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SU4.1-4 | Burns — Practice Quiz
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A 70 kg man sustains flame burns involving the whole of his anterior trunk, the whole of one entire upper limb, and the front and back of one entire lower limb. Using the Wallace Rule of Nines, what is his approximate percentage total body surface area (%TBSA) burned?
Correct. Anterior trunk 18% + whole upper limb 9% + whole lower limb (front and back) 18% = 36% TBSA.
Rule of Nines (adult): head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%. Only partial- and full-thickness burns count toward %TBSA.
Rule of Nines: anterior trunk = 18%, one whole upper limb = 9%, one whole lower limb (front + back) = 18%. Total = 18 + 9 + 18 = 36%.
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Using the Parkland formula, calculate the total crystalloid (Ringer's lactate) volume to be given in the first 24 hours to a 70 kg adult with 36% TBSA burns, and state how it is administered.
Correct. Parkland = 4 mL × 70 kg × 36 = 10,080 mL; give half (5,040 mL) in the first 8 hours calculated from the time of the burn, and the remaining half over the next 16 hours.
Parkland: 4 mL/kg/%TBSA of Ringer's lactate over 24 h; first half in 8 h FROM THE TIME OF THE BURN. Titrate to urine output 0.5–1 mL/kg/h.
Parkland formula = 4 mL × body weight (kg) × %TBSA = 4 × 70 × 36 = 10,080 mL. Crucially, the first half is given in the first 8 hours measured from the TIME OF THE BURN, not from arrival.
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A burned patient arrives at the emergency department three hours after the injury. Resuscitation has not yet started. When the Parkland regimen is begun, over how long should the first half of the calculated fluid now be infused?
Correct. The first 8-hour window runs from the time of the burn. Three hours have already passed, so the first half must be delivered over the remaining 5 hours.
Always time Parkland resuscitation from the moment of the burn. A delayed arrival compresses the time available to deliver the first half — never give it as one rapid catch-up bolus.
The Parkland clock starts at the moment of the burn, not at arrival. With 3 hours already elapsed, only 5 hours of the first 8-hour window remain to deliver the first half of the fluid.
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During fluid resuscitation of a major burn, which clinical end point is the best practical guide to the adequacy of resuscitation in an adult?
Correct. Hourly urine output of 0.5–1 mL/kg/h indicates adequate end-organ perfusion and is the standard bedside target to titrate burn fluid resuscitation.
Titrate burn fluids to urine output 0.5–1 mL/kg/h in adults — the formula gives the starting rate, the urine output guides adjustment up or down.
The Parkland volume is only a starting estimate; resuscitation is titrated to urine output of 0.5–1 mL/kg/h, the best practical marker of perfusion. Pain control and fixed rates are not resuscitation end points.
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In Jackson's burn-wound model, which zone is potentially salvageable and may either recover or progress to necrosis depending on the adequacy of resuscitation?
Correct. The zone of stasis surrounds the central coagulated tissue and has compromised but potentially recoverable perfusion; good resuscitation can save it, poor resuscitation lets it convert to necrosis.
Jackson's zones: coagulation (dead), stasis (salvageable — protect with good resuscitation, avoid hypotension), hyperaemia (recovers). Preventing stasis-zone conversion is a key goal of early burn care.
Jackson described three concentric zones: central coagulation (irreversibly dead), the surrounding zone of stasis (salvageable — at risk), and the outer zone of hyperaemia (will recover). The salvageable, at-risk tissue is the zone of stasis.
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A recently married young woman is admitted with extensive deep flame burns and gives an account that they were accidental. Regarding the doctor's medico-legal duty, which action is correct?
Correct. Serious burns in such circumstances are medico-legal cases: provide clinical care, intimate the police, obtain consent, and document contemporaneously in the patient's own words while remaining strictly non-accusatory.
Burns medico-legal care: care first, intimate police, obtain consent, document contemporaneously and factually (patient's own words, body-map), stay non-accusatory. A dying declaration may be recorded if the patient is conscious and competent.
Clinical care is never withheld. The doctor must treat the patient, treat it as a medico-legal case (intimate the police), and document factually and contemporaneously in the patient's own words — staying strictly non-accusatory and never recording personal conclusions of guilt.
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