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Section
2a
SMOKE
INHALATION INJURY CONTINUED
As
edema increases, it becomes much more
difficult to secure an airway. Endotracheal
intubation is thus preferably performed on
admission, before severe edema develops. A
patient with inhalation injury can be closely
monitored for upper airway obstruction without
a tube, preferably with the head elevated at
30%, only if intubation will be technically
possible later. However, if anatomic
distortion from face and neck burns is
increasing to a point where safe intubation
might soon be precluded, the procedure is
carried out immediately.
Continuous
administration of humidified oxygen is
indicated to maintain adequate oxygen delivery
as well as to assist in the clearance of
secretions. If the patient’s hemodynamic
condition will tolerate it, elevation of the
head and chest by 20% to 30% is helpful in
reducing neck and chest wall edema. The early
addition of bronchodilators, usually by
aerosol, is especially advantageous in
managing the bronchospasm seen after chemical
injury.
 
Massive
edema from facial burn is evident by 8 hours
post burn. Note endotracheal tube is secured
with string around neck to avoid displacement.
Bronchoscope
Assessment of the Airway |
Supraglottic
edema 12 hours post-smoke exposure
Endotracheal intubations required |
Infraglottic
injury evident by erythema and narrowing of
the airways by edema and bronchospasm |
  
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