Circumferential Burns, Special Populations, Abuse, and Transport Practice Questions

25 multiple-choice questions on Circumferential burns, special populations, abuse, and transport for paramedic and EMT students, from Chapter 33 (Burns). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A circumferential full-thickness burn of the chest is dangerous mainly because the eschar can:

   1. A. Bleed heavily from the wound edges
   2. B. Trap heat and keep the burn deepening
   3. C. Compress the heart and cause tamponade
   4. D. Restrict chest expansion
   Show answer

   Answer: D. Restrict chest expansion

   Inelastic eschar acts like a tight band as tissues swell beneath it, so ventilation becomes difficult. Escharotomy releases it; bleeding is not the main risk. Eschar does not keep burning deeper once the heat source is gone, and it squeezes the chest wall rather than filling the pericardium.

2. A 30-year-old man with circumferential full-thickness chest burns becomes increasingly hard to ventilate with a BVM through his ET tube. Breath sounds are equal and the tube is in place. The likely cause is:

   1. A. Bilateral tension pneumothoraces from the fire
   2. B. Esophageal placement of the ET tube
   3. C. Eschar restricting chest wall movement
   4. D. Bronchospasm caused by the dry oxygen
   Show answer

   Answer: C. Eschar restricting chest wall movement

   Equal breath sounds and a confirmed tube point to a stiff chest wall from eschar, which needs urgent escharotomy. Tension pneumothorax usually causes unequal breath sounds.

3. Escharotomy is a procedure in which:

   1. A. Blisters are drained with a needle
   2. B. The eschar is cut to relieve pressure
   3. C. Dead skin is replaced with donor skin
   4. D. A tube is placed into the chest wall
   Show answer

   Answer: B. The eschar is cut to relieve pressure

   Incisions through the eschar allow underlying tissue to expand and restore ventilation or blood flow. It is usually done by a physician in the hospital, not by paramedics in the field.

4. A patient has a circumferential full-thickness burn of the forearm. The finding that most suggests developing compartment syndrome is:

   1. A. Bright red skin all around the burned area
   2. B. Intact blisters along the wound edges
   3. C. A mild rise in heart rate during transport
   4. D. Increasing pain and numbness of the hand
   Show answer

   Answer: D. Increasing pain and numbness of the hand

   Progressive pain, paresthesias, and later loss of pulses signal rising pressure under the eschar. Loss of the radial pulse is a late sign, so do not wait for it.

5. For a patient with circumferential burns of an arm, you should:

   1. A. Elevate it and check distal pulses
   2. B. Wrap the arm tightly to limit swelling
   3. C. Lower the arm below the level of the heart
   4. D. Apply ice packs around the wrist
   Show answer

   Answer: A. Elevate it and check distal pulses

   Elevation reduces edema, and frequent checks of distal circulation detect compartment syndrome early. Tight wrapping adds to the constriction.

6. A 7-year-old was splashed with hot cooking oil from a deep fryer. Compared with a scald from hot water, this burn is likely to be:

   1. A. Shallower, because oil cools very quickly
   2. B. Deeper, as oil gets far hotter and clings
   3. C. The same depth, since each is a liquid
   4. D. Shallower, since oil protects the skin
   Show answer

   Answer: B. Deeper, as oil gets far hotter and clings

   Cooking oil can exceed 175 C (350 F), far above the 100 C ceiling of water, and its viscosity keeps it in contact with the skin longer, so oil and grease burns are typically deeper than water scalds. Cool with running water for about 20 minutes and transport; children with deep burns warrant burn center consultation.

7. Small children receiving burn resuscitation also need maintenance fluid containing dextrose because they:

   1. A. Cannot tolerate lactated Ringer solution at all
   2. B. Need extra sugar for burned skin to heal
   3. C. Can become hypoglycemic
   4. D. Lose large amounts of glucose through the wound
   Show answer

   Answer: C. Can become hypoglycemic

   Young children, especially those under about 30 kg, have small glycogen stores and can become hypoglycemic during resuscitation. They can receive lactated Ringer's; dextrose is added separately.

8. The target urine output for a burned child weighing less than 30 kg is about:

   1. A. 0.5 mL/kg/hour
   2. B. 0.1 mL/kg/hour
   3. C. 3 mL/kg/hour
   4. D. 1 mL/kg/hour
   Show answer

   Answer: D. 1 mL/kg/hour

   Small children need a higher urine output target than adults. 0.5 mL/kg/hour is the adult target and would accept under-resuscitation in a child.

9. A 2-year-old has burns of both feet and lower legs with a sharp line at mid-calf, uniform depth, and no splash marks. This pattern is most consistent with:

   1. A. Forced immersion in hot water
   2. B. Accidentally pulling a pot down
   3. C. Stepping on a hot surface once
   4. D. A flash burn from a stove
   Show answer

   Answer: A. Forced immersion in hot water

   Stocking-pattern burns with clear margins and no splashes suggest the child was held in hot water. Accidental spills cause irregular splash marks and varying depth.

10. A 3-year-old has a scald of the buttocks and perineum with a spared, unburned circle in the center of the buttocks. This 'doughnut' pattern suggests:

    1. A. A spill of hot coffee pulled from a table
    2. B. The child was held against a cool tub bottom
    3. C. A splash of hot water from the running faucet
    4. D. Sitting on a hot car seat in summer
    Show answer

    Answer: B. The child was held against a cool tub bottom

    Skin pressed against the tub floor is spared while surrounding skin is scalded. This is a classic sign of forced immersion abuse. A spill or splash leaves irregular splash marks, and a contact burn from a seat burns the skin that touched it rather than sparing the center.

11. Small, round burns about 8 to 10 mm across on a child's back and hands are most suspicious for:

    1. A. Impetigo or insect bites
    2. B. Accidental curling iron burns
    3. C. Intentional cigarette burns
    4. D. Chickenpox lesions
    Show answer

    Answer: C. Intentional cigarette burns

    Cigarette burns are uniform, round, and often in clusters. Impetigo can mimic them but is usually crusted and irregular; the pattern and history should prompt a report.

12. Which history finding most strongly suggests that a child's burn was inflicted?

    1. A. Delayed care and a changing story
    2. B. A prompt call to 911 by the parent
    3. C. A clear story that matches the injury
    4. D. A burn on the palm from touching a stove
    Show answer

    Answer: A. Delayed care and a changing story

    Delay in care and inconsistent histories are red flags for abuse. A toddler grabbing a hot stove often burns the palm, which fits an accidental mechanism.

13. When you suspect that a child's burn was intentional, you should:

    1. A. Confront the caregiver at the scene
    2. B. Avoid mentioning it to hospital staff
    3. C. Ask the child to name the abuser
    4. D. Document and report as required
    Show answer

    Answer: D. Document and report as required

    Paramedics are mandated reporters in most areas; record findings and statements factually and notify the hospital and proper agency. Confrontation can make the scene unsafe.

14. Older adults with burns have higher mortality than younger adults mainly because of:

    1. A. Thicker skin that hides the burn depth
    2. B. Higher rates of inhalation injury
    3. C. Faster healing of deep wounds in old age
    4. D. Thin skin and less reserve
    Show answer

    Answer: D. Thin skin and less reserve

    Thin skin makes burns deeper, and heart, lung, and kidney disease limit tolerance of shock and fluids. Older adults heal more slowly and are more prone to infection. Skin thins rather than thickens with age, and inhalation injury is not the main reason for their higher mortality.

15. An 82-year-old with heart failure has 25% TBSA burns and is receiving fluids by the burn formula. Compared with a younger patient, you should be especially alert for:

    1. A. Fluid overload with crackles and dyspnea
    2. B. A need for much more fluid than calculated
    3. C. Faster healing that shortens the stay
    4. D. Lower risk of death for the same burn
    Show answer

    Answer: A. Fluid overload with crackles and dyspnea

    Older adults and those with heart failure tolerate fluid poorly, so they can develop pulmonary edema during resuscitation; titrate to urine output and reassess lung sounds and breathing often. They also have higher, not lower, mortality and slower healing. The formula is a starting estimate, not a target to exceed.

16. A 70-year-old woman on home oxygen has burns of her face and nostrils after lighting a cigarette. Besides her airway, you should:

    1. A. Increase her oxygen flow rate
    2. B. Remove all of her clothing at the scene
    3. C. Turn off the oxygen source at the scene
    4. D. Apply ointment to her face
    Show answer

    Answer: C. Turn off the oxygen source at the scene

    Oxygen feeds the fire and can reignite flammable material. Smoking while using home oxygen is a common cause of facial burns in older adults.

17. For a patient with facial burns and no suspected spinal injury, transport positioning should include:

    1. A. Lying flat with the legs raised
    2. B. Elevating the head about 30 degrees
    3. C. The prone position
    4. D. Trendelenburg to protect the airway
    Show answer

    Answer: B. Elevating the head about 30 degrees

    Head elevation limits facial and airway edema. Trendelenburg increases head and neck swelling and is not used.

18. A pregnant woman at 30 weeks with 25% TBSA burns is hypotensive. The best way to protect the fetus is to:

    1. A. Prioritize fetal monitoring over fluids
    2. B. Limit fluids to protect the fetus
    3. C. Position her flat on her back
    4. D. Resuscitate the mother; tilt her left
    Show answer

    Answer: D. Resuscitate the mother; tilt her left

    Fetal survival depends on maternal oxygenation and perfusion. Left uterine displacement prevents aortocaval compression, and fluids should not be withheld.

19. During transport of a major burn patient, which finding should be documented and reported to the burn center as it guides fluid timing?

    1. A. The time the call was received
    2. B. The time IV access was obtained
    3. C. The time the burn occurred
    4. D. The time the patient arrived
    Show answer

    Answer: C. The time the burn occurred

    Fluid calculations count from the time of injury, not the time care started. Reporting the call time or IV time would shift the 8-hour window.

20. A child with a 20% TBSA scald is shivering during transport. The best action is to:

    1. A. Continue cooling the burns with water
    2. B. Cover her and warm the cab
    3. C. Remove the dressings to release heat
    4. D. Apply ice packs to reduce the pain
    Show answer

    Answer: B. Cover her and warm the cab

    Shivering signals hypothermia, which worsens outcomes. Cooling should have been brief; now the priority is keeping her warm.

21. A man with 30% TBSA burns has a 3-hour ground transport to the burn center. A helicopter is available and would take 45 minutes. The main advantage of air transport is:

    1. A. Faster arrival at definitive burn care
    2. B. Cabin pressure that limits airway swelling
    3. C. Cooler cabin air that eases burn pain
    4. D. Room to start fluids after liftoff
    Show answer

    Answer: A. Faster arrival at definitive burn care

    Long ground times delay definitive care and resuscitation. Air transport is appropriate when it substantially shortens time to the burn center. Cabin pressure does not limit airway swelling, cooling a large burn risks hypothermia, and fluids can be started in either vehicle.

22. A 20-kg 6-year-old has 20% TBSA partial-thickness scalds. Using the ABA pediatric formula of 3 mL/kg/%TBSA, the volume due in the first 8 hours after the burn (not counting maintenance fluid) is:

    1. A. 1,200 mL
    2. B. 400 mL
    3. C. 800 mL
    4. D. 600 mL
    Show answer

    Answer: D. 600 mL

    3 mL x 20 kg x 20 = 1,200 mL for 24 hours, and half, 600 mL, is given in the first 8 hours. 1,200 mL is the full 24-hour amount, and 800 mL is what the old 4 mL/kg formula would give for the first 8 hours.

23. Which feature best distinguishes an accidental spill scald from an immersion scald in a child?

    1. A. Sharp, uniform lines of demarcation
    2. B. Irregular margins with splash marks
    3. C. Uniform depth over the whole area
    4. D. Spared skin in the flexion creases
    Show answer

    Answer: B. Irregular margins with splash marks

    Spilled liquid flows and cools, causing irregular shapes, varied depth, and drip marks. Sharp lines, uniform depth, and spared creases suggest the child was held still in water.

24. A patient with burns of both hands should have the fingers dressed:

    1. A. Together in one tight dressing
    2. B. Without any covering at all
    3. C. Separately, with gauze between them
    4. D. With adhesive tape directly on burns
    Show answer

    Answer: C. Separately, with gauze between them

    Separating the fingers prevents burned surfaces from sticking together and allows for swelling. Tight dressings can act as a tourniquet as edema develops.

25. Compared with an adult with the same burn, a burned infant's airway is at greater risk because it:

    1. A. Is narrow, so small swelling obstructs it
    2. B. Is wider, so it collapses more easily
    3. C. Has mucosa that is more resistant to heat
    4. D. Cannot be intubated with any cuffed tube
    Show answer

    Answer: A. Is narrow, so small swelling obstructs it

    Airway resistance increases sharply as radius decreases, so a little edema can cause obstruction in a small child. Early, expert airway management is essential.