A 34-year-old factory worker splashes hydrofluoric acid onto two fingers. Initially there is minimal erythema, but 2 hours later he reports severe, escalating pain. After immediate copious water irrigation, what is the best next step?

A 72-year-old woman with 25% TBSA partial-thickness burns is receiving LR per an initial formula-based rate. After 2 hours, urine output is 0.2 mL/kg/hour, heart rate is 128, blood pressure is 102/64, lungs are clear, and repeat assessment suggests TBSA may have been overestimated because large areas are superficial erythema only. What is the best next step?

Dietary Reference Intakes (DRIs): Tolerable Upper Intake Levels (ULa), Vitamins Food and Nutrition Board, Institute of Medicine, National Academies Life Stage Group Vitamin A (μg/d)a Vitamin C (mg/d) Vitamin D (μg/d) Vitamin E (mg/d)b,c Vitamin K Thiamin Riboflavin Niacin (mg/d)c Vitamin B6 (mg/d) Folate (μg/d)c Vitamin B12 Pantothenic Acid Biotin Choline (g/d) Carotenoidsd Infants 0–6 mo 600 NDe 25 ND ND ND ND ND ND ND ND ND ND ND ND 6–12 mo 600 ND 38 ND ND ND ND ND ND ND ND ND ND ND ND Children 1−3 y 600 400 63 200 ND ND ND 10 30 300 ND ND ND 1 ND 4−8 y 900 650 75 300 ND ND ND 15 40 400 ND ND ND 1 ND Males 9−13 y 1,700 1,200 100 600 ND ND ND 20 60 600 ND ND ND 2 ND 14−18 y 2,800 1,800 100 800 ND ND ND 30 80 800 ND ND ND 3 ND 19−30 y 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND ND ND 3.5 ND 31−50 y 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND ND ND 3.5 ND 51−70 y 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND ND ND 3.5 ND > 70 y 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND ND ND 3.5 ND Females 9−13 y 1,700 1,200 100 600 ND ND ND 20 60 600 ND ND ND 2 ND 14−18 y 2,800 1,800 100 800 ND ND ND 30 80 800 ND ND ND 3 ND 19−30 y 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND ND ND 3.5 ND 31−50 y 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND ND ND 3.5 ND 51−70 y 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND ND ND 3.5 ND > 70 y 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND ND ND 3.5 ND Pregnancy 14−18 y 2,800 1,800 100 800 ND ND ND 30 80 800 ND ND ND 3 ND 19−30 y 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND ND ND 3.5 ND 31−50 y 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND ND ND 3.5 ND Lactation 14−18 y 2,800 1,800 100 800 ND ND ND 30 80 800 ND ND ND 3 ND 19−30 y 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND ND ND 3.5 ND 31−50 y 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND ND ND 3.5 ND

An 80 kg adult male has 30% TBSA partial-thickness burns from a flame injury. Time from burn is now 2 hours. EMS administered 1 liter of lactated Ringer’s (LR) prior to arrival to the emergency department. Using the American Burn Association consensus approach for initial adult burn shock resuscitation (the ABA updated approach to the traditional Parkland or Baxter model),  what INITIAL infusion rate (without considering possible future rate changes based on perfusion, urine output, or other endpoints) is most appropriate to start upon patient arrival to the ED? Round your answer to the nearest 10.  

A 68-year-old patient presents to the pulmonology clinic with progressive dyspnea on exertion over 18 months and a persistent dry cough. Physical examination reveals bibasilar inspiratory crackles and digital clubbing. Pulmonary function tests show FEV1/FVC ratio of 0.82 with reduced total lung capacity. High-resolution CT reveals reticular opacities with honeycombing in the subpleural and basilar regions. Which condition is mostly the cause of his symptoms? 

A 56-year-old with 35% TBSA burns is in the ICU on day 6. Over 12 hours he develops progressive tachycardia, progressive tachypnea, new feeding intolerance, and platelet count drops from 190,000 to 85,000. The wound shows new dark discoloration with rapid conversion of previously viable partial-thickness areas to necrosis. Blood pressure becomes refractory to fluids. What is the most appropriate management strategy?

A 56-year-old man is admitted to the medical floor for management of acute decompensated heart failure. His wife mentions that he snores loudly at night and she frequently observes him stop breathing for 10-20 seconds, followed by gasping or choking sounds. The patient reports chronic daytime fatigue and falling asleep frequently during the day. His medical history includes hypertension, type 2 diabetes, obesity (BMI 36 kg/m²), and atrial fibrillation. Neck circumference 19 inches. Cardiovascular exam reveals an irregular rhythm and 2+ pitting edema bilaterally. Retrognathia is noted. Oropharyngeal exam shows a crowded airway with enlarged tonsils and low-lying soft palate (Mallampati class IV).  Chest x-ray showing small pleural effusions, otherwise clear lungs. The AGACNP is concerned for repetitive dynamic collapse of the upper airway during sleep. What action by the AGACNP is most appropriate? 

A 45-year-old man presents to the clinic with a 5-day history of fever (temperature 38.9°C/102°F), diffuse pruritic rash, and facial edema. He started taking carbamazepine 4 weeks ago for newly diagnosed trigeminal neuralgia. He reports that the rash initially began on his trunk and has progressively spread to his extremities. On examination, he has a generalized morbilliform eruption with areas of confluence on the trunk, along with periorbital edema and bilateral cervical lymphadenopathy. Laboratory studies show: WBC: 13,500/μL with 18% eosinophils Atypical lymphocytes: 12% Hemoglobin: 14.2 g/dL Platelets: 140,000/μL AST: 285 U/L (normal: 10-40) ALT: 320 U/L (normal: 10-40) Alkaline phosphatase: 95 U/L (normal: 30-120) Total bilirubin: 1.8 mg/dL (normal: 0.1-1.2) Creatinine: 1.8 mg/dL (baseline: 0.9 mg/dL) Sodium: 138 mEq/L Potassium: 4.2 mEq/L Which of the following features are characteristic of DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome? Select all that apply.

A 71-year-old female with a history of hypertension, congestive heart failure (EF 35%), atrial fibrillation, and hyperlipidemia presents to the emergency department with progressive dyspnea and shortness of breath over the past week. She reports increased lower extremity swelling and orthopnea requiring three pillows to sleep. Physical examination findings: Vital signs: BP 148/88, HR 92, RR 24, SpO2 91% on room air, Temperature 98.90F  General: Mild respiratory distress, speaking in short sentences Cardiac: Regular rhythm, S3 gallop present, JVP elevated at 10 cm Pulmonary: Decreased breath sounds at the right base, dullness to percussion over the right lower lung field Extremities: 2+ pitting edema bilaterally to mid-calf Laboratory Results: WBC: 10.1 × 10³/µL (normal: 4.5-11.0) Hemoglobin: 11.2 g/dL (normal: 12.0-16.0 for females) Platelets: 245 × 10³/µL (normal: 150-400) Sodium: 133 mEq/L (normal: 136-145) Potassium: 3.8 mEq/L (normal: 3.5-5.0) Creatinine: 1.6 mg/dL (baseline 1.0 mg/dL) BUN: 32 mg/dL (normal: 7-20) BNP: 1,850 pg/mL (normal:

A 52-year-old man presents to the urgent care clinic with a 2-day history of a painful, red rash on his right forearm. He reports the area started as a small red spot that has expanded. He denies any recent trauma. States he is a factory worker.  Vital signs: Temperature 99.2F, blood pressure 132/78 mmHg, heart rate 88 bpm, RR 18bpm, O2 99% on room air. Physical examination reveals a bright red, indurated plaque with a sharply demarcated, raised border on the right forearm. The area is warm and tender to palpation. There is no crepitus, fluctuance, or purulent drainage. No lymphangitic streaking is noted, but there is mild right axillary lymphadenopathy. What is the most appropriate treatment for this patient?