Thermal Burn Management and Fluid Resuscitation Practice Questions

25 multiple-choice questions on Thermal burn management and fluid resuscitation 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. The first priority in caring for a patient whose clothing is still smoldering is to:

   1. A. Estimate the TBSA
   2. B. Stop the burning
   3. C. Start an IV line
   4. D. Apply sterile dressings
   Show answer

   Answer: B. Stop the burning

   Smoldering clothing and hot material keep injuring tissue. Assessment and IV access come after the burning is stopped and the scene is safe.

2. A man runs toward you with his shirt on fire. You should first:

   1. A. Have him stop, drop, and roll
   2. B. Let him run to the ambulance for water
   3. C. Pour saline on his face only
   4. D. Pull the burning shirt over his head
   Show answer

   Answer: A. Have him stop, drop, and roll

   Running fans the flames, and pulling burning fabric over the face can burn the airway. Smothering the fire on the ground stops it quickly.

3. A 25-year-old touched a hot pan 2 minutes ago and has a 1% partial-thickness burn on her hand. The best immediate treatment is:

   1. A. Ice applied directly
   2. B. Ice water immersion
   3. C. Butter or ointment
   4. D. Cool running water
   Show answer

   Answer: D. Cool running water

   Cool water stops ongoing heat injury and relieves pain. Ice causes vasoconstriction that can deepen the burn and adds cold injury.

4. Ice should not be applied to a burn because it:

   1. A. Removes the protective roof of each blister
   2. B. Reacts chemically with the burned proteins
   3. C. Can deepen injury and chill the patient
   4. D. Makes the burn margins hard to measure
   Show answer

   Answer: C. Can deepen injury and chill the patient

   Ice constricts vessels in the zone of stasis and promotes hypothermia. It does not react chemically with tissue.

5. Cooling of a large burn (for example, 40% TBSA) should be limited mainly to prevent:

   1. A. Hypothermia
   2. B. Infection
   3. C. Rhabdomyolysis
   4. D. Hyperkalemia
   Show answer

   Answer: A. Hypothermia

   Wetting large areas causes rapid heat loss, and hypothermia worsens coagulopathy and outcomes. Brief cooling to stop the burning is enough; then keep the patient warm.

6. A 28-year-old woman has 45% TBSA flame burns and you have finished cooling the hot areas. The best way to manage the wounds next is to:

   1. A. Keep the burns soaked in cool saline
   2. B. Cover with dry sheets and keep her warm
   3. C. Apply antibiotic ointment to all the burns
   4. D. Leave the wounds uncovered for airflow
   Show answer

   Answer: B. Cover with dry sheets and keep her warm

   Dry, clean coverings reduce contamination and heat loss. Keeping a large burn wet invites hypothermia, and ointments must be removed at the burn center.

7. The patient compartment of the ambulance during transport of a major burn patient should be:

   1. A. Cool to ease pain
   2. B. Room temperature only
   3. C. Warm
   4. D. As cold as possible
   Show answer

   Answer: C. Warm

   Burned patients cannot regulate heat, so a warm compartment helps prevent hypothermia. A cool environment may feel soothing but accelerates heat loss.

8. A roofer has hot tar stuck to his forearm. After cooling, the tar should be:

   1. A. Peeled off immediately in the field
   2. B. Scraped off with a tongue blade
   3. C. Dissolved off with gasoline
   4. D. Left for removal at the hospital
   Show answer

   Answer: D. Left for removal at the hospital

   Removing hardened tar tears off viable skin. Once cooled with water, it is later dissolved with petroleum-based ointments at the hospital; gasoline is toxic and flammable.

9. Under current ABA guidelines, the initial 24-hour fluid estimate for an adult with a thermal burn is:

   1. A. 4 mL/kg/%TBSA of normal saline
   2. B. 2 mL/kg/%TBSA of LR
   3. C. 1 mL/kg/%TBSA of D5W
   4. D. 3 mL/kg/%TBSA of albumin
   Show answer

   Answer: B. 2 mL/kg/%TBSA of LR

   The ABA now recommends starting at 2 mL/kg/%TBSA for adults to reduce over-resuscitation. The traditional Parkland formula used 4 mL/kg/%TBSA and often led to fluid creep.

10. Under current ABA guidelines, the initial 24-hour fluid estimate for a child with a thermal burn is:

    1. A. 2 mL/kg/%TBSA
    2. B. 4 mL/kg/%TBSA
    3. C. 6 mL/kg/%TBSA
    4. D. 3 mL/kg/%TBSA
    Show answer

    Answer: D. 3 mL/kg/%TBSA

    Children receive 3 mL/kg/%TBSA because of their higher surface area to mass, and small children also need maintenance fluid with dextrose. The adult value is 2 mL/kg/%TBSA.

11. Half of the calculated 24-hour burn fluid should be given within the first:

    1. A. 8 hours from hospital arrival
    2. B. 2 hours from the time of injury
    3. C. 8 hours from the time of injury
    4. D. 16 hours from the time of injury
    Show answer

    Answer: C. 8 hours from the time of injury

    Timing starts at the burn, not when care begins, because capillary leak starts immediately. The remaining half is given over the next 16 hours.

12. An 80-kg man has 30% TBSA partial- and full-thickness flame burns. Using the ABA adult formula, his estimated fluid for the first 24 hours is:

    1. A. 4,800 mL
    2. B. 9,600 mL
    3. C. 2,400 mL
    4. D. 7,200 mL
    Show answer

    Answer: A. 4,800 mL

    2 mL x 80 kg x 30 = 4,800 mL. 9,600 mL is the result of the older 4 mL Parkland formula.

13. For the same 80-kg man with 30% TBSA burns, the rate for the first 8 hours, if you start at the time of injury, is:

    1. A. 300 mL/hour
    2. B. 600 mL/hour
    3. C. 150 mL/hour
    4. D. 200 mL/hour
    Show answer

    Answer: A. 300 mL/hour

    Half of 4,800 mL is 2,400 mL over 8 hours, or 300 mL/hour. 200 mL/hour would spread the full 4,800 mL evenly over 24 hours, under-resuscitating the early phase.

14. A 70-kg woman has 40% TBSA burns. Using 2 mL/kg/%TBSA, she has 5,600 mL for 24 hours. You start fluids 2 hours after the burn. The rate for the rest of the first 8 hours is about:

    1. A. 350 mL/hour
    2. B. 700 mL/hour
    3. C. 233 mL/hour
    4. D. 467 mL/hour
    Show answer

    Answer: D. 467 mL/hour

    Half, 2,800 mL, is due within 8 hours of the burn, so it must run over the remaining 6 hours: 2,800 divided by 6 is about 467 mL/hour. 350 mL/hour ignores the 2 hours already lost.

15. Before the patient's weight and TBSA are known, ABLS suggests a starting fluid rate for an adult (14 years or older) with a major burn of:

    1. A. 125 mL/hour
    2. B. 500 mL/hour
    3. C. 250 mL/hour
    4. D. 1,000 mL/hour
    Show answer

    Answer: B. 500 mL/hour

    ABLS initial rates are 125 mL/hour for age 5 and under, 250 mL/hour for ages 6 to 13, and 500 mL/hour for 14 and older. The rate is then adjusted once the formula and urine output are known.

16. The preferred IV fluid for burn resuscitation is:

    1. A. Normal saline
    2. B. D5W
    3. C. Lactated Ringer's
    4. D. Hypertonic saline
    Show answer

    Answer: C. Lactated Ringer's

    Lactated Ringer's is balanced and avoids the hyperchloremic acidosis caused by large volumes of normal saline. D5W does not stay in the vascular space.

17. A 70-kg man with 35% TBSA burns is receiving fluids by the ABA formula. His heart rate is 118 and his urine output is 45 mL/hour. You should:

    1. A. Continue the current fluid rate
    2. B. Double the rate for the tachycardia
    3. C. Give a 1-L bolus immediately
    4. D. Stop the fluids to limit edema
    Show answer

    Answer: A. Continue the current fluid rate

    45 mL/hour is about 0.6 mL/kg/hour, which meets the adult target of 0.5 mL/kg/hour. Tachycardia is expected from pain and stress, so chasing the heart rate with boluses causes fluid creep.

18. The target urine output for an adult with thermal burns is about:

    1. A. 0.1 mL/kg/hour
    2. B. 0.5 mL/kg/hour
    3. C. 2 mL/kg/hour
    4. D. 5 mL/kg/hour
    Show answer

    Answer: B. 0.5 mL/kg/hour

    ABLS sets the adult target at 0.5 mL/kg/hour, about 30 to 50 mL/hour, and the infusion is adjusted up or down to stay near it. 0.1 mL/kg/hour is oliguria and signals under-resuscitation. 2 mL/kg/hour in an adult with a thermal burn means too much fluid is running, which drives edema and fluid creep, and 5 mL/kg/hour is far beyond any target.

19. Giving much more fluid than the formula calls for, known as fluid creep, can cause:

    1. A. Less upper airway swelling
    2. B. Shrinking of the burn wound edema
    3. C. Abdominal compartment syndrome
    4. D. Improved healing of the burn wound
    Show answer

    Answer: C. Abdominal compartment syndrome

    Excess fluid worsens edema, causing abdominal and extremity compartment syndromes and pulmonary edema. It increases rather than reduces airway and wound swelling and does not improve healing. The formula is a starting point, adjusted to urine output, not a minimum to exceed.

20. A 35-year-old man with 25% TBSA burns needs IV access, but his only unburned extremity is his left leg, which has a deformed fracture. You may:

    1. A. Withhold fluids until hospital arrival
    2. B. Give fluids by mouth instead
    3. C. Use an IO in the fractured leg
    4. D. Use burned skin as an IV site
    Show answer

    Answer: D. Use burned skin as an IV site

    An IV may be placed through burned tissue when no unburned site is available, or an IO can be used in an uninjured bone. An IO in a fractured bone will leak and is contraindicated.

21. Pain medication for a patient with a major burn should be given:

    1. A. IV in small titrated doses
    2. B. IM into an unburned area
    3. C. By mouth with water
    4. D. Only after hospital arrival
    Show answer

    Answer: A. IV in small titrated doses

    Poor tissue perfusion makes IM absorption unpredictable, so IV (or IO, or intranasal) titration works best. Withholding analgesia is not justified; burns are among the most painful injuries.

22. A 70-kg woman has painful partial-thickness burns of 15% TBSA. Her BP is 128/80 mmHg. A typical initial dose of fentanyl is:

    1. A. 10 mcg/kg IV, about 700 mcg
    2. B. 0.1 mcg/kg IV, about 7 mcg
    3. C. 1 mg/kg IV, about 70 mg
    4. D. 1 mcg/kg IV, about 70 mcg
    Show answer

    Answer: D. 1 mcg/kg IV, about 70 mcg

    Fentanyl 1 mcg/kg titrated to effect is a common prehospital starting dose; follow local protocol. 10 mcg/kg is ten times too much and risks apnea.

23. A 5-year-old has painful partial-thickness scalds and no IV access yet. A reasonable option for early pain control is:

    1. A. IM morphine in the burned thigh
    2. B. Intranasal fentanyl
    3. C. Oral acetaminophen with water
    4. D. No medication until IV access
    Show answer

    Answer: B. Intranasal fentanyl

    Intranasal fentanyl works quickly without an IV and is widely used for pediatric burn pain. IM injection into burned tissue is poorly absorbed and painful.

24. A 30-year-old spilled boiling water on her forearm 10 minutes ago, causing a 2% partial-thickness burn. She has no other injuries. For how long should the burn be cooled with cool running water?

    1. A. About 1 minute
    2. B. Until the area turns numb
    3. C. About 20 minutes
    4. D. Until she reaches the hospital
    Show answer

    Answer: C. About 20 minutes

    For a small burn, about 20 minutes of cool (not ice-cold) running water, started as soon as possible and still useful up to about 3 hours after injury, relieves pain and limits progression of the zone of stasis; this is the duration recommended by international burn first-aid guidance and supported by pediatric outcome data. One minute stops the surface heat but gives little benefit for depth or pain. Cooling until the skin is numb risks cold injury and vasoconstriction. Cooling all the way to the hospital is unnecessary for a small burn, and on larger burns invites hypothermia; once cooled, cover the burn and keep the patient warm.

25. A 60-kg patient with 15% TBSA partial-thickness burns of the legs, no inhalation injury, and stable vitals is 15 minutes from the hospital. Regarding IV fluid, you should:

    1. A. Infuse 2 L rapidly before arrival
    2. B. Give 4 mL/kg/%TBSA by bolus
    3. C. Start an IV and run at a modest rate
    4. D. Start no line because fluids are harmful
    Show answer

    Answer: C. Start an IV and run at a modest rate

    Formal burn resuscitation is generally reserved for burns of 20% TBSA or more in adults; a smaller burn needs access and modest fluid. Large boluses for a stable patient contribute to fluid creep.