A patient was pulled from a burning building and brought to the ER. She shows no signs of tissue damage but is extremely anxious and leans forward when speaking. The nurse is concerned about what? 单项选择题
A
smoke inhalation injury
B
deep tissue burn injury
C
lung fibrosis
D
fluid shift

Question

A patient was pulled from a burning building and brought to the ER. She shows no signs of tissue damage but is extremely anxious and leans forward when speaking. The nurse is concerned about what?

BlackTom AI · Accepted Answer

Tripod positioning—leaning forward to breathe—is a classic sign of respiratory distress and increased work of breathing, indicating the airway or lungs are compromised. In the context of a patient rescued from a fire, the most relevant concern is smoke inhalation injury.

Relevant knowledge points and concepts:
- Smoke inhalation injuries include thermal injury to the upper airway, chemical irritation and damage to lower airways and alveoli, and systemic toxicities (carbon monoxide, cyanide).
- Clinical clues: hoarseness, stridor, soot in the nose/mouth, singed nasal hairs, persistent cough, carbonaceous sputum, anxiety, tachypnea, and tripod posture from use of accessory muscles.
- Airway edema from thermal injury can be progressive and life‑threatening even when external burns are absent; early assessment and often early intubation are indicated.

Step-by-step reasoning:
1. Patient exposed to a burning building: high pretest probability of inhalation injury or smoke/toxin exposure.
2. No visible tissue (skin) damage externally rules against isolated superficial or deep cutaneous burns being the immediate cause of respiratory distress.
3. The patient is extremely anxious and leans forward when speaking—tripod position—which signals respiratory compromise (difficulty ventilating, airway obstruction, or severe bronchospasm).
4. Combining exposure history with respiratory distress signs leads directly to smoke inhalation injury (thermal/chemical airway injury or inhalation toxicity) as the primary concern.
5. Clinically, this warrants immediate airway assessment, pulse oximetry, consideration of CO and cyanide poisoning, and early otolaryngology/intubation if signs of impending airway loss are present.

Why other options are incorrect:
- Deep tissue burn injury: would usually present with visible skin damage, not isolated respiratory distress without external burns.
- Lung fibrosis: a chronic process developing over months to years, not an acute finding after a fire.
- Fluid shift: burn‑related fluid shifts occur with significant cutaneous burns and cause hypotension/edema systemically; they do not explain acute tripod breathing after inhalation exposure.

Final confirmation: The correct answer is smoke inhalation injury.

A patient was pulled from a burning building and brought to the ER. She shows no signs of tissue damage but is extremely anxious and leans forward when speaking. The nurse is concerned about what? 单项选择题

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