Emergency Care in the Streets: Assessment in Action
By Nancy Caroline
You are dispatched to a private residence to care for an unconscious victim with possible smoke inhalation. You arrive on scene to find an 81-year-old woman outside being attended to by fire department personnel. The firefighters report that the patient was found on the floor in the kitchen by her grandson. The kitchen was full of smoke, and the grandson carried her outside. The patient is conscious but combative and asking repetitive questions. The firefighters transfer the patient to the ambulance, where you begin your assessment.
The patient’s blood pressure is 150/90 mm Hg, respirations are 18 breaths/min, heart rate is 110 beats/min, and pulse oximetry is 95% while breathing room air. You notice a significant amount of soot around the patient’s face, especially in the nostrils, mouth, and oral airway. The patient remains conscious but does not recognize her family and continues to ask repetitive questions. You insert an IV line, give lactated Ringer’s solution, and begin your transport to the local burn center, which is approximately 25 minutes away.
En route to the hospital, you sedate the patient and successfully intubate her with a 7.0 ET tube. You notice a significant amount of soot around the vocal cords. You transfer the patient to the emergency department. When doing your follow-up at the end of your shift, you are told the patient was admitted to the intensive care unit for respiratory failure secondary to an inhalation injury.
1. What type of burn is described in this scenario?
- A. Thermal burn
- B. Scald burn
- C. Contact burn
- D. Airway burn
2. Anyone exposed to smoke from a fire may have _____________ burns.
- A. thermal
- B. scald
- C. contact
- D. radiation
3. _______________ airway damage is more often associated with the inhalation of superheated gases.
- A. Upper airway
- B. Lower airway
- C. Upper and lower airway
- D. None of these
4. In the lower airway, ______________ and _______________ may result from heat inhalation.
- A. laryngospasm, pulmonary damage
- B. pulmonary damage, bronchospasm
- C. laryngospasm, bronchospasm
- D. mild, severe damage
5. True or false? If your patient greets you with a hoarse voice and a chief complaint of “trouble breathing,” your general impression should be that there is probably nothing wrong with this patient.
- A. True
- B. False
6. Combative patients should be considered:
- A. as having head trauma.
- B. intoxicated.
- C. diabetic.
- D. hypoxic.
7. __________________ can develop with alarming speed in burn patients, especially in infants and children.
- A. Laryngeal edema
- B. A pulmonary injury
- C. An inhalation burn
- D. Bronchial edema
8. After listening to lung sounds, you hear ________________. This may be a sign of impending upper airway compromise.
- A. wheezing
- B. stridor
- C. rhonchi
- D. rales
9. Burn patients fall into several general categories for airway management. They include:
- A. the patient with the acutely decompensating airway who requires field intubation.
- B. the patient with the deteriorating airway from burns and toxic inhalations.
- C. the patient with no signs of or risk factors for airway compromise who is in no distress.
- D. all of the above.
10. Approximately ___________ older adults die of fire-related causes each year, making it the sixth leading cause of death in this population group.
- A. 1,200
- B. 1,000
- C. 200
- D. 1,100
| Challenging Questions It is 2:00 AM and you are sent to a “structure fire.” On arrival, you hear the members of the fire department calling your name, stating they have a victim. The patient was inside the burning house and was standing on the roof when the firefighters arrived. Firefighters had the patient drop and roll. The patient is still smoldering and is in a great deal of pain. You call for a medical helicopter and transfer the patient to the landing zone. You estimate that the burn involves 30% of the TBSA.
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