You have just received a change-of-shift report for the burn unit. Which client should you assess first?

• A. Client with deep partial-thickness burns on both legs who reports severe and continuous leg pain
• B. Client who has just arrived from the emergency department with facial burns sustained in a house fire
• C. Client who has just been transferred from the postanesthesia care unit after having skin grafts applied to the anterior chest
• D. Client admitted 3 weeks ago with full-thickness leg and buttock burns who has been waiting for 3 hours to receive discharge teaching

Answer: (B)

Prioritizing airway safety is the most urgent step in burn patients. Facial burns from a house fire raise strong concern for inhalation injury and rapid airway edema, which can lead to airway obstruction in a short time. Assessing breathing and airway status first allows you to intervene early—consider administering high-flow oxygen and being prepared for possible intubation if signs of airway compromise appear (hoarseness, stridor, singed nasal hairs, carbonaceous sputum, voice changes, or increasing respiratory distress).

The other clients, while important to care for, do not present an immediate threat to life in the moment. A patient with deep partial-thickness burns and severe leg pain needs pain control and wound care but is not at imminent risk of airway failure. A post-anesthesia care unit patient after skin grafts is typically stable from an airway standpoint but requires routine post-op monitoring. A patient hospitalized for weeks waiting for discharge teaching is not acutely at risk. Focusing first on airway ensures the most life-saving intervention is addressed before other care needs.