Burns and Burn Injury Q 72

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Nurse Rodrigo is receiving an endorsement from the burn unit. Which of the following clients should he assess first?

  

    A. A client who has just been transferred from the PACU after having allograft.

    B. A client admitted 1 week ago with a superficial-thickness burn on the buttocks which has been waiting for 2 hours to receive discharge instructions.

    C. A client who has just arrived from the emergency department with burns on the neck and chest.

    D. A client with deep partial-thickness burns on both thighs who is complaining of severe and continuous pain.

    

    

Correct Answer: C. A client who has just arrived from the emergency department with burns on the neck and chest.

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Burns of the neck and chest are associated with inflammation and swelling of the airway. Hence this patient requires the most immediate attention. Although a patient may be capable of spontaneous breathing in the early hours after a burn, compromise of the airway can still develop. This may be due to external pressure on the airway, with edema developing in the head and neck region, or in the upper airway due to inhalation of hot gases, including steam or aspiration of hot liquids.

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Option A: Split-thickness grafts can cover the extensive defects created after scar release. These grafts will need meticulous attention to achieve complete and early wound closure, but thereafter prolonged splinting will be important to maintain release and prevent contracture.

Option B: In the superficial burn, wound dressings suffice. These can be biological or synthetic. Some medicated elements can prevent secondary infection. Superficial facial wounds can also be treated exposed, with or without the application of topical ointments.

Option D: Opioids may be given to this patient. These burns need to be shaved to preserve residual elements capable of regeneration. Burns of the face and neck rarely fall into aesthetic units, and professional judgment must determine how the excision should be performed. Grafting should be in aesthetic units if at all possible, and sheet grafts should be used on the face.

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