# A 4-year-old child is brought to the emergency department with burns covering 18% of the total body surface area (TBSA) from a house fire. The burns involve the face, neck, and upper chest. What is the nurse's priority assessment for this child?

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## 문제

A 4-year-old child is brought to the emergency department with burns covering 18% of the total body surface area (TBSA) from a house fire. The burns involve the face, neck, and upper chest. What is the nurse's priority assessment for this child?

## 보기

1. Pain level using age-appropriate pain scale
2. Fluid and electrolyte balance through urine output monitoring
3. Airway patency and respiratory status **✔ 정답**
4. Burn depth and extent using the rule of nines

**정답: 3**

## 해설

Airway assessment is the absolute priority for any burn patient, especially children with facial burns, as airway compromise can be life-threatening and requires immediate intervention. Pain assessment, fluid monitoring, and burn evaluation are important but secondary to securing an open airway.

## 심화 해설

Priority Assessment for a Child with Face and Neck Burns

The correct answer is Airway patency and respiratory status.

In the initial management of any burn patient, the primary survey always begins with Airway, Breathing, and Circulation (ABCs). For this child, the anatomical location of the burns—the face, neck, and upper chest—makes airway compromise an immediate and life-threatening risk. The pathophysiological rationale is that burns to the face and neck are in close proximity to the airway, which strongly predisposes the patient to inhalation injury and subsequent airway edema [1]. The clinical evidence supporting this is stark: a cohort study found that patients with facial and neck burns had a dramatically higher incidence of inhalation injury (34.8%) compared to those without such burns (2.8%) [1]. This thermal and chemical damage to the respiratory tract can lead to rapid, unpredictable swelling of the upper airway, especially in a young child whose airway anatomy is already smaller and more easily obstructed.

This assessment priority is further reinforced by the critical nature of the intervention that often follows. The same study demonstrated that the presence of facial and neck burns necessitated endotracheal intubation in 51.9% of cases, a rate nearly four times higher than in patients without these injuries (14.1%) [1]. This statistic underscores why the nurse must immediately assess for signs of stridor, hoarseness, singed nasal hairs, carbonaceous sputum, and increased work of breathing. A delay in recognizing a deteriorating airway can lead to a difficult intubation scenario, a high-acuity, low-frequency event made even more challenging in pediatric patients with airway edema from inhalational injuries [3]. While flexible bronchoscopy is considered the gold standard for diagnosing the severity of an inhalation injury, the bedside nurse's clinical assessment of airway patency is the crucial first step that triggers the need for such advanced diagnostics and life-saving interventions [2].

Although the other options represent important aspects of burn care, they are secondary to securing the airway. Monitoring fluid balance through urine output (Option 2) addresses circulation, which is the third step in the ABCs. Assessing pain (Option 1) and determining burn depth and extent (Option 4) are vital components of the secondary survey, which is performed only after the primary survey is complete and life-threatening conditions are addressed. The immediate risk of respiratory failure from a compromised airway always takes precedence.References (research sources)

- [1]The Impact of Face and Neck Burns on Respiratory Complications and Mortality.Research articleGiurgiu RA, Bordeanu-Diaconescu EM, Grosu-Bularda A, Frunza A, Grama S, Costache RA, Cristescu CI, Neagu TP, Lascar I, Hariga CS. (2025) · DOI: 10.3390/ebj6020027

- [2]The prognostic role of inhalation injury in burn patients assessed by flexible bronchoscopy: a systematic review and meta-analysis.Meta-analysis/systematic reviewVirdis E, Fara G, Paliogiannis P, Zinellu A, Zoroddu S, Mangoni AA, Di Lorenzo B, Pirina P, Fois AG. (2026) · DOI: 10.3389/fmed.2026.1808915

- [3]Pediatric Difficult Airway Simulation Day.Research articleChen S, Athale A, Runkle A. (2026) · DOI: 10.5070/m5.52208

## 임상 시나리오

Pediatric Burn with Facial InvolvementImmediate Priority Assessment
For a child with burns involving the face, neck, and upper chest, the absolute priority is assessing airway patency and respiratory status. The proximity of these burns to the airway creates a high risk for inhalation injury and rapid airway edema, which can progress to complete obstruction within hours.

Look for clinical indicators of inhalation injury: stridor, hoarseness, singed nasal hairs, soot around the mouth or nose, and carbonaceous sputum. The incidence of inhalation injury is significantly higher with facial burns (34.8%) compared to burns without facial involvement (2.8%).

CautionA child's airway is smaller and more easily obstructed by edema. Do not delay airway assessment for pain scoring or burn mapping. Up to 51.9% of patients with facial and neck burns require endotracheal intubation. Prepare for early intubation before edema makes it impossible.

## 핵심 개념

- **Inhalation Injury** — Damage to the respiratory tract caused by inhaling superheated air, steam, or toxic chemicals; strongly suspected with facial burns and can cause rapid airway edema.
- **Primary Survey (ABCs)** — The initial rapid assessment of Airway, Breathing, and Circulation to identify and manage immediate life-threatening conditions in trauma or burn patients.
- **Airway Edema** — Swelling of the airway tissues, a major risk in facial/neck burns that can lead to obstruction, especially in children due to their smaller airway diameter.
- **Rule of Nines** — A method for estimating the percentage of total body surface area (TBSA) burned, used to guide fluid resuscitation calculations, with adjusted proportions for children.

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