Burns: Initial Resuscitation Priorities - NCLEX-RN

Administer $100%$ humidified oxygen via nonrebreather. High-concentration oxygen therapy accelerates carboxyhemoglobin dissociation, improving oxygen delivery in carbon monoxide-exposed tissues.

Signs of inhalation injury (eg, stridor or hoarseness). These indicators suggest upper airway edema, which can rapidly progress to complete obstruction, necessitating proactive airway management.

Airway with cervical spine protection. This aligns with the ABC trauma priorities, ensuring airway patency while protecting against potential cervical spine injury in burn patients.

Diminished distal pulses or increasing pain/paresthesia. These signs indicate evolving compartment syndrome, prompting urgent escharotomy to restore perfusion and prevent tissue necrosis.

Intramuscular injections. Hypoperfusion and edema in burned areas lead to erratic drug uptake, making this route ineffective for pain control.

IV opioid analgesia (titrate to effect). Severe burns cause intense pain, and IV administration ensures rapid, titratable relief in hemodynamically unstable patients.

Neurovascular compromise from constricting eschar. Eschar restricts tissue expansion from edema, causing ischemia, which escharotomy relieves by incising the constricting tissue.

Cover with clean dry sheets and warm the environment/fluids. Burned skin impairs thermoregulation, so these measures minimize heat loss and maintain core temperature during resuscitation.

Continuous cardiac monitoring for dysrhythmias. Electrical injuries can cause myocardial damage, leading to arrhythmias, so monitoring enables early detection and intervention.

Remove rings and constricting items immediately. Edema can cause constriction, leading to ischemia, so early removal prevents circulatory compromise in affected limbs.

Stop the burning process and remove the source. Halting ongoing thermal injury prevents further tissue damage and stabilizes the patient for subsequent assessment.

Partial-thickness and full-thickness burns only. These deeper burns cause significant fluid loss and systemic response, unlike superficial burns which do not require resuscitation calculation inclusion.

Rule of Nines TBSA estimate. This method divides the body into multiples of 9% for quick TBSA approximation, essential for guiding fluid resuscitation volumes.

Intraosseous access. It allows immediate vascular access in unstable patients when peripheral veins are inaccessible due to burns or edema.

Two large-bore peripheral IVs through unburned skin. These provide rapid, reliable access for high-volume fluid infusion while avoiding complications from burned tissue.

Copious irrigation with water (unless contraindicated by agent). Irrigation dilutes and neutralizes the chemical agent, limiting ongoing tissue damage, except for agents like dry lime that react with water.

$1\ \text{mL/kg/hr}$. Higher output is targeted to flush myoglobin and prevent acute kidney injury from rhabdomyolysis in these high-risk cases.

$0.5\ \text{mL/kg/hr}$. This rate reflects adequate renal perfusion and effective fluid resuscitation without overloading the cardiovascular system.

Greater than $20%$ TBSA. Burns exceeding this threshold cause significant fluid shifts, leading to hypovolemic shock requiring systematic IV resuscitation.

Give the remaining $$ over the next $16$ hours. Slower infusion over the subsequent period maintains volume replacement as capillary permeability begins to normalize.

Give $$ in the first $8$ hours from time of burn. Rapid initial infusion addresses the peak fluid shift and hypovolemia occurring in the first hours post-burn.

$4\ \text{mL} \times \text{kg} \times %\text{TBSA (partial/full thickness)}$. The Parkland formula calculates crystalloid needs based on burn size and weight to restore intravascular volume lost from capillary leak.

Lactated Ringer solution. This isotonic crystalloid minimizes acidosis risk compared to normal saline during large-volume resuscitation in hypovolemic burn shock.

Hydroxocobalamin. It binds cyanide to form cyanocobalamin, which is excreted renally, mitigating metabolic acidosis and toxicity from smoke inhalation.