Following an explosion at a factory, the patient is brought by ambulance to the emergency department. The patient has soot on the face and around the mouth and is coughing up black sputum. He verbalizes severe pain in his leg and his voice is noted to be a hoarse whisper. Further assessment reveals full thickness burns to the arms and hands and partial thickness burns to the legs. Shrapnel appears to have been embedded in the patient’s thigh. While moving the leg to assess the inner thigh, a piece of shrapnel shifts and the patient begins bleeding profusely from the wound. The patient cries out in pain and requests pain relief. Which action does the nurse take first?

Question

Following an explosion at a factory, the patient is brought by ambulance to the emergency department. The patient has soot on the face and around the mouth and is coughing up black sputum. He verbalizes severe pain in his leg and his voice is noted to be a hoarse whisper. Further assessment reveals full thickness burns to the arms and hands and partial thickness burns to the legs. Shrapnel appears to have been embedded in the patient&rsquo;s thigh. While moving the leg to assess the inner thigh, a piece of shrapnel shifts and the patient begins bleeding profusely from the wound. The patient cries out in pain and requests pain relief. Which action does the nurse take first?

Accepted Answer

Apply firm pressure to the shrapnel wound to control bleeding. The patient who has suffered severe burns and injuries from the explosion has several rather immediate needs. The situation that will kill him the quickest is the profuse bleeding from the shrapnel wound. Therefore, the first nursing action is to apply pressure to control bleeding. Ideally, a colleague would be contacting the provider for further management. The patient&rsquo;s hoarse whisper voice, black sputum, and soot around the face and mouth indicate the patient has experienced smoke inhalation; the patient will likely require rapid sequence intubation medications to maintain a patent airway, but the patient can still speak. Therefore, this intervention can wait until the hemorrhage is controlled. The patient requires significant pain management; however, pain will not kill him as quickly as the hemorrhage or respiratory failure. Assessing for circumferential burns around limbs and the torso can wait until the patient&rsquo;s condition is stabilized as the tourniquet-like effect does not cause compartment syndrome immediately.

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