1	Burns Treatment, Management, and Pathophysiology Review
2	Question The skin is composed of how many distinct layers of tissue?
3	Answer 3 (epidermis, dermis, subcutaneous layers)
4	Question What are the primary functions of the skin?
5	Answer 1. Protect the body from infection 2. Functions as an organ of sensation to temperature, pressure and pain 3. Stores and moves body fluids into and out of the body as needed 4. Temperature regulation thru sweating and shivering 5. Insulation from trauma 6. Accommodates free body movement
6	Question What are the two rudimentary results of body tissue when exposed to excessive heat?
7	Answer Evaporation and denatured proteins.
8	Question According to Jackson’s theory of thermal wounds, which zone is characterized by the are surrounding the burn and white because of decreased blood flow?
9	Answer Zone of stasis
10	Question According to Jackson’s theory of thermal wounds, which zone is characterized by red color surrounding the burn associated with increased blood flow?
11	Answer Zone of hyperemia
12	Question According to Jackson’s theory of thermal wounds, which zone is characterized by the area nearest the heat source that suffers the most damage and has clotted blood and thrombosed blood vessels?
13	Answer Zone of coagulation
14	Question Which stage of the burn process is characterized by a catecholamine release and pain-mediated reaction?
15	Answer Emergent phase
16	Question Which stage of the burn process is characterized by an increase in body metabolism in an attempt by the body to heal?
17	Answer Hypermetabolic phase
18	Question Which stage of the burn process is characterized by the production of scar tissue and the completion of the healing process?
19	Answer Resolution phase
20	Question Which stage of the burn process is characterized by a massive shift of fluid from the intravascular to extravascular space?
21	Answer Fluid shift phase
22	Question How long after a critical burn does the fluid shift peak and how long does this phase last?
23	Answer Peaks in 6 to 8 hours and can last up to 24 hours.
24	Question What cardiac dysrhythmia is usually the result of an alternating current electrocution?
25	Answer V. Fib
26	Question What cardiac dysrhythmia is usually the result of a direct current electrocution?
27	Answer asystole
28	Question What is the paramedics primary concern when treating an electrical burn victim?
29	Answer Scene Safety
30	Question What type of flesh offers the least resistance to electrical current and may result in damage even from very small current?
31	Answer Mucous membranes (ie: lip and oral burns in children)
32	Question True or false: It is necessary to assume c-spine immobilization precautions on a victim of electrocution?
33	Answer True Fractures may occur because of violent muscle contractions
34	Question What is the name of the process in which acidic substances form a thick, insoluble mass, or coagulum when in contact with tissue?
35	Answer Coagulation necrosis
36	Question What is the name of the process in which alkaline substances destroy cell membranes, releasing the intercellular and interstitial fluids, destroying tissue?
37	Answer Liquefaction necrosis
38	Question Does an acid or base burn typically produce a more severe burn with greater tissue destruction?
39	Answer Base (alkali) burns. (acidic burns form an insoluble coagulum which limits the burn depth)
40	Question On a daily bases, which type of radiation are we exposed to in the greatest amount?
41	Answer Alpha radiation
42	Question Which type of radiation is only a threat if our patient ingest or inhales the particles?
43	Answer Alpha radiation
44	Question What is the only type of radiation that does not have mass? It is pure energy!
45	Answer Gamma radiation
46	Question What are three important points of information we need to know about a patient that was exposed to dangerous radiation?
47	Answer Time (duration) Distance Shielding
48	Question By doubling the distance between you and a radiation source, by how much radiation are you being exposed to compared to your initial position?
49	Answer ¼ the initial amount Exposure = _____1______ (distance²) Therefore if you increase your distance by three fold, the amount decreases to 1/9 the initial exposure.
50	Question What is the basic unit of absorbed radiation doses?
51	Answer rad
52	Question Which of the following is more likely to cause subglottic burns: Moist air or Dry air
53	Answer Moist air
54	Question True or False The supraglottic airway is more likely to absorb heat and reduce the risk of lower airway burns.
55	Answer True
56	Question How would you describe the burn depth of a burn that produced pain, minor edema, and erythema?
57	Answer Superficial burn (1^st degree)
58	Question How would you describe the burn depth of a burn that produced waxy or mottled skin with or without blisters?
59	Answer Partial thickness burn (2nd degree)
60	Question How would you describe the burn depth of a burn that produced injury to the epidermis and dermis layers of the skin?
61	Answer Partial thickness burn (2^nd degree)
62	Question True or False A sunburn can produce a superficial or partial thickness thermal burn?
63	Answer False Although a sunburn can cause a superficial or even partial thickness burn, it is not a thermal burn. It is a radiation burn from UV radiation.
64	Question How would you describe the burn depth of a burn that produced injury to the epidermis only?
65	Answer Superficial burn (1^st degree)
66	Question How would you describe the burn depth of a burn that produced eschar?
67	Answer Full thickness (3^rd degree)
68	Question How would you describe the burn depth of a burn that produced white or black colored skin and have a dry, leather like experience?
69	Answer Full thickness (3^rd degree)
70	Question According to the Rule of Nines, an adult’s entire head is what percent of his body surface area?
71	Answer 9%
72	Question According to the Rule of Nines, an infant’s entire head is what percent of his body surface area?
73	Answer 18%
74	Question According to the Rule of Nines, an adult with burns to his entire anterior chest and the anterior surface of his right arm has burned what percent of his body surface area?
75	Answer 13.5%
76	Question According to the Rule of Nines, an adult’s entire left arm and left leg as well as the left side of his chest, abdomen, back and flank, has burned what percent of his body surface area?
77	Answer 45%
78	Question According to the Rule of Nines, an infant that has spilled hot water and burned the anterior surface of his left leg, has burned what percent of his body surface area?
79	Answer 6.5 to 7%
80	Question What is the best initial treatment to avoid hyperkalemic complications with large thermal burns?
81	Answer Careful ECG monitoring and appropriate fluid resuscitation. (In rare cases of severe hyperkalemia Sodium bicarbonate may be used)
82	Question True or False: If the burn is extensive, uncontrolled body heat loss induces rapid and severe hypothermia.
83	Answer True
84	Question True or False: With massive shift of fluid to the interstitial space, the body’s ability to regulate sodium, potassium, and other electrolytes becomes overwhelmed.
85	Answer True
86	Question Minor, Moderate, or Critical 35% BSA partial thickness burns
87	Answer Critical
88	Question Minor, Moderate, or Critical 90% BSA Superficial Burns
89	Answer Moderate
90	Question Minor, Moderate, or Critical 5% BSA Partial Thickness Burns
91	Answer Minor
92	Question Minor, Moderate, or Critical Patient with a raspy voice
93	Answer Critical
94	Question Minor, Moderate, or Critical Full Thickness burn to the genitalia
95	Answer Critical
96	Question What is the Parkland Burn Formula?
97	Answer It is used to calculate the amount of intravenous fluid that should be provided in the first 24 hours? (BSA) x (kg) x (4 mL/kg) = fluid in first 24 hours
98	Question Half of the fluid calculated in the Parkland Burn Formula should be administered in the first ____ hours.
99	Answer 8
100	Question How much fluid should be administered to a 100 kg burn victim with a 20% BSA in the first 8 hours?
101	Answer 4 Liters
102	Question You have a patient that was removed from a structure fire whit dyspnea and AMS experiencing grand mal seizures. What is the cause of his condition?
103	Answer Cyanide toxicity
104	Question What is the amount of fentanyl you should initially administer to a patient in severe pain secondary to a burn?
105	Answer 25 to 50 mg
106	Question What medications should be used in the treatment of cyanide toxicity?
107	Answer Amyl nitrite (ampule crushed and inhaled) Sodium nitrite (300mg IVP) Sodium thiosulfate (12.5g IVP)
108	Question When should amyl nitrite be administered over sodium nitrite in cases of cyanide toxicity?
109	Answer When IV access is not available
110	Question True or False You should perform 2 minutes of CPR prior to defibrillating a lightening strike victim with an unknown down time in ventricular fibrillation.
111	Answer False Victims of electrocutions should be defibrillated immediately if still in VF or pulseless VT.
112	Question What should be used to remove phenol from the skin prior to flushing with cool water?
113	Answer alcohol
114	Question What metal reacts violently with water and should be coated with oil if on your patient’s skin?
115	Answer Sodium
116	Question What is a strong corrosive substance that reacts with water and should be brushed off prior to flushing with copious amounts of water?
117	Answer Dry lime
118	Question What 3 basic treatments should be performed for all burns?
119	Answer Stop the burning process if needed Cover with a dry, sterile dressing Keep your patient warm
120	Question Your patient is experiencing airway burns due to inhalation injury. You elect to perform RSI to protect the patient’s airway. Which paralytic should you use with caution, if at all, because it may worsen hyperkalemia?
121	Answer succinylcholine