MEDizzy - A 42-year-old man who was in a house fire is transferred to

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Critical Care Anesthesiology Blood Gases and Respiratory Care

A 42-year-old man who was in a house fire is transferred to your burn unit. He has singed nose hairs and facial burns. Direct laryngoscopy in the emergency room demonstrates pharyngeal edema and mucosal sloughing. He has 60% total body surface area burns. Which of the following is the next step in the management of this patient?

ExplanationD. The patient requires intubation because of suspicion of upper airway burns. Clinical suspicion should be increased given the singed nose hairs and facial burns. Intubation should be considered in the presence of posterior pharyngeal edema, mucosal sloughing, or carbonaceous sputum on direct laryngoscopy. Significant upper airway edema can result of upper airway burns, particularly 12 to 24 hours post-injury. Bronchoscopy can be used to evaluate for lower airway burn injuries, but would not change management in this patient given the high clinical suspicion for airway burn injuries and the need for intubation. Inhaled or intravenous steroids for airway burn injuries are not indicated in patients with large burns due to the increased risk of infections. Carbon monoxide poisoning is treated with 100% inhaled oxygen; hyperbaric oxygen is used in patients with neurologic symptoms and small burns as it reduces the half-life of carboxyhemoglobin. However, the risks outweigh the benefits in patients with large burns.