Valid points concerning the initial physical examination in a burn patient include which of the following statement(s)?

a. Patients should be examined in a warm environment to prevent hypothermia

c. Inhalation injury is suggested by the presence of singed facial hair and nasal vibrissae, carbonaceous sputum, and a hoarse voice

d. Blistering in or around the mouth may suggest hot liquid aspiration in small children

An organized approach to serious burn injuries facilitates achieving the optimal outcome and begins with a systematic initial evaluation that includes a primary survey, effective vascular and airway access, and a systematic secondary survey. Many burn patients have sustained concurrent injuries and the initial evaluation should therefore be approached as any multiple trauma patient. After evaluating and securing the airway, while maintaining control of the cervical spine, breathing mechanics are assessed, a rough estimate is made of circulating volume, the level of consciousness is documented, and the patient is completely exposed. This should be done in a warm environment to avoid hypothermia. The burn specific secondary survey includes a complete history, vital signs, a detailed physical examination and laboratory and radiologic studies appropriate for the mechanism of injury. The patient’s neurologic status should be carefully documented early during the evaluation, because many patients will become progressively obtunded secondary to the administration of analgesics and sedatives and from intravascular volume depletion. The corneal epithelium and globes should be examined prior to the development of adnexal edema which will render adequate examination more difficult. Major corneal epithelial burns are obvious by the opaque appearance that results. More subtle defects are apparent only after staining with topical fluorescein. Upper airway injuries are suspected by the presence of a hoarse voice, burns to the lips or tongue, singed facial hair and nasal vibrissae, or carbonaceous sputum.

Hot liquid aspiration may complicate facial scald burns with small children, and should be suspected if there is blistering in or around the mouth.