2024 ATLS Module 9 - Thermal Injuries Latest Questions With Complete Grade A Answers
- Primary Survey and resuscitation of burn patients
Answer:
Stop the burning process Ensure airway and ventilatory adequacy Manage circulation
- How to stop the burning process
Answer:
-completely undress patient -Prevent overexposure and hypothermia -Recognize possibility of wound contamination -Brush and dry chemical powders from the wound and then rinse.
- Factors that increase the risk of upper airway obstruction
Answer:
-Increasing burn size and depth -Burns to the head and face -Inhalation injury -burns inside the mouth
-Age: children with burn injures are at higher risk for airway problems
- AIRWAY considerations in burn patients
Answer: Look for early indication for intuba tion!
Reassess frequently
- BREATHING considerations in burn patients
Answer:
-Hypoxia could be related to: inhalation injury, circumferential chest burns, or thoracic trauma unrelated to the thermal injury.
-Administer supplemental oxygen with or without intubation.
-Look out for Carbon Monoxide poisoning. Look for baseline levels. Assume in pts who were burned in enclosed areas. Provide 100% O2 via non-rebreather.
6. Ensuring adequate ventilation:
Answer: 1 / 2
Obtain baseline CXR and ABGs Provide supportive treatment Intubate pts with significant burns Elevate the patients head and chest 30 degrees to reduce edema (when appropri- ate/c-spine injury ruled out)
- CIRCULATION considerations in burn patients
Answer:
-Treat shock according to ATLS principles -Replace ongoing fluid losses from inflammation -Provide burn resuscitation fluids for deep partial and full-thickness burns larger than
20% TBSA.
-Establish 2 large bore IVs in peripheral veins. Consider central venous catheter or IO if you can't get IVs. UE preferred. Note- edema can dislodge IVs.-Urine catheter in all patients getting burn resuscitation fluids. Begin infusion with warmed isotonic crystalloid Insert and indwelling urinary catheter in all patients and monitor urine output to assess perfusion.
- initial fluid rate for adults with 2nd and 3rd degree burns
Answer: 2 mL LR x patients body weight in kg x TBSA
-1/2 in the first 8 hours.-1/2 over the next 16 hours.
Adjust fluids based on urine output.
- initial fluid rate for peds with 2nd and 3rd degree burns
Answer: 3 mL LR x patients's body weight in kg x TBSA
-1/2 in the first 8 hours.-1/2 over the next 16 hours.
Children < 30 kg: Add mx fluids of 5% dextrose in water.
- Over or under resuscitation of burn patients
Answer:
-Titrate based on urine output
-Recognize factors that affect volume of resusication and urine output: inhalation injury, age of pt, renal failure, diuretics, ETOH
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