Medical Emergencies

Question 1

Criteria for a major thermal burn

Answer 1

✓ Partial thickness burns greater than 10% TBSA

✓ Burns that involve the face, hands, feet, genitalia, perineum, or major joints

✓ Third-degree burns in any age-group

✓ Electrical burns, including lightning injury

✓ Chemical burns

✓ Inhalation injury

Question 2

Care for client with major thermal burn

Answer 2

• Assess the client’s airway, breathing, and circulation and obtain vital signs (crucial in determining the client’s hemodynamic status)
• Administer supplemental oxygen if indicated and cover burns with sterile gauze (remove any jewelry to affected extremities as swelling is likely to occur. Keeping the wound covered with sterile gauze will reduce infection)
• Establish a large bore peripheral vascular access device to unburned skin (essential to obtain blood for laboratory work and to provide fluids. An isotonic fluid replacement will be necessary for such a significant thermal burn)
• Administer prescribed isotonic fluids intravenously to maintain fluid balance (isotonic fluid replacement will be necessary)
• Insert an indwelling urinary catheter to maintain urinary output 0.5 mL/kg/hr (needs to occur after administering the IV fluids because the administration of these fluids is crucial to maintaining the client’s hemodynamic stability)
• Administer tetanus prophylaxis as prescribed (the wound bed serves as a reservoir for the client getting this bacterial infection)

Question 3

Evacuating clients from a fire

Answer 3

• Evacuate the client who is in immediate danger (the client closest to the fire)
• Once that has been completed, the nurse should evacuate the most ambulatory client (require fewer resources and can be speedily evacuated)
• Critical clients (those on a ventilator) will require the most resources. If they are not in immediate danger of fire/ smoke, these critical patients should be kept in a closed room and can be safely evacuated last.