Objectives
The burn patient Is a polytrauma and their approach should follow established trauma algorithms. The primary survey and stabilisation aim to identify and treat life threatening situations. Airway assessment is therefore a priority and early intubation plays an important role in symptomatic patients with inhalation injuries or in facial, oral and oropharyngeal burns that compromise airway patency. Nonetheless, intubation is not innocuous. Therefore, we should weight risks and benefits to avoid unnecessary procedures and iatrogenesis.


Methods
Referred patient with burn sustained after gas cylinder explosion. ABCDE approach performed according to ATLS guidelines. Early orotracheal intubation and resuscitation according to Parklands formula were performed according to findings. When haemodynamically stable, the patient was transferred to a specialised burns centre for subsequent management.


Results
Total burn surface area of 26%, with superficial and superficial partial thickness burns to head, neck, upper chest, both upper limbs (circumferential), left face and lower back. Dysphonia and glossal oedema were present warranting orotracheal intubation. Laryngoscopy grade III, with oedema of the base of the tongue and supraglottic area with narrowing of the lumen of the upper airway tract. Fluid resuscitation was initiated according to Parklands formula. When in specialised burn centre, bronchofibroscopy performed showed no alterations of the tracheobronchial tree, namely oedema or erythema. Twenty-six hours after burn patient was extubated safely due to absence of glossal oedema, direct laryngoscopy with no evidence of oedema/erythema of upper airway tract.


Conclusion
Airway patency assessment is paramount in the assessment of the burn patient. Airway compromise is an indication for early orotracheal intubation. Not to intubate when clinically indicated is associated with greater risks when compared to unnecessary intubation. It’s essential to carefully evaluate need for maintaining intubation, after stabilising the patient, and opt for early extubation in the presence of extubation criteria to reduce risk of iatrogenic damage.

4 - Approach to airway management in burns.