Kitchen Fire Scenario

Question 1 of 15

1. Question

What is your first action?

Ask the firefighters to stop briefly so you can start your assessment

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Let the firefighters continue to cool the burns as much as possible; they need to maintain this for 20 minutes

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Let the firefighters continue to cool the burns as much as possible; they need to maintain this for 30 minutes

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Don't stop the firefighters, the patient needs as much cooling as possible

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Question 2 of 15

2. Question

The firefighters pause for your assessment and inform you they’ve been cooling the patient for 5 minutes. The patient was using a deep fat fryer, which exploded and caused the fire. The burns are reported as full thickness on the chest and partial thickness on the arms. What best describes deep dermal partial thickness burns?

The skin appears dry, blotchy or mottled, red, and typically painful (due to exposed superficial nerves). There may be blisters and capillary refill does not blanch

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The skin is red or pale pink and painful with blistering. Capillary refill blanches but returns slowly

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The skin is red and painful but not blistered. Capillary refill blanches and rapidly refills

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The skin is white, brown, or black (charred), with no blisters. It appears dry, leathery, or waxy, and is painless. Capillary refill does not blanch

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Question 3 of 15

3. Question

It appears oil caused the burn. What type of burn would this be classed as?

Thermal

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Chemical

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Electrical

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Question 4 of 15

4. Question

The burns extend to the patient’s chin and neck. The patient is giving minimal responses. You note redness and inflammation around the mouth and nose, an intermittent cough, and a hoarse, painful voice. GCS is 14. You are concerned about airway burns. What actions should you take at this stage to help manage their airway?

Call for enhanced team backup

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Prepare advanced airway kit

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Administer high-flow oxygen

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Attempt conscious intubation to secure the airway

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Question 5 of 15

5. Question

You prepare for deterioration. The enhanced care team is 5 minutes away. Observations: HR 112, BP 98/67, SpO₂ 98%, RR 32, Temp 36.0°C. You hear wheezing on auscultation. You’re unsure if there was smoke exposure. Can you trust the SpO₂ reading and begin titrating oxygen down?

No

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Yes

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Question 6 of 15

6. Question

You maintain high-flow oxygen and gain cannulation in the foot. You ask the firefighters to resume burn cooling. The patient is still in pain. What pain relief would be appropriate at this stage?

Morphine

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IV Paracetamol

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Entonox

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Methoxyflurane

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Question 7 of 15

7. Question

You administer paracetamol and titrated morphine doses to avoid hypotension. You estimate total body surface area (TBSA) burned. What method could be used for a quick assessment?

Rule of Nines

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Lund and Browder Chart

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Mersey Burns App

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Patient’s palmar surface

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Question 8 of 15

8. Question

Burns are on the anterior chest up to the chin, and both forearms including hands. What is the estimated TBSA?

18–20%

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27%

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30–35%

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10–15%

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Question 9 of 15

9. Question

You estimate TBSA at 18–20% and hospital is over 30 minutes away. Should you consider fluid administration now that you have IV access?

Yes

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No

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Question 10 of 15

10. Question

What volume of fluid should you administer pre-hospitally?

1L

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500ml, then another 500ml if still 30 minutes from hospital

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250ml

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2L

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Question 11 of 15

11. Question

What other medication might support the patient’s breathing?

Salbutamol

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Dexamethasone

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Ipratropium Bromide

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Adrenaline 1:1000

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None

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Question 12 of 15

12. Question

You start fluid administration and prepare salbutamol. The patient’s GCS drops to 9 (E3/V1/M5), and breathing becomes increasingly laboured. What should you do next?

Reassess your Primary Survey

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Maximise fluid rate to support dropping BP

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Begin dressing the burns

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Administer additional pain relief

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Question 13 of 15

13. Question

Reassessment shows significant airway swelling and deteriorating GCS. What airway would you attempt first in this situation, where clinical skill was available?

Intubation

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Cricothyroidotomy

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NPA

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OPA

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BVM

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Question 14 of 15

14. Question

You attempt intubation but are unsuccessful. The enhanced care team arrives. You brief them, and they secure the airway with a video laryngoscope. What other actions could you take to assist with patient management?

Dress burns with cling film or burn dressings

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Document burn exposure and treatment

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Record second set of obs

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Administer another 1L fluid challenge

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Question 15 of 15

15. Question

The enhanced care team prepares direct referral to the burns unit. They mention the patient may not require surgical escharotomy. What is an escharotomy?

An incision to relieve pressure on a circumferential burn area on a limb, digit, or trunk

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A surgical drain to ease pressure on burn tissue

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A surgical airway technique

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Nerve repair of burnt areas on the chest

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