A 48-year-old Hispanic woman with no past medical history is brought to the emergency department by an ambulance after being rescued from a burning apartment building. The woman was trapped in a smoke-filled back bedroom of the apartment. On physical exam, her vital signs are stable, and while there is some singeing of her facial hair, there is no visible evidence of burns. An arterial blood gas is obtained, and the values are as follows: What potential development is of most concern in this woman over the next 24 hours?

Question

A 48-year-old Hispanic woman with no past medical history is brought to the emergency department by an ambulance after being rescued from a burning apartment building.  The woman was trapped in a smoke-filled back bedroom of the apartment.  On physical exam, her vital signs are stable, and while there is some singeing of her facial hair, there is no visible evidence of burns.  An arterial blood gas is obtained, and the values are as follows:  What potential development is of most concern in this woman over the next 24 hours?

Quizplus · Accepted Answer

Explanation: The majority of burn center deaths are due to inhalation injuries. Supraglottic damage is one of the most alarming types of inhalation injuries and stems from inhaling hot air, steam, or smoke. The ensuing inflammatory response results in edema of surrounding soft tissues and significant narrowing of the airway. Fiberoptic laryngoscopy or bronchoscopy may be necessary to properly assess the extent of airway involvement. In patients such as this woman, the clinician must maintain a high index of suspicion for airway injury and a correspondingly low threshold for intubation. (Choice A) Night terrors are episodes of sleep disturbance that are typically found in children aged 3-12 years, and are not of concern in this woman. (Choice B)Acute stress disorder is a psychiatric condition that occurs when an individual feels intense fear, horror, or helplessness during a traumatic event that involves actual or threatened death, or serious injury. Subsequently, the individual exhibits dissociative symptoms, but continues to be functionally impaired by re-experiencing the traumatic event. Unlike the more chronic posttraumatic stress disorder, acute stress disorder lasts a maximum of 4 weeks after the traumatic event. While this woman is certainly at risk for developing either acute stress disorder or posttraumatic stress disorder, neither condition would put her in immediate danger within the next 24 hours. (Choice C) Sepsis would be of grave concern if this woman had experienced substantial burns to her body that disrupted the skin's protective barrier. Since no such burns are evident in her physical examination, the potential consequences of inhalation injury are much more ominous. (Choice E) The development of cardiac arrhythmias is indeed potentially lethal in any individual deprived of oxygen for a lengthy period; however, since this woman has normal vital signs and normal arterial blood gas values, it appears unlikely that her tissues were subjected to hypoxic stress great enough to induce life-threatening arrhythmias in the next 24 hours. Educational Objective: Suspect airway injury and edema in any individual who has been exposed to smoke or superheated air. Remember the ABCs (airway, breathing, circulation) and intubate early if the airway is in danger.

A 48-Year-Old Hispanic Woman with No Past Medical History Is