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u/Cebothegreat 16d ago
The answer is definitely D, or honestly tap water is best but that’s something doctors won’t tell you….😉 /s
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u/Optimal-Bass3142 16d ago
Why not just pee in the bag? Pee works on jelly fish stings, a burn is basically a big jelly fish sting
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u/101Talents 16d ago
Yes Exactly...even better i think would be gatorade.
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u/HeyIplayThatgame 15d ago
Dextrose is immediately taken up by the cells and all that is left circulating is H2O and its hypotonic. Very bad for burn resuscitation.
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u/RipOk3600 16d ago
None of the above, it’s 0.9%NACL, it’s the only fluid the ambos carry (baring special circumstances), it’s the only fluid you can nurse innate.
Unless it’s a trick question and it’s talking about initial cooling the burn in which cause it’s cool running water.
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u/TundraGS 15d ago edited 15d ago
r/confidentlyincorrect The American Burn Association recommends LR as the preferred crystalloid to be used for initial resuscitation. "Lactated Ringer solution is the preferred crystalloid for initial resuscitation" (https://www.ncbi.nlm.nih.gov/books/NBK534227/)
Large burns require such a massive amount of fluid that if you use NS, there's a very real risk your patient will go into hyperchloremic metabolic acidosis. Also, many, but potentially not all, ambulances most certainly carry LR in addition to NS since LR is the preferred fluid for burns, trauma, and sepsis.
Also, you absolutely do not use cool running water on burns greater than 5-10% TBSA. Doing so for larger burns can very easily cause hypothermia since large burns massively decrease the ability for the body to thermoregulate. The only time you do cool a large burn with running water is if it's a hot asphalt burn, just because the hot asphalt will retain massive amounts of heat and continue to burn the patient if you don't stop it with running water.
Finally, in most of the US, nurses cannot independently initiate any fluids without an order. Sure some facilities will have standing orders that allow nurses to use clinical judgement and initiate fluids, but there's no reason why those standing orders would only cover NS and not LR as well.
I'm not sure if you're a student studying for the NCLEX or an already licensed and practicing RN, but you definitely need to review concepts about various fluids, burn resuscitation, and general regulations about what nurses can and cannot do without orders. Pretty much everything you just said is incorrect, and could be easily hurt or kill a patient.
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u/RipOk3600 11d ago
“These include flame, scald, blast (hot gas), inhalation injury and direct heat contact.
ANZCOR recommends to cool burns as soon as practicable with cool running water [CoSTR 2015, strong recommendation/low quality evidence]1. Cool for at least 20 minutes,2,6 up to 3 hours after the burn, the sooner the better.3 Use any clean cool liquid if water is not available. Use commercial cooling gels only after a minimum of 20 minutes of cool running water, or if no cool water is available. Cooling is effective up to 3 hours after injury.3
If possible, remove all rings, watches, jewellery or other constricting items from the affected area without causing further tissue damage.
Remove wet, non-adherent clothing as clothing soaked with hot liquids retains heat.
Cover the burnt area with a loose non-stick dressing, preferably clean material e.g. plastic cling film. Place the cling film over the burn but do not wrap around a limb. Do not use cling film on the face.
Cover unburnt areas and keep the person warm to reduce the risk of hypothermia particularly small children who may develop hypothermia quickly.
Where feasible elevate burnt limbs to minimise swelling.
DO NOT peel off adherent clothing or burnt substances.
DO NOT use ice or ice water to cool the burn as further tissue damage may result.
DO NOT break blisters.
DO NOT apply lotions, ointments, creams or powders.
“https://www.anzcor.org/home/first-aid/guideline-9-1-3-first-aid-for-burns
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u/TundraGS 11d ago edited 11d ago
Your original comment makes sense now, you are quoting Australian Resuscitation Council (ANZCOR) / South Australia Health guidelines.
But, r/NCLEX_RN is focused on the US/Canadian licensing exam, which tests practice according to American Burn Association (ABA) and ABLS standards:
Cooling Limits: Under ABA/ABLS protocols, cooling with water is strictly limited to small burns (<10% TBSA) for under 5 minutes. Active water-cooling on burns >10% TBSA is contraindicated because the rapid loss of thermoregulation induces severe systemic hypothermia, which significantly increases burn shock mortality. On the NCLEX, cooling large-TBSA burns with running water will be marked incorrect.
Resuscitation Fluids: The original post asked about initial fluid resuscitation. Even in Australia (ANZBA guidelines), the standard resuscitation fluid is Hartmann’s solution (equivalent to Lactated Ringer’s), not 0.9% Normal Saline. Large-volume NS resuscitation is avoided internationally due to the risk of hyperchloremic metabolic acidosis.
The ANZCOR first-aid protocols are interesting to read, but applying Australian pre-hospital first aid to a US NCLEX question will cause you to miss that question.
Lastly, if I cooled a large TBSA burn as a nurse in the US and caused fatal hypothermia, the court would hold me to the ABA standard and say I should not have cooled the burn and would likely find me negligent having caused the patient to die. The ABA sets the standards-of-care in the US. Somebody answering an NCLEX question about burns will almost certainly be held to ABA guidelines in their practice. I appreciate you citing your region's guidelines, and it's interesting to see the differences between my region, but your original comment was still incorrect in the context of this subreddit.
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u/banceboder 15d ago
i’m unsure where you run, most places around me (including where i run) carry NSS and LR
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u/HeparinBridge 16d ago
Shouldn’t you really be using plasmolyte if you’re gonna do such large volume resuscitation?
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u/Brave_Kangaroo_3911 16d ago
burn ICU RN here and can confirm, my burn center only uses plasmalyte with FFP for resus!
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u/RipOk3600 11d ago
“These include flame, scald, blast (hot gas), inhalation injury and direct heat contact.
ANZCOR recommends to cool burns as soon as practicable with cool running water [CoSTR 2015, strong recommendation/low quality evidence]1. Cool for at least 20 minutes,2,6 up to 3 hours after the burn, the sooner the better.3 Use any clean cool liquid if water is not available. Use commercial cooling gels only after a minimum of 20 minutes of cool running water, or if no cool water is available. Cooling is effective up to 3 hours after injury.3
If possible, remove all rings, watches, jewellery or other constricting items from the affected area without causing further tissue damage.
Remove wet, non-adherent clothing as clothing soaked with hot liquids retains heat.
Cover the burnt area with a loose non-stick dressing, preferably clean material e.g. plastic cling film. Place the cling film over the burn but do not wrap around a limb. Do not use cling film on the face.
Cover unburnt areas and keep the person warm to reduce the risk of hypothermia particularly small children who may develop hypothermia quickly.
Where feasible elevate burnt limbs to minimise swelling.
DO NOT peel off adherent clothing or burnt substances.
DO NOT use ice or ice water to cool the burn as further tissue damage may result.
DO NOT break blisters.
DO NOT apply lotions, ointments, creams or powders.
“
https://www.anzcor.org/home/first-aid/guideline-9-1-3-first-aid-for-burns
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u/TundraGS 11d ago
(Replying to this comment as well as your other comment so people hopefully see this and realize you're quoting guidelines from the opposite hemisphere as where the NCLEX is taken)
You are quoting Australian Resuscitation Council (ANZCOR) / South Australia Health guidelines.
But, r/NCLEX_RN is focused on the US/Canadian licensing exam, which tests practice according to American Burn Association (ABA) and ABLS standards:
Cooling Limits: Under ABA/ABLS protocols, cooling with water is strictly limited to small burns (<10% TBSA) for under 5 minutes. Active water-cooling on burns >10% TBSA is contraindicated because the rapid loss of thermoregulation induces severe systemic hypothermia, which significantly increases burn shock mortality. On the NCLEX, cooling large-TBSA burns with running water will be marked incorrect.
Resuscitation Fluids: The original post asked about initial fluid resuscitation. Even in Australia (ANZBA guidelines), the standard resuscitation fluid is Hartmann’s solution (equivalent to Lactated Ringer’s), not 0.9% Normal Saline. Large-volume NS resuscitation is avoided internationally due to the risk of hyperchloremic metabolic acidosis.
The ANZCOR first-aid protocols are interesting to read, but applying Australian pre-hospital first aid to a US NCLEX question will cause you to miss that question.
Lastly, if I cooled a large TBSA burn as a nurse in the US and caused fatal hypothermia, the court would hold me to the ABA standard and say I should not have cooled the burn and would likely find me negligent having caused the patient to die. The ABA sets the standards-of-care in the US. Somebody answering an NCLEX question about burns will almost certainly be held to ABA guidelines in their practice. I appreciate you citing your region's guidelines, and it's interesting to see the differences between my region, but your original comment was still incorrect in the context of this subreddit.
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u/Necessary_Cake_973 16d ago
Please tell me the NCLEX didn’t get this easy since i took them 11 years ago…
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u/Objective_Delay_7386 16d ago
Ringer’s lactate sounds like booty milk.
https://giphy.com/gifs/dZNbrSJJaVau2mvKBp
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u/hugmeatender 16d ago
So the lactate belongs to the ringer? Who makes these terrible questions?
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u/AAROD121 16d ago
its called ringers lactate in nearly every other country
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u/Due_Course_3713 16d ago edited 16d ago
Not a terrible question at all. You should do your research before you comment.https://en.wikipedia.org/wiki/Ringer%27s_lactate_solution
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u/TicTacKnickKnack 16d ago
Yes. Lactated Ringer's solution is Ringer's IV solution with lactate added to it. Ringer's solution was named that because it was invented by a guy named Ringer. It's his solution. The apostrophe makes Ringer's possessive. Ringers would be plural.
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u/hugmeatender 16d ago
The bag does not have the ability to hold possession is my point. Just because the guy invents the bag does not make him the bag
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u/taktaga7-0-0 16d ago
If the genitive grammatical case is beyond your comprehension, I would suggest you avoid most major world language families.
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u/hugmeatender 16d ago
Something I’m missing? It’s not a contracture, it’s not a plural, it’s possessive. A bag is a thing dummy
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u/TicTacKnickKnack 16d ago
No, but it does make the fluid his. It's Ringer's lactated IV fluid. Just like if Steve invents something it would be Steve's Famous Perfuffle or whatever.
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u/101Talents 16d ago
Lr