Airaway Managment in Burn Patient

Last Updated on by FRCEM Intermediate

Assess the airway

  • Does the patient respond appropriately to a question?
  • Look for signs of airway obstruction (stridor, use of accessory muscles, paradoxical chest movements).
  • Listen for any upper-airway noises and breath sounds.

Suspect inhalation injury if:

  • Exposure to fire and smoke in an enclosed setting
  • Hoarseness or change in voice
  • Harsh cough, stridor
  • Burns to the face,
  • head and neck swelling,
  • inflamed oropharynx
  • Singed nasal hair, eyebrows or eyelashes
  • Soot in the saliva, sputum, nose or mouth.

A patient with a history or signs suggestive of inhalation injury requires repeated airway assessment over time if they are not intubated

Consider intubation:

Consider intubation if there are any warning signs of:

  • Pending airway obstruction: stridor, hoarse voice; (requires urgent emergency intubation)
  • Decreased level of consciousness
  • Unprotected airway
  • An airway is at risk in transit
  • Uncooperative/combative patient leading to distress and further risk of injury

Airway Management

  • Call for Help
  • 15L/min + reservoir bag
  • may need ETT urgently – Check warning signs
  • may need surgical airway

Failed airway management ( Check!!!)

  • Call for help (anesthetic/Surgeons), Involve ED Seniors
  • Apply 100 % oxygen, face mask ventilate as needed
  • Prepare Difficult airway trolley
  • Prepare for the failure of intubation and failure of ventilation with Plans A, B, C and D

Important Factors to consider in any burn

  • Resuscitation – airway patency, breathing, circulation, LOC
  • Adequacy of resuscitation to date – HR, BP, urine output, fluid received
  • Associated trauma
  • Airway burn or inhalational injury – stridor, burns to face, nose and mouth, carbonaceous sputum
  • Facial and/or corneal burns, perineal burns
  • Circumferential burns – extremities -> compartment syndrome, ventilator inadequacy -> escharotomy
  • Rhabdomyolysis
  • Inhalation of toxic gases – CO
  • Temperature
  • Adequacy of analgesia
  • Problems with vascular access
  • Evidence of drug/alcohol ingestion
  • Co-morbid conditions
  • Transfer to a definitive care facility

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