CBRN Electrical, Chemical & Cold Injuries — Questions and Answers
Question 1: What is the priority nursing action for a patient with an alkali chemical burn to the arm?
- Apply a neutralizing acid
- Remove contaminated clothing and irrigate with copious water, continuing longer than for acid burns (Correct answer)
- Apply silver sulfadiazine immediately
- Cover with a dry sterile dressing and transport
Correct answer: Remove contaminated clothing and irrigate with copious water, continuing longer than for acid burns
Immediate dilution with large volumes of water and removal of contaminated clothing is the priority. Alkalis penetrate deeper and need prolonged irrigation. Neutralizing agents generate heat and cause further injury. Dry powders should be brushed off first.
Question 2: A patient with a hydrofluoric acid burn develops muscle twitching and a prolonged QT interval. Which treatment is most appropriate?
- Calcium gluconate (Correct answer)
- Potassium chloride
- Sodium bicarbonate only
- Magnesium restriction
Correct answer: Calcium gluconate
Fluoride ions bind calcium and magnesium, causing hypocalcemia and hypomagnesemia, which lead to dysrhythmias and tetany. Topical, subcutaneous, or IV calcium gluconate, with electrolyte replacement and cardiac monitoring, is the treatment.
Question 3: A worker has a high-voltage electrical injury with small entry and exit wounds. Why is the visible skin injury misleading?
- Electrical current causes only superficial damage
- Current travels along low-resistance tissue, causing extensive deep muscle damage, possible rhabdomyolysis, and dysrhythmias (Correct answer)
- The injury is always limited to the entry site
- Electrical burns never cause cardiac effects
Correct answer: Current travels along low-resistance tissue, causing extensive deep muscle damage, possible rhabdomyolysis, and dysrhythmias
High-voltage current passes through nerves, vessels, and muscle, causing deep injury under small skin wounds. Nursing priorities include continuous cardiac monitoring, assessing for compartment syndrome, and maintaining urine output to flush myoglobin.
Question 4: A patient with an electrical injury has dark, tea-colored urine. What is the appropriate fluid goal?
- Restrict fluids to 30 mL/hr
- Increase fluids to maintain urine output of about 75–100 mL/hr until the urine clears (Correct answer)
- Give diuretics before any fluid
- Make no change because this is expected
Correct answer: Increase fluids to maintain urine output of about 75–100 mL/hr until the urine clears
Dark urine suggests myoglobinuria from muscle breakdown. Higher urine output protects the kidneys from myoglobin-induced acute kidney injury. Fluids are increased and urine is monitored until the pigment clears.
Question 5: What is the recommended rewarming method for frostbitten fingers once refreezing can be prevented?
- Rub the fingers with snow
- Dry heat from a heater
- Rapid rewarming in circulating water at about 37–39°C (98.6–102°F) for 15–30 minutes (Correct answer)
- Slow rewarming at room temperature for several hours
Correct answer: Rapid rewarming in circulating water at about 37–39°C (98.6–102°F) for 15–30 minutes
Rapid rewarming in warm circulating water restores perfusion while minimizing scald risk. Rubbing and dry heat cause additional tissue damage. Refreezing after thawing is more harmful than delaying rewarming.
Question 6: What is the recommended initial approach to a hot tar burn after the tar is cooled with water?
- Peel the tar off forcibly
- Scrub with gasoline
- Emulsify and remove it with a petrolatum-based or mineral oil product (Correct answer)
- Leave the tar on and never remove it
Correct answer: Emulsify and remove it with a petrolatum-based or mineral oil product
Cooling stops the burning process, and tar is then removed gently with petrolatum-based or other emulsifying agents. Forceful removal takes skin with it, and organic solvents are toxic and irritating.
