A lesson from Beyond the Burn: Navigating Modern Burn Care

Airway Management for Burn Victims

Airway management stands as a critical facet of burn victim care. Despite strides in ventilatory support, inhalation injury persists as a primary cause of mortality among adult burn victims. The risk of such injury escalates with the extent of burns, afflicting two-thirds of patients with burns exceeding 70 percent of the total body surface area (TBSA). During airway assessment, clinicians must judiciously stabilize the cervical spine. Vigilance for signs of respiratory distress and smoke inhalation injury is paramount, given its frequent fatal consequences. Although initial assessment may yield no apparent injury, sudden laryngeal edema can ensue unexpectedly. Aggressive airway management, including early intubation, is imperative upon detecting signs such as persistent cough, stridor, wheezing, hoarseness, and specific burn patterns indicative of inhalation injury. Maintaining the airway and delivering supplemental oxygen are vital in major burn cases. While dedicated studies on severe burn injuries are scarce, oxygen supplementation should be administered to maintain arterial oxygen saturation between 90 and 96 percent, akin to other critically ill patients. Prompt intubation is warranted for those exhibiting severe inhalation injury or respiratory distress, with considerations for pre-transport intubation for patients requiring transfer to a burn center. Fluid resuscitation may exacerbate laryngeal swelling, complicating tracheal intubation. Therefore, delay in intubation should be avoided when severe inhalation injury or respiratory distress is evident or anticipated. Succinylcholine may be utilized for rapid sequence intubation within the initial 24 hours post-severe burn, with caution regarding its usage thereafter due to the risk of severe hyperkalemia.  Signs of significant smoke inhalation injury warranting intubation include persistent cough, stridor, wheezing, hoarseness, deep facial or circumferential neck burns, nare inflammation or singed hair, carbonaceous sputum or burnt matter in the mouth or nose, and blistering or edema of the oropharynx. Depressed mental status, respiratory distress, hypoxia, hypercapnia, and elevated carbon monoxide and/or cyanide levels further underscore the need for intervention. Inhalation injuries primarily affect the upper airway, causing substantial edema, while flash burns typically spare the airway despite facial involvement.

Free lesson

This lesson is part of “Beyond the Burn: Navigating Modern Burn Care”

Lesson 5 of 17

Unlock all 17 lessons, the quiz, and 1.5 Class A credits.

See the moduleIncluded in Edition I - ISO

More free lessons from this module