

Ans: B Page: 1599

37. Unlike chemical burns, radiation burns: 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.

Ans: B Page: 1599

66. A full-thickness burn is considered to be critical if it: A) is located on any part of the thorax or abdomen. B) covers more than 5% of the total body surface area. C) was irrigated with water prior to the arrival of EMS. D) occurs in a patient with a significant medical illness.

Ans: D Page: 1585-1586

60. The application of ice to partial-thickness burns: A) often negates the need to administer a narcotic. B) is not necessary because such burns are painless. C) offers excellent pain relief and minimizes swelling. D) can exacerbate tissue injury and should be avoided.

Ans: D Page: 1590

18. Chemicals such as Lewisite and phosgene oxime: A) are strong alkalis that cause liquefaction necrosis. B) damage the body by extracting water from the tissues. C) are most commonly found in drain and oven cleaners. D) are vesicant agents that produce cutaneous blisters rapidly.

Ans: D Page: 1591

30. Which of the following locations would provide the BEST protection from a lightning strike? 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

Ans: D Page: 1598

1. The LEAST significant complication associated with damage to the skin following a burn injury is: A) decreased melanin granules. B) disturbances in fluid balance. C) difficulty with thermoregulation. D) susceptibility to bacterial invasion.

Ans: A Page: 1576

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

Ans: A Page: 1579

8. Flash burns: 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.

Ans: A Page: 1579

45. Which of the following statements regarding partial-thickness burns is correct? 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.

Ans: A Page: 1580

13. Which of the following statements regarding carbon monoxide (CO) poisoning is correct? A) Never rule out CO poisoning because of 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%.

Ans: A Page: 1581

39. While standing by at the scene of a structural fire, it is MOST important to remember that: A) toxic gases are often present, even after the fire is out. B) the lead paramedic determines where you should stage. C) most fabric materials release cyanide when they burn. D) you may need to provide rehabilitation for fire fighters.

Ans: A Page: 1582

48. Which of the following statements regarding the rule of palms is correct? 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.

Ans: A Page: 1584

25. Victims standing near an object that is struck by lightning: A) most commonly experience blast-type injuries. B) often have burns characterized by a feathering pattern. C) typically experience intractable ventricular fibrillation. D) experience full-thickness burns that require debridement.

Ans: B Page: 1597

74. 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: 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.

Ans: A Page: 1592

76. 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: 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.

Ans: A Page: 1596-1597

33. Compared to beta radiation particles, alpha radiation particles: 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.

Ans: A Page: 1599

53. Assessment of a patient who may have been exposed to radiation begins by: 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.

Ans: A Page: 1599

2. The skin sheds excess heat from the body through: A) retention of salt and water. B) the evaporation of sweat. C) cutaneous vasoconstriction. D) decreased sebum production.

Ans: B Page: 1576

5. Which of the following statements regarding scald burns is correct? A) Once hot liquids come in contact with clothing, heat is rapidly dissipated. B) Scald burns often cover large surface areas because liquids spread quickly. C) Scald burns caused by grease or oil are typically limited to the epidermis. D) Scald burns are less commonly seen in pediatric patients than adult patients.

Ans: B Page: 1578

12. Which of the following is the LEAST common cause of death from fires? A) Pulmonary injury B) Integument burns C) Upper airway compromise D) Inhalation of toxic gases

Ans: B Page: 1580

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

Ans: B Page: 1582

38. When assessing a burn patient, it is MOST important to: 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.

Ans: B Page: 1582

58. Which of the following statements regarding prehospital vascular access and fluid therapy in the severely burned patient is correct? A) Most burn patients will require at least 4 L of IV fluid immediately. B) At least one large-bore IV should be started while en route to the hospital. C) Intraosseous cannulation is absolutely contraindicated in severely burned patients. D) An IV line in a lower extremity is preferable to one in a burned upper extremity.

Ans: B Page: 1584, 1588

64. Which of the following burn injuries would MOST likely require transport to a burn specialty center? 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

Ans: B Page: 1584-1585

68. During your primary assessment of a 21-year-old man with a suspected inhalation injury, you note that he is combative and his 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: 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 his trachea. C) administer humidified oxygen, start at least one large-bore IV, and visualize his upper airway to assess the severity of soft-tissue swelling. D) insert an oropharyngeal airway, ventilate him with a bag-mask device at 20 breaths/min, and prepare to nasotracheally intubate him.

Ans: B Page: 1587-1588

57. If intubation of a burn patient becomes necessary, you should avoid cutting the ET tube down to make it shorter because: A) doing so increases the risk of intubating the right mainstem bronchus. B) facial edema may cause tube dislodgement 2 to 3 days after the burn. C) drugs given via the ET tube will not adequately disperse in the lungs. D) it may result in excessive volumes of air being delivered to the patient.

Ans: B Page: 1588

10. If an acutely burned patient is in shock in the prehospital setting: A) it is likely that he or she is experiencing burn shock. B) you should look for another injury as the source of shock. C) administer a 250-mL bolus of normal saline and reassess. D) avoid IV fluids unless the systolic BP is below 80 mm Hg.

Ans: B Page: 1589

70. 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 99% on room air. He denies any other injuries. Initial management for this patient involves: 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.

Ans: B Page: 1590

73. A 74-year-old man experienced partial- and full-thickness burns to his arms and chest resulting from a fire that started after he fell asleep while smoking his cigar. The patient's son, who arrived at the scene shortly after you, states that his father has congestive heart failure, rheumatoid arthritis, and atrial fibrillation. In addition to administering supplemental oxygen, it is MOST important for you to: A) avoid narcotic analgesics because of his medical history. B) auscultate his breath sounds before administering IV fluids. C) obtain a 12-lead ECG to assess for signs of cardiac ischemia. D) apply cold, moist dressings to his burns to provide pain relief.

Ans: B Page: 1600

9. Burn shock is caused by: A) a massive infection that occurs when microorganisms breach burned skin. B) renal failure secondary to excess myoglobin production from burned muscle. C) fluid loss across damaged skin and volume shifts within the rest of the body. D) acute dehydration, and it commonly manifests within 30 minutes after the burn.

Ans: C Page: 1577-1578

4. Thermal burns are MOST commonly caused by exposure to: A) hot liquids. B) hot solid objects. C) an open flame. D) superheated steam.

Ans: C Page: 1578

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

Ans: C Page: 1583

40. Upon initial contact with a severely burned patient, you must: 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.

Ans: C Page: 1583, 1587

67. 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? A) 18% B) 27% C) 36% D) 45%

Ans: C Page: 1585

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

Ans: C Page: 1590

15. The degree of absorption of a corrosive chemical determines: 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.

Ans: C Page: 1590-1591

21. A person who is exposed to cement: 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.

Ans: C Page: 1591

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

Ans: C Page: 1599

72. A 4-year-old boy pulled a pot of boiling water off of the stove and experienced partial-thickness splash burns to his neck, anterior trunk, and both anterior arms. During your assessment, you note that the child is conscious but is not crying. He is tachypneic and tachycardic, and his skin is cool and moist. Other than the burns, there are no other gross injuries. Which of the following statements regarding this scenario is correct? A) You should assist the child's ventilations and prepare to intubate his trachea. B) An IV should be established and you should administer a 20-mL/kg bolus of D5W. C) The child may be hypoglycemic and requires assessment of his blood glucose level. D) It is likely that this child's burn was intentionally inflicted and you should report it.

Ans: C Page: 1600

3. The severity of a thermal burn correlates directly with: A) the body's ability to effectively dissipate significant heat energy and the patient's general state of health. B) the presence of any underlying medical problems, the duration of exposure, and the temperature of the heat source. C) the duration of exposure, the physical size of the patient, and the presence of concomitant traumatic injuries. D) the temperature of the heat source, the amount of heat energy possessed by the object or substance, and the duration of exposure.

Ans: D Page: 1578

43. With regard to a thermal burn injury, the zone of coagulation: 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.

Ans: D Page: 1579

6. Which of the following burn injuries or patterns should make you the MOST suspicious for abuse? A) Burns to the forearm B) Splash burns to a leg C) An arc burn to the hand D) Burns with formed shapes

Ans: D Page: 1579

71. A 33-year-old man was burned when the hot water heater he was working on 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: 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.

Ans: D Page: 1584

49. The purpose of estimating a patient's total body surface area burns in the prehospital setting is to: 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.

Ans: D Page: 1585