Airway
The airway is at risk by three major mechanisms:
- Generalised oedema as a systemic response from an increasing burn size and depth can cause swelling of the airway and compromise airflow.8,9
- Localised oedema as a result or direct thermal damage to the airway can obstruct airflow.8
- Inhalation injury as a result of heat, smoke or toxic chemicals can cause damage to the airway.8
Assessment
Factors that increase the suspicion of airway obstruction or inhalation injury include9:
| Hoarse voice |
| Respiratory distress/ stridor |
| Carbonaceous sputum |
| Singed nasal/facial hairs |
| Inflamed oropharynx |
| Burns to the face/oropharynx |
| History of burns in an enclosed space |
| Raised blood gas carbon monoxide (CO) level |
Airway compromise can develop over a matter of hours and may only come to light when the patient is in crisis.9 Figure 5 shows airway change over a period of 1 hour.
Management
- Sit patient upright
- Any suspected airway injury necessitates senior anaesthetic review to identify and predict deterioration.8
- If indicated, early intubation with an uncut tube prevents the tube moving in the event of further swelling.9
Common pitfall
Failure to recognise or predict the deteriorating airway.