4.6 of 5 Ratings
A 27-year-old male presents to the emergency department after being brought in from a house fire. The patient has extensive burns covering his body and is conscious but in severe pain. The patient has a past medical history notable for marijuana use. He is not currently on any medications. Physical exam is notable for extensive burns covering the patients back, chest, thighs, and legs. The patient's oropharynx reveals no signs of damage or extensive smoke inhalation. The patient is breathing on his own and has normal breath sounds bilaterally. His temperature is 99.5°F (37.5°C), pulse is 145/min, blood pressure is 100/70 mmHg, respirations are 27/min, and oxygen saturation is 93% on room air. Which of the following interventions is most likely to reduce mortality in this patient?
Normal saline soaked dressings
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A 13-year-old male is brought by ambulance to the ED with bilateral foot pain. He reports making footprints on some freshly laid sidewalk cement the day before with his friends. He states that his jeans' heels were slightly soaked, and that he did not attempt to wash the cement off of them. On physical exam, there is marked tissue necrosis on both ankles extending down to the bone in some places (Figure A). Which chemical was this patient most likely exposed to?
A 45-year-old male comes into the trauma bay by EMS transport with a known history of gross contamination of an unknown dry/powder chemical from a research laboratory accident. Currently his vital signs are stable but he is in obvious discomfort with diffuse skin irritation. What should be done for this patient during the primary survey?
Take a sample of the unknown substance and send it to the lab for stat identification
Sedate and intubate the patient for concern of poor airway protection
Dilute the unknown substance load by washing the patient off in a chemical burn shower
Brush off the gross amount of unknown chemical and then remove all of the patient's clothes
Cover the patient's skin burns with topical mineral oil
A 35-year-old man is brought to the emergency department from a kitchen fire. The patient was cooking when boiling oil splashed on his exposed skin. His temperature is 99.7°F (37.6°C), blood pressure is 127/82 mmHg, pulse is 120/min, respirations are 12/min, and oxygen saturation is 98% on room air. He has dry, nontender, and circumferential burns over his arms bilaterally, burns over the anterior portion of his chest and abdomen, and tender spot burns with blisters on his shins. A 1L bolus of normal saline is administered and the patient is given morphine and his pulse is subsequently 80/min. A Foley catheter is placed which drains 10 mL of urine. What is the best next step in management?
Additional fluids and admission to the ICU
Additional fluids, escharotomy, and admission to the ICU
Continuous observation in the emergency department
Moist dressings and discharge
A 34-year-old woman is brought into the emergency department by emergency medical services after an electrical fire in her apartment. She is coughing with an O2 saturation of 98%, on 2L of nasal cannula. The patient's physical exam is significant for a burn on her right forearm that appears to be dry, white, and leathery in texture. Her pulses and sensations are intact in all extremities. The patient's vitals are HR 110, BP 110/80, T 99.2, RR 20. She has no evidence of soot in her mouth and admits to leaving the room as soon as the fire started. Which is the following is the best treatment for this patient?
Excision and grafting
A 60-year-old patient comes into your clinic with a new concern. He states that about 20 years ago, he was shot in his right quadriceps while serving in the military. Since then, he has had a wound that partially heals, but has never closed completely. Now, the patient describes the wound as somewhat different. He states it is ulcerated with elevated edges and has been bleeding. You perform a full thickness biopsy of the lesion as shown in Figure A. What is the most likely diagnosis?
Basal cell carcinoma
Squamous cell carcinoma