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burns

burns

to intubate or not

immediate intubation if either:

  • deep burns to face or neck
  • stridor
  • respiratory distress
  • hypoxic
  • hypercapnoeic

risk stratification for early prophylactic intubation

  • the following are derived from the Sth Australian RAH burns service guidelines 20091)
  • 90% of burn oedema will develop by 4 hours post-burn
  • patients at risk of airway oedema should be intubated well BEFORE the airway becomes compromised as then intubation may be impossible
  • patients with possible inhalational injury in whom it is decided not to intubate should be closely monitored with head elevated to 45deg (if Cx spine cleared), continuous SaO2, 15min airways obs for 1st 4hrs, then 1/24 observations for until 12hrs, then 4/24 obs
  • if there is oropharyngeal erythema or hoarseness, an option may be to do laryngoscopy and intubate if upper airway oedema rather than just erythema is present2)
  • those at high risk for lower airway injury generally need longer term intubation while upper airway injuries generally need only short term intubation.

high risk features suggesting early intubation for lower airway injury

  • history of prolonged confinement in smoke filled environment ie house or car fire including under car hood
  • “significant” facial burns
  • history of unconsciousness or obtundation
  • raised carboxyhaemoglobin
  • hypoxia
  • respiratory difficulty (dyspnoea, tachypnoea, increased use of accessory muscles and increased work of breathing)
  • sooty or productive sputum
  • wheezing or added sounds on auscultation
  • abnormal finding below the cords on bronchoscopy
  • deteriorating condition

low risk features for lower airway injury which suggest close observation without intubation

  • explosive or short contact with thermal agent (eg. petrol)
  • no confinement in smoke filled environment
  • scalds or contact burns
  • normal mentation and speech
  • normal appearance below the vocal cords

high risk features suggesting early intubation for upper airway injury

  • steam inhalation
  • intraoral burns or blisters
  • hoarse voice
  • stridor
  • deteriorating condition

low risk features for upper airway injury which suggest close observation without intubation

  • history of explosive or short contact with thermal agent such gas/petrol explosion characterized by superficial facial burn or erythema, with some singing of facial hair/nostril hair.
  • normal voice at initial examination
burns.txt · Last modified: 2016/10/04 07:40 by gary1