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Difficulty: MediumTrauma and Burns

Match each specific burn or environmental injury presentation with the most appropriate immediate or targeted management step.

  • A 35-year-old firefighter is rescued from an enclosed structural fire with singed eyebrows, carbonaceous sputum, and progressive hoarseness.Early endotracheal intubation to secure the airway
  • A 42-year-old industrial worker sustains a deep, leathery, circumferential burn to the right lower extremity; pedal pulses are no longer palpable.Urgent bedside escharotomy to relieve tissue pressure
  • A 24-year-old electrician presents after a high-voltage electrical shock; a Foley catheter drains dark, reddish-brown urine.Aggressive intravenous fluid resuscitation to maintain a high urine output
  • A 50-year-old laboratory technician spills a solution on their hand and experiences severe, unrelenting pain that is completely out of proportion to the minimal visible skin erythema.Copious water irrigation followed by application of topical calcium gluconate gel

Answer

The correct matches pair inhalational injury with early intubation, circumferential burns causing ischemia with escharotomy, electrical injury rhabdomyolysis with aggressive fluid resuscitation, and hydrofluoric acid burns with calcium gluconate.
Each specific burn presentation carries a unique, immediate threat that dictates the next best step: airway loss (inhalational injury) requires intubation; limb ischemia (circumferential burn) requires escharotomy; acute kidney injury (electrical rhabdomyolysis) requires aggressive fluids; and hypocalcemic tissue necrosis (hydrofluoric acid) requires topical calcium.

Step-by-Step Solution

1
Analyze the firefighter's presentation (enclosed fire, carbonaceous sputum, hoarseness).
Identify high risk for imminent airway obstruction from inhalational injury.
Supraglottic edema can progress rapidly and make delayed intubation impossible.
2
Evaluate the industrial worker's pulseless limb with a leathery burn.
Identify burn-induced compartment syndrome.
The inelastic eschar prevents tissue expansion as edema forms, requiring surgical release (escharotomy).
3
Assess the electrician with dark urine following a high-voltage shock.
Identify myoglobinuria secondary to rhabdomyolysis.
Electrical current travels through deep tissues (muscle/bone), causing massive necrosis. Aggressive fluid resuscitation prevents pigment nephropathy.
4
Analyze the laboratory technician's pain out of proportion to visible injury.
Identify hydrofluoric acid exposure.
Fluoride ions penetrate tissue and deplete local calcium, causing severe nerve pain and tissue death, necessitating calcium gluconate therapy.

Key Concept

Immediate management of specific life- and limb-threatening burn complications
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Topics

Trauma and Burns

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