HM2 ADVANCEMENT 2026 EXAM SCRIPT QUESTIONS AND
SOLUTIONS GRADED A+
✔✔Calculation of 5% Albumin Volume - ✔✔(*mL) × (%TBSA burned) × (preburn weight,
kg)
%TBSA 30-49 use 0.3ml
%TBSA 50-69 use 0.4ml
%TBSA 70+ use 0.5ml
For example, in a burn of approximately 40% in an 80-kg patient:
Albumin volume = (*mL) × (40%) × (80 kg) = (0.3) × (3,200) = 960 mL/24 h = 40 mL/h.
✔✔Silver Nylon Dressings can be left in place for - ✔✔72hrs
✔✔Topical Antimicrobial Solutions and Creams for Burns - ✔✔-5% Aqueous Mafenide
Acetate (Sulfamylon)
-1% Silver Sulfadiazine (Silvadene)
-8.5% Mafenide Acetate (Sulfamylon)
✔✔Tx for Corneal Abrasions in Burn Pts - ✔✔Gentamicin or a quinolone q4hrs
alternating with erythromycin q4hrs
✔✔Erythema extending beyond 1cm around the burn wound margin -
✔✔Representative of gram-positive cellulitis (beta-hemolytic streptococcus or
staphylococcus)
✔✔Extremity Burn Care - ✔✔o Elevate.
o Exercise burned extremities hourly.
o Evaluate pulses and neurological status hourly.
o Perform escharotomy as indicated.
✔✔If increasing hydration fails to result in a progressive clearing of the urinary
pigmenturia over a period of 3-4 hours - ✔✔Add 12.5 g mannitol to each liter of LR
infused
✔✔First-aid treatment of casualties with imbedded phosphorus particles - ✔✔copious
water irrigation and placement of a saline-soaked dressing that must be kept
continuously wet.
✔✔Nerve Agent MOA - ✔✔block the action of the enzyme acetylcholinesterase (AChE).
The normal function of acetylcholinesterase is to break down (hydrolyze) the chemical
messenger, or neurotransmitter, acetylcholine (ACh).
, ✔✔Cholinergic Crisis - ✔✔Nerve agents act directly upon AChE. When a nerve agent
inhibits AChE, it cannot perform its normal function of hydrolyzing ACh. ACh then
accumulates, and the target cell's action continues uncontrolled.
✔✔Nerve Agents Effect on Eyes - ✔✔The main effect of the agent is to cause miosis, or
pinpointing of the pupils, unresponsive to light or darkness. Pinpoint pupils cause a
complaint of dim vision that is more pronounced in low light conditions; Soldiers may
complain that everything "looks black," even in the middle of the day, eyes may be
reddened.
✔✔Nerve Agents Effect on Nose and Mouth - ✔✔Even after low concentrations of
agent, runny nose (rhinorrhea) may be severe. The mouth will secrete saliva so copious
that watery secretions run out the corners of the mouth.
✔✔Nerve Agents Effect on Respiratory Tract - ✔✔Excessive ACh stimulates the
muscles in the airways to contract and constrict the airways (bronchoconstriction). As
the concentration increases, breathing difficulty will become severe (feeling like a
severe asthma attack). Excessive bronchial and upper airway secretions (bronchorrhea)
caused by stimulation of the airway glands by the excessive ACh will compound
breathing difficulty. These secretions can obstruct the airway and cause difficulty in
moving air into and out of the lungs.
✔✔Nerve Agents Effect on GI Tract - ✔✔Nausea and vomiting may also be the first
effects from liquid nerve agent exposure on the skin. The patient may also complain of
"heartburn" and pain in the abdomen, and he or she may belch frequently and have
diarrhea or involuntary defecation and urination.
✔✔Nerve Agents Effect on Cardiac Muscle - ✔✔The heart rate can either increase or
decrease after nerve agent exposure.
✔✔Nerve Agents Effect on Sweat Glands - ✔✔When penetration occurs after either
liquid or vapor exposure, localized sweating occurs and progressively spreads over the
surrounding skin area as nerve agent is absorbed.
✔✔Nerve Agents Effect on Skeletal Muscles - ✔✔The muscles may show a rippling
effect (fasciculation). As the nerve agent effect progresses, muscles can go into a
prolonged contraction. The hyperactivity of the muscles in these instances leads to
muscle fatigue and flaccid paralysis.
✔✔Nerve Agents Effect on CNS - ✔✔The Soldier almost immediately loses
consciousness, followed seconds later by seizure activity.
✔✔Nerve Agent Tx - ✔✔Atropine is the drug of choice for treating nerve agent
poisoning. Atropine will not relieve miosis, muscle twitching, or spasms, or increase
diaphragm effort.
SOLUTIONS GRADED A+
✔✔Calculation of 5% Albumin Volume - ✔✔(*mL) × (%TBSA burned) × (preburn weight,
kg)
%TBSA 30-49 use 0.3ml
%TBSA 50-69 use 0.4ml
%TBSA 70+ use 0.5ml
For example, in a burn of approximately 40% in an 80-kg patient:
Albumin volume = (*mL) × (40%) × (80 kg) = (0.3) × (3,200) = 960 mL/24 h = 40 mL/h.
✔✔Silver Nylon Dressings can be left in place for - ✔✔72hrs
✔✔Topical Antimicrobial Solutions and Creams for Burns - ✔✔-5% Aqueous Mafenide
Acetate (Sulfamylon)
-1% Silver Sulfadiazine (Silvadene)
-8.5% Mafenide Acetate (Sulfamylon)
✔✔Tx for Corneal Abrasions in Burn Pts - ✔✔Gentamicin or a quinolone q4hrs
alternating with erythromycin q4hrs
✔✔Erythema extending beyond 1cm around the burn wound margin -
✔✔Representative of gram-positive cellulitis (beta-hemolytic streptococcus or
staphylococcus)
✔✔Extremity Burn Care - ✔✔o Elevate.
o Exercise burned extremities hourly.
o Evaluate pulses and neurological status hourly.
o Perform escharotomy as indicated.
✔✔If increasing hydration fails to result in a progressive clearing of the urinary
pigmenturia over a period of 3-4 hours - ✔✔Add 12.5 g mannitol to each liter of LR
infused
✔✔First-aid treatment of casualties with imbedded phosphorus particles - ✔✔copious
water irrigation and placement of a saline-soaked dressing that must be kept
continuously wet.
✔✔Nerve Agent MOA - ✔✔block the action of the enzyme acetylcholinesterase (AChE).
The normal function of acetylcholinesterase is to break down (hydrolyze) the chemical
messenger, or neurotransmitter, acetylcholine (ACh).
, ✔✔Cholinergic Crisis - ✔✔Nerve agents act directly upon AChE. When a nerve agent
inhibits AChE, it cannot perform its normal function of hydrolyzing ACh. ACh then
accumulates, and the target cell's action continues uncontrolled.
✔✔Nerve Agents Effect on Eyes - ✔✔The main effect of the agent is to cause miosis, or
pinpointing of the pupils, unresponsive to light or darkness. Pinpoint pupils cause a
complaint of dim vision that is more pronounced in low light conditions; Soldiers may
complain that everything "looks black," even in the middle of the day, eyes may be
reddened.
✔✔Nerve Agents Effect on Nose and Mouth - ✔✔Even after low concentrations of
agent, runny nose (rhinorrhea) may be severe. The mouth will secrete saliva so copious
that watery secretions run out the corners of the mouth.
✔✔Nerve Agents Effect on Respiratory Tract - ✔✔Excessive ACh stimulates the
muscles in the airways to contract and constrict the airways (bronchoconstriction). As
the concentration increases, breathing difficulty will become severe (feeling like a
severe asthma attack). Excessive bronchial and upper airway secretions (bronchorrhea)
caused by stimulation of the airway glands by the excessive ACh will compound
breathing difficulty. These secretions can obstruct the airway and cause difficulty in
moving air into and out of the lungs.
✔✔Nerve Agents Effect on GI Tract - ✔✔Nausea and vomiting may also be the first
effects from liquid nerve agent exposure on the skin. The patient may also complain of
"heartburn" and pain in the abdomen, and he or she may belch frequently and have
diarrhea or involuntary defecation and urination.
✔✔Nerve Agents Effect on Cardiac Muscle - ✔✔The heart rate can either increase or
decrease after nerve agent exposure.
✔✔Nerve Agents Effect on Sweat Glands - ✔✔When penetration occurs after either
liquid or vapor exposure, localized sweating occurs and progressively spreads over the
surrounding skin area as nerve agent is absorbed.
✔✔Nerve Agents Effect on Skeletal Muscles - ✔✔The muscles may show a rippling
effect (fasciculation). As the nerve agent effect progresses, muscles can go into a
prolonged contraction. The hyperactivity of the muscles in these instances leads to
muscle fatigue and flaccid paralysis.
✔✔Nerve Agents Effect on CNS - ✔✔The Soldier almost immediately loses
consciousness, followed seconds later by seizure activity.
✔✔Nerve Agent Tx - ✔✔Atropine is the drug of choice for treating nerve agent
poisoning. Atropine will not relieve miosis, muscle twitching, or spasms, or increase
diaphragm effort.
