Burns and Bites
A patient has a dry, leathery, painless burn with visible subcutaneous tissue. Name the burn depth.
What is a full-thickness (third-degree) burn?
Rationale: Full-thickness burns destroy the epidermis and dermis and may extend into subcutaneous tissue. The center may be painless because nerve endings are destroyed, although surrounding areas can remain painful.
A marathon runner is sweating heavily, feels weak and dizzy, has cool clammy skin, and remains mentally alert. Identify the condition.
What is heat exhaustion?
Rationale: Heat exhaustion results from fluid and electrolyte loss. Move the patient to a cool area, remove excess clothing, cool the skin, and give oral electrolyte fluids if alert and not vomiting; use IV isotonic fluids when indicated.
After a drowning rescue, the patient is coughing and hypoxic. What is the first nursing priority?
What is support of airway, oxygenation, and ventilation?
Rationale: Hypoxemia is the major immediate threat after drowning. Begin high-concentration oxygen, suction as needed, assist ventilation, and prepare for advanced airway support while preventing heat loss and monitoring for pulmonary edema.
After head trauma, a patient becomes increasingly drowsy, develops a unilateral dilated pupil, and shows weakness on the opposite side. What complication is suspected?
What is expanding intracranial hemorrhage with brain herniation?
Rationale: Declining level of consciousness, anisocoria, and focal deficits are neurologic red flags. Protect the airway, maintain oxygenation and perfusion, elevate the head as appropriate, avoid hypotension, and obtain immediate trauma/neurosurgical evaluation.
Several people develop fever, cough, and dyspnea days after an intentional aerosol release; person-to-person spread is possible. What type of disaster is this?
What is a biologic disaster?
Rationale: Biologic agents may have delayed, nonspecific presentations and can spread before recognition. Surveillance, isolation based on transmission, PPE, public-health notification, prophylaxis or treatment, and exposure tracking are central responses.
Using the Parkland formula, calculate the total lactated Ringer’s volume for the first 24 hours for an 80-kg adult with 30% TBSA burns.
What is 9,600 mL in the first 24 hours?
Rationale: Parkland formula: 4 mL × 80 kg × 30 = 9,600 mL. Give 4,800 mL during the first 8 hours from the time of injury and 4,800 mL during the next 16 hours. Titrate to clinical response and urine output per protocol.
A construction worker has a core temperature of 40.6°C (105.1°F), hot skin, confusion, and ataxia. State the priority treatment.
What is immediate rapid cooling for heat stroke?
Rationale: Heat stroke is defined by severe hyperthermia with CNS dysfunction. Begin rapid active cooling immediately while supporting airway, breathing, circulation, glucose, electrolytes, renal function, and coagulation. Antipyretics do not correct environmental heat stroke.
A rescued swimmer initially feels better after oxygen. Why is continued observation still necessary?
What is delayed respiratory deterioration from aspiration-related lung injury or pulmonary edema?
Rationale: Aspiration can cause inflammation, impaired gas exchange, and ARDS that evolves over time. Reassess oxygen saturation, work of breathing, lung sounds, ABGs as indicated, mental status, and chest findings.
After blunt chest trauma, the patient is hypotensive with distended neck veins, muffled heart sounds, and clear lung sounds. Identify the emergency.
What is cardiac tamponade?
Rationale: Beck’s triad suggests tamponade, although all findings may not be present. Pericardial pressure reduces ventricular filling and cardiac output. Urgent decompression and surgical management are required while supporting ABCs.
After a radiologic dispersal event, what three principles reduce external radiation exposure?
What are time, distance, and shielding?
Rationale: Minimize time near the source, maximize distance, and use appropriate shielding. Remove contaminated clothing, bag it, survey the patient, and decontaminate while treating life-threatening injuries first.
This spider bite commonly causes immediate pain, muscle rigidity, abdominal cramping, diaphoresis, and hypertension.
What is a black widow bite?
Rationale: Black widow venom is neurotoxic and may produce severe muscle spasms and autonomic symptoms. Priorities include airway and vital-sign monitoring, analgesia, benzodiazepines for spasms as ordered, wound care, and antivenom consultation for severe cases.
During treatment of severe hyperthermia, which organ-system complications require close trending even after the temperature improves?
What are rhabdomyolysis/acute kidney injury, hepatic injury, electrolyte abnormalities, and DIC?
Rationale: Heat stroke can trigger multisystem injury. Serial CK, creatinine, potassium, liver tests, coagulation studies, urine output, neurologic status, and cardiac rhythm help identify deterioration.
A family is found in a home with a faulty heater. They have headache, nausea, confusion, and normal-looking skin. Identify the poison and priority therapy.
What is carbon monoxide poisoning treated with 100% oxygen?
Rationale: Carbon monoxide binds hemoglobin and impairs oxygen delivery. Pulse oximetry can appear falsely reassuring. Give 100% oxygen and obtain carboxyhemoglobin; consult for hyperbaric oxygen when severe features or qualifying risks are present.
After abdominal trauma, a patient has left upper-quadrant pain, left shoulder pain, tachycardia, and falling blood pressure. Which organ is likely injured?
What is the spleen?
Rationale: Splenic injury can cause major internal hemorrhage. Kehr’s sign is referred pain to the left shoulder from diaphragmatic irritation. Priorities are hemorrhage recognition, large-bore IV access, blood preparation, rapid imaging or operative management, and frequent reassessment.
Victims near an industrial release have tearing, coughing, wheezing, and contaminated clothing. What action protects both the patient and hospital?
What is decontamination before entry into the clean treatment area?
Rationale: Chemical contamination can spread to staff and facilities. Use appropriate PPE, remove clothing, perform agent-appropriate decontamination, protect the airway, and avoid bringing contaminated patients directly into the emergency department.
This spider bite may begin with mild pain, then develop a pale or blistered center, a violaceous area, and progressive local necrosis.
What is a brown recluse bite?
Rationale: Brown recluse venom is cytotoxic and can cause dermonecrosis; systemic hemolysis is uncommon but serious. Clean the wound, apply cold packs intermittently, elevate the extremity, update tetanus status, and monitor for infection or systemic toxicity. Routine early excision is avoided.
A cold-exposed patient is shivering, confused, bradycardic, and has a core temperature of 31°C (87.8°F).What is this condition called?
What is moderate hypothermia?
Rationale: A core temperature of about 28–32°C is generally moderate hypothermia. Handle gently, prevent additional heat loss, use active external rewarming, consider warmed oxygen and IV fluids, and monitor continuously for dysrhythmias.
A farm worker has salivation, lacrimation, urination, diarrhea, bronchorrhea, bradycardia, and pinpoint pupils after pesticide exposure. Name the toxidrome and antidotes.
What is organophosphate/cholinergic poisoning treated with atropine and pralidoxime?
Rationale: Organophosphates inhibit acetylcholinesterase. Decontaminate safely while protecting staff, manage the airway and secretions, give atropine to reverse muscarinic effects, and give pralidoxime early to reactivate acetylcholinesterase as ordered.
A patient with a tibial fracture reports severe pain out of proportion to the injury and pain with passive toe movement. What complication is developing?
What is acute compartment syndrome?
Rationale: Pain out of proportion and pain with passive stretch are early findings. Paresthesia and tense swelling may follow; pulselessness is late. Remove external constriction, keep the limb near heart level, notify the surgeon immediately, and prepare for fasciotomy.
Following a major earthquake, which preparedness action most directly prevents the hospital from losing essential operations?
What is an all-hazards emergency operations plan with backup utilities, communications, supplies, and continuity procedures?
Rationale: Natural disasters disrupt transportation, power, water, communication, staffing, and supply chains. Practiced incident command, redundant systems, evacuation/shelter plans, and continuity procedures improve resilience.
One snake usually causes progressive swelling and coagulopathy, while the other may produce cranial nerve weakness and respiratory paralysis with little local injury. Name both.
What are rattlesnake and coral snake envenomation?
Rationale: Rattlesnake (pit viper) venom commonly causes local tissue injury, edema, bleeding, and coagulopathy. Coral snake venom is primarily neurotoxic and may cause delayed weakness and respiratory failure. Immobilize the limb, remove constricting items, avoid ice/tourniquets/cutting/suction, and obtain urgent poison-control and antivenom guidance.
Why should a severely hypothermic patient be moved gently and assessed for a pulse for longer than usual?
What is the risk of triggering ventricular dysrhythmias and the presence of profound bradycardia?
Rationale: The hypothermic myocardium is irritable, and rough movement can precipitate ventricular fibrillation. Pulse and respirations may be extremely slow, so assess carefully for up to 60 seconds while beginning appropriate resuscitative care.
An unresponsive patient has slow respirations and pinpoint pupils. Name the immediate antidote and the assessment priority that cannot wait.
What is naloxone, with immediate ventilation and airway support?
Rationale: Opioid poisoning causes life-threatening respiratory depression. Ventilate first, administer naloxone, reassess frequently, and repeat or infuse naloxone as ordered because its effect may wear off before the opioid’s effect.
A patient arrives with an object impaled in the chest. What should the nurse do with the object?
What is leave it in place and stabilize it?
Rationale: Removing an impaled object can release tamponade and worsen hemorrhage. Stabilize it with bulky dressings, control bleeding around it, assess ABCs, and prepare for removal in a controlled surgical setting.
During START triage, an adult is not breathing. After the airway is repositioned, the patient still does not breathe. Which tag is assigned?
What is black/expectant-deceased?
Rationale: In START, an apneic adult who remains apneic after airway repositioning is tagged black. This population-based approach directs limited resources toward patients with the greatest likelihood of survival.