Airway Management in Burn Patients
Burns with suspected inhalation injury are a time‑critical, high‑risk situation. Thermal injury and soot can cause progressive upper‑airway oedema and lower‑airway inflammation; exposure in enclosed spaces raises the risk of carbon monoxide (CO) and hydrogen cyanide (HCN) toxicity.
The priority is early recognition, prompt high‑flow oxygen, and a low threshold for early (elective) intubation performed with senior/anaesthetic support and a full difficult‑airway plan (GOV.UK; RCEM/EMSB).
Why the airway is at risk
- Thermal injury to supraglottic tissues produces mucosal inflammation, blistering and oedema that can progress over minutes to hours, often peaking in the first 24 hours.
- Smoke and particulate inhalation cause mucosal damage, bronchospasm, increased secretions and may precipitate acute lung injury/ARDS.
- CO impairs oxygen delivery (measured as carboxyhaemoglobin, CO‑Hb); cyanide impairs cellular oxygen use and may present with high lactate.
- Enclosed‑space exposure increases likelihood of CO and HCN toxicity; both should be considered after enclosed‑space fires (GOV.UK).
Initial assessment and monitoring
- Follow the primary survey (Airway, Breathing, Circulation).
- Give high‑flow oxygen immediately to all patients with possible inhalation injury (reserve bag/non‑rebreather, ~15 L/min) while you assess and arrange definitive care (GOV.UK; Resuscitation Council UK).
- Look for predictors of airway compromise: stridor, hoarseness, change in voice, progressive dyspnoea, facial/neck/full‑thickness burns, singed nasal hairs, soot in the mouth or sputum, oropharyngeal blistering/erythema, and inhalation in an...