EXAM ITLS: INTERNATIONAL TRAUMA
LIFE SUPPORT, 2025/2026 WITH
CORRECT/ACCURATE ANSWERS
Zone of coagulation
Portion of the skin that is necrosis by thermal insult
Zone of Stasis
Area around zone of coagulation. Blood flow is compromised and
tissues will die if blood flow is not restored
Zone of Hyperemia
Surround zone of stasis. There is increased blood flow to the
tissue as a result of inflammatory mediators.
First degree burn
Superficial burn of the outer epidermal layer. Causes intense pain
from the inflammatory response. Think Sunburn
Cause: Sun or minor flash
Skin colour: red
Skin surface: dry, no blisters
Sensation: painful
Healing: 3-6 days
Second degree burn
Partial thickness burn causing damage through the epidermis and
into variable depths of the dermis.
,Treatment: Cooling, covering with clean-dry dressing
Cause: Hot liquids, flashes, or flame
Skin colour: mottled red
Skin surface: blisters with evening
Sensation: painful
Healing: 2-4 weeks (depending on depth)
Third degree burn
Full thickness burn that damages all layers of the epidermis and
dermis. No more skin cells remain so healing is impossible. Skin
proteins can become denatured and hard, forming a firm, leather-
like covering that is referred to as Eschar.
Cause: Chemicals, electrical, flame, hot metals
Skin colour: pearly white and/or charred, translucent and
parchment-like
Skin surface: Dry with Thrombosed blood vessels
Sensation: Anesthetic with peripheral pain
Healing: requires skin grafting
Rules of 9s
Partial-thickness and full-thickness burned are used for this
calculation.
Note:
- The palmer surface one the patients hand (including the fingers)
= ~1% BSA
- for small children consider using a Lund and Browder chart.
Burn Unit admission guidelines
,- Partial-thickness greater than >10% TBSA
- Burn of face, hands, feet, genitalia, perineum, major joints
- Third degree burns
- Chemical burns
- Electrical burns
- Inhalation burns
- Preexisting medical disorders that could complicate
management
- With Burn + trauma patient consider which injury will result in
greatest mortality/morbidity and transport to that site
(trauma/burn capable site)
- Burned children in hospital without specialization
- Special social, emotional, long-term rehab interventions
Flash Burns
Virtually always superficial or partial-thickness burns. Typically
the face/hands are involved.
Inhalation Burns
Account for over half of burn related deaths. Caused by carbon
monoxide, heat inhalation, smoke inhalation injuries. Often Hx of
confined space. Flash explosions practically never cause
inhalation burns. Lower airways generally not affected due to
efficient cooling by most mucous membranes.
The loose mucosa in the supraglotic area (hypopharynx) swell and
can easily progress to complete airway obstruction. (Vocal cords
do not swell!) Hoarse voice and Stridor are indications for ETT.
Aggressive fluid resus can worsen edema.
Carbon Monoxide Poisoning
- Bound to hgb 257 times more than O2.
- Byproduct of combustion of common items.
, Carboxyhemoglobin levels
- 20%: Headache common, throbbing in nature, SOB on exertion
- 30%: Headache, Altered central nervous system with disturbed
judgement, irritability, dizziness, decreased vision
-40-50%: marked CNS alteration with confusion, collapse, fainting
with exertion
- 60-70%: Convulsions, LOC, apnea
-80%: Rapidly fatal.
Treatment:
- 100% Oxygenation
- RA = 7 hours to reverse CO poisoning
- 100% O2 = 90-120mins
- 100% O2 and Hyperbaric chamber = 30mins
Cyanide
Byproduct of plastic combustion. Causes cellular hypoxia by
preventing cells from using O2 to generate energy function.
Patients who do not responds to high flow O2 with suspected
carbon monoxide poisoning should be considered for cyanide
poisoning.
Cyanokit: Hydroxocobalamin is combines with cyanide to form
cyanocobalamin (vitamin B12)
Smoke inhalation
Inhaled toxic chemical cause structural damage to lung cells
(especially in the alveoli). Smoke from plastic and synthetic
product is the most damaging.
Chemical Injury
Factors that lead to tissue damage
- Concentration
- Amount
LIFE SUPPORT, 2025/2026 WITH
CORRECT/ACCURATE ANSWERS
Zone of coagulation
Portion of the skin that is necrosis by thermal insult
Zone of Stasis
Area around zone of coagulation. Blood flow is compromised and
tissues will die if blood flow is not restored
Zone of Hyperemia
Surround zone of stasis. There is increased blood flow to the
tissue as a result of inflammatory mediators.
First degree burn
Superficial burn of the outer epidermal layer. Causes intense pain
from the inflammatory response. Think Sunburn
Cause: Sun or minor flash
Skin colour: red
Skin surface: dry, no blisters
Sensation: painful
Healing: 3-6 days
Second degree burn
Partial thickness burn causing damage through the epidermis and
into variable depths of the dermis.
,Treatment: Cooling, covering with clean-dry dressing
Cause: Hot liquids, flashes, or flame
Skin colour: mottled red
Skin surface: blisters with evening
Sensation: painful
Healing: 2-4 weeks (depending on depth)
Third degree burn
Full thickness burn that damages all layers of the epidermis and
dermis. No more skin cells remain so healing is impossible. Skin
proteins can become denatured and hard, forming a firm, leather-
like covering that is referred to as Eschar.
Cause: Chemicals, electrical, flame, hot metals
Skin colour: pearly white and/or charred, translucent and
parchment-like
Skin surface: Dry with Thrombosed blood vessels
Sensation: Anesthetic with peripheral pain
Healing: requires skin grafting
Rules of 9s
Partial-thickness and full-thickness burned are used for this
calculation.
Note:
- The palmer surface one the patients hand (including the fingers)
= ~1% BSA
- for small children consider using a Lund and Browder chart.
Burn Unit admission guidelines
,- Partial-thickness greater than >10% TBSA
- Burn of face, hands, feet, genitalia, perineum, major joints
- Third degree burns
- Chemical burns
- Electrical burns
- Inhalation burns
- Preexisting medical disorders that could complicate
management
- With Burn + trauma patient consider which injury will result in
greatest mortality/morbidity and transport to that site
(trauma/burn capable site)
- Burned children in hospital without specialization
- Special social, emotional, long-term rehab interventions
Flash Burns
Virtually always superficial or partial-thickness burns. Typically
the face/hands are involved.
Inhalation Burns
Account for over half of burn related deaths. Caused by carbon
monoxide, heat inhalation, smoke inhalation injuries. Often Hx of
confined space. Flash explosions practically never cause
inhalation burns. Lower airways generally not affected due to
efficient cooling by most mucous membranes.
The loose mucosa in the supraglotic area (hypopharynx) swell and
can easily progress to complete airway obstruction. (Vocal cords
do not swell!) Hoarse voice and Stridor are indications for ETT.
Aggressive fluid resus can worsen edema.
Carbon Monoxide Poisoning
- Bound to hgb 257 times more than O2.
- Byproduct of combustion of common items.
, Carboxyhemoglobin levels
- 20%: Headache common, throbbing in nature, SOB on exertion
- 30%: Headache, Altered central nervous system with disturbed
judgement, irritability, dizziness, decreased vision
-40-50%: marked CNS alteration with confusion, collapse, fainting
with exertion
- 60-70%: Convulsions, LOC, apnea
-80%: Rapidly fatal.
Treatment:
- 100% Oxygenation
- RA = 7 hours to reverse CO poisoning
- 100% O2 = 90-120mins
- 100% O2 and Hyperbaric chamber = 30mins
Cyanide
Byproduct of plastic combustion. Causes cellular hypoxia by
preventing cells from using O2 to generate energy function.
Patients who do not responds to high flow O2 with suspected
carbon monoxide poisoning should be considered for cyanide
poisoning.
Cyanokit: Hydroxocobalamin is combines with cyanide to form
cyanocobalamin (vitamin B12)
Smoke inhalation
Inhaled toxic chemical cause structural damage to lung cells
(especially in the alveoli). Smoke from plastic and synthetic
product is the most damaging.
Chemical Injury
Factors that lead to tissue damage
- Concentration
- Amount
