A structure-fire patient forces decisions about airway timing, burn size, resuscitation, toxic combustion products and transfer. Commit first; feedback and teaching follow.
Single-best-answer decisions. Teaching remains hidden until an answer is selected.
A 46-year-old man is rescued from an enclosed house fire. He is agitated, hoarse and coughing carbonaceous sputum. Facial burns and soot are present in the oropharynx.
Which of the following is the most appropriate next step?
What is the best adult TBSA estimate requiring burn resuscitation?
Using 4 mL/kg/%TBSA, what rate should run over the next 6 hours to complete the first half?
Which treatment should be administered immediately in addition to 100% oxygen and support?
Which of the following is the most appropriate next step?
The reference sequence is preserved and reorganized into focused interactive modules.
| Depth | Appearance | Sensation | Course |
|---|---|---|---|
| Superficial | Red, dry, blanching | Painful | Excluded from TBSA resuscitation |
| Superficial partial | Moist, blistered, brisk blanching | Very painful | Often heals in ~2–3 weeks |
| Deep partial | Mottled, drier, reduced blanching | Diminished | May require grafting |
| Full thickness | White/brown/charred, leathery | Insensate centrally | Usually excision/grafting |
Depth evolves. Reassess after cleaning and restoration of perfusion and over the next 24–72 hours.
Select partial-thickness or deeper regions.
The patient’s entire palmar surface including fingers approximates 1%. Use Lund–Browder in children.
Coefficient × kg × %TBSA estimates 24-hour crystalloid. Give half during the first 8 hours from injury time, then the remainder over 16 hours. Protocols vary.
Adult urine output is commonly targeted near 0.5 mL/kg/hour. Reassess perfusion, acid-base status, edema and pulmonary function hourly.
Excess resuscitation worsens edema and compartment syndromes. The formula is a starting point—not a fixed finish line.
Titrate IV analgesia for major burns; avoid relying on IM/SC absorption in shock. Use multimodal therapy and premedicate wound care.
Temperature, glucose, serial neurovascular/respiratory exams, ECG for electrical injury and urine output when resuscitating major burns.
Use the current ABA referral guideline and local pathway.
Full-thickness≥10% TBSA partial-thicknessFace/hands/feet/genitalia/perineum/jointsInhalation injuryHigh-voltage electricalChemicalConcomitant traumaPediatric burnsCall early, stabilize, prevent hypothermia, document extent/depth and arrange monitored transport.
Headache, dizziness, weakness, nausea, chest pain, confusion, syncope, seizure or coma. Severity does not reliably track a single COHb value.
Obtain co-oximetry. Standard pulse oximetry may look normal; PaO₂ may be normal. Add ECG/troponin for significant exposure or cardiac symptoms.
Remove from exposure and give 100% oxygen promptly. Support ABCs. Consult Poison Control/hyperbaric medicine for severe neurologic, cardiac, acid-base or pregnancy-related risk.
Use symptoms, organ injury, exposure, trajectory and source control—not an isolated threshold. Counsel about delayed neurologic symptoms.
Cyanosis, SpO₂ near the mid-80s despite oxygen, chocolate blood, saturation gap and oxidant exposure.
Confirm by co-oximetry. Remove oxidant, support oxygenation and consider methylene blue for symptomatic/significant cases with G6PD and serotonergic cautions.
Severe enclosed-space fire plus altered mental status, cardiovascular collapse or marked lactatemia. Confirmation is rarely timely.
Adult initial dose: 5 g IV over 15 minutes; a second 5 g may be considered. Expect red skin/urine and lab/dialysis interference.
100% oxygen, airway/ventilation, fluids/pressors and seizure care. Sodium thiosulfate may be used in selected protocols.
Treat clinically when suspicion is high; avoid methemoglobin-forming nitrites in smoke inhalation when oxygen carriage is already impaired.
Completion adds 20 points.
Complete all five decisions and the critical-action checklist.
Links reviewed September 21, 2026.