A 27-year-old male presents to the emergency department after being brought in from a house fire. The patient has extensive burns covering his body and is conscious but in severe pain. The patient has a past medical history notable for marijuana use. He is not currently on any medications. Physical exam is notable for extensive burns covering the patient's back, chest, thighs, and legs. The patient's oropharynx reveals no signs of damage or extensive smoke inhalation. The patient is breathing on his own and has normal breath sounds bilaterally. His temperature is 99.5°F (37.5°C), pulse is 145/min, blood pressure is 100/70 mmHg, respirations are 27/min, and oxygen saturation is 93% on room air. Which of the following interventions is most likely to reduce mortality in this patient?
ATopical antibiotics
BIV fluids
COxygen administration
DOral antibiotics
ENormal saline soaked dressings
A 55-year-old man with a history of IV drug abuse presents to the emergency department with an altered mental status. He was found unconscious in the park by police. His temperature is 100.0°F (37.8°C), blood pressure is 87/48 mmHg, pulse is 150/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for multiple scars and abscesses in the antecubital fossa. His laboratory studies are ordered as seen below. Serum: Na+: 139 mEq/L Cl-: 105 mEq/L K+: 4.3 mEq/L HCO3-: 19 mEq/L BUN: 20 mg/dL Glucose: 95 mg/dL Creatinine: 1.5 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most appropriate treatment for this patient’s blood pressure and acid-base status?
ARinger lactate
BDextrose 5% normal saline
CSodium bicarbonate
DHypertonic saline
ENormal saline
A 44-year-old man is brought to the emergency department after sustaining high-voltage electrical burns over his left upper limb. On examination, the tip of his left middle finger is charred, and there are 2nd-degree burns involving the whole of the left upper limb. Radial and ulnar pulses are strong, and there are no signs of compartment syndrome. An exit wound is present over the sole of his right foot. His temperature is 37.7°C (99.8°F), the blood pressure is 110/70 mm Hg, the pulse is 105/min, and the respiratory rate is 26/min. His urine is reddish-brown, and urine output is 0.3 mL/kg/h. Laboratory studies show: Hemoglobin 13.9 g/dL Hematocrit 33% Leukocyte count 11,111/mm3 Serum Creatinine 4.6 mg/dL Creatine phosphokinase 15,230 U/L K+ 7.7 mEq/L Na+ 143 mEq/L What is the most likely mechanism for this patient's renal failure?
ASepticemia leading to acute pyelonephritis
BRhabdomyolysis, myoglobinuria, and renal injury
CDirect visceral electrical injury to the kidneys
DFluid and electrolyte loss and hypovolemia
EVolume overload because of excessive intravenous fluid resuscitation
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