Which of the following patients best fits the criteria for a critical burn?

Correct Answer: A

Rationale: The correct answer is A because a 10-year-old patient with superficial burns over 60% of the body is considered a critical burn due to the extent of body surface area involved and the age of the patient. Young children have less physiological reserve and are more prone to fluid loss and complications. Superficial burns over a large body surface area can lead to significant fluid loss, electrolyte imbalances, and potential systemic complications. Choice B is incorrect as full-thickness burns are more severe than superficial burns, but the extent of burns on the left upper/lower arm is limited compared to Choice A. Choice C is incorrect because although the patient has partial-thickness burns over 25% of the body, the age of the patient is not as critical as in Choice A. Choice D is incorrect for the same reasons as Choice C; the extent of burns is similar but the age of the patient is different, and the patient's age is a crucial factor in determining the severity of burns.

Correct Answer: C

Rationale: The correct answer is C: Control internal hemorrhage operatively. In cases of gunshot wounds to the abdomen, the priority is to control internal bleeding through surgical intervention. This is crucial to prevent hypovolemic shock and potential complications. Administering O-negative blood (choice A) is important for resuscitation but is not the definitive treatment. Applying external warming devices (choice B) is not the primary concern in this scenario. Using a pneumatic antishock garment (PASG) (choice D) may be used in some cases but is not the definitive treatment for managing internal hemorrhage. Operating to control the bleeding is essential for the patient's survival.

Correct Answer: D

Rationale: The correct answer is D: Endotracheal intubation and mechanical ventilation. In the case of a flail chest, where multiple ribs are fractured causing a segment of the chest wall to move independently from the rest of the thorax, the patient is at high risk of respiratory compromise. Endotracheal intubation and mechanical ventilation are necessary to ensure adequate oxygenation and ventilation, as the flail segment impairs the ability of the chest wall to expand effectively. High-flow oxygen via a nonrebreathing mask alone may not be sufficient to support the patient's respiratory needs. Choice A is incorrect because the patient's confusion is likely due to inadequate oxygenation and ventilation, not fluid resuscitation. Choice B is incorrect because cyanosis is a late sign of respiratory distress and should not be solely relied upon for management decisions. Choice C is incorrect as tachypnea is a compensatory mechanism and not a definitive management strategy for a flail chest.

Correct Answer: D

Rationale: The correct answer is D - Less brain contusions. The scenario described suggests a rapid deterioration in neurological status after an initial period of lucidity, indicating the possibility of a traumatic brain injury. The presence of a large left pupil suggests uncal herniation, which can be due to increased intracranial pressure from brain contusions. The sudden decline in GCS from 15 to 6 further supports this. The lack of focal neurological signs like flail chest or pulmonary contusion makes choices A and C less likely. Choice B is unrelated to the scenario provided. Therefore, the most likely explanation for the patient's worsening condition is the development of brain contusions leading to increased intracranial pressure and subsequent herniation.

Correct Answer: D

Rationale: Tension pneumothorax is a life-threatening condition caused by trapped air in the pleural space, leading to increased pressure in the chest cavity. "Flail chest" can result in lung puncture and subsequent pneumothorax. Cardiac tamponade can compress the heart and cause air to enter the pleural space. Clamping a chest tube can prevent air from escaping, leading to tension pneumothorax. Therefore, the correct answer is D, as all choices can potentially cause tension pneumothorax by different mechanisms.