Case of the Month #46 A Major Burn Injury: Taming the Flames

Published 13/02/2024

What are the potential indications for intubation, what signs & symptoms are of relevance to airway management in burns, and what special considerations may you need to make in airway management?

  • Potential indications: 

    • Airway obstruction (or high risk of developing airway obstruction) 
    • Respiratory distress requiring ventilation 
    • Reduced conscious level 
    • Need for transfer in major burns 
  • Important signs & symptoms suggesting potential airway injury: 

    • Facial burns 
    • Voice changes/hoarseness 
    • Stridor 
    • Perioral/intraoral soot 
  • Special considerations in airway management: 

    • Prepare for a difficult airway – there may be early airway swelling 
      • Ensure backup plans, including smaller ETTs and FONA 
      • Consider advanced techniques e.g. AFOI 
    • Inhalational injury and respiratory distress 
    • In concurrent trauma, there may be a need for cervical spine stabilisation 
    • Use an uncut ET tube – this allows for evolving swelling of the tissues 
      • Ideally larger diameter to facilitate bronchoscopy