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

1. Sit patient upright
2. Any suspected airway injury necessitates senior anaesthetic review to identify and predict deterioration.⁸
3. 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.