Getting warmed up with a multiple-choice question
Amani H et al. Assessing the need for intubation in patients sustaining burn injury secondary to home oxygen therapy. Journal of Burn Care & Research 2012.
“Health care providers with limited or infrequent exposure to the treatment of burn patients with singed facial and nasal hair often interpret these physical findings to be consistent with the presence of a possible inhalation injury. This often results in unnecessary intubation in a patient who demonstrates no signs of respiratory distress or, as in a patient with COPD, no change in respiratory status from baseline.”
Muehlberger T et al. Domiciliary oxygen and smoking: an explosive combination. Burns 1998.
|Patient image from Muehlberger et al.|
Vercruysse GA et al. A rationale for significant cost savings in patients suffering home oxygen burns: Despite many comorbid conditions, only modest care is necessary. Journal of Burn Care & Research 2012.
Answering to the introductory question
Choice (D) may be best (observation). For patients with severe smoke inhalation injury (e.g. due to being trapped in a burning building), there is a risk of delayed airway edema with subsequent airway crisis. Therefore, an aggressive approach to the airway is typically recommended with airway inspection and pre-emptive intubation if there is evidence of airway edema or blistering. However, patients with flash cigarette burns do not appear to develop delayed airway edema. Therefore, there is no indication for airway inspection or pre-emptive intubation.
|More on the anxiety-COPD vortex of badness here.|
- Patients who have limited facial burns following a flash burn (from rapid combustion of a cigarette) typically do well with conservative therapy. Skin grafting or intubation are only rarely required.
- There is no role for pre-emptive intubation or routine airway examination for a patient with a limited flash burn. If the patient has already been intubated pre-emptively, they should be aggressively weaned and extubated.
- Patients with a COPD exacerbation following a flash burn may be managed similarly to other patients with COPD exacerbation. Attentive pain control will often go a long ways towards making these patients feel and look better.