Airway management in inhalation injury: a case series

Abstract

A 32-year-old man was in a parking lot trying to jump-start a car battery when the engine exploded. He suffered 18% total body surface area (TBSA) burns as well as inhalation injury. At initial presentation at the A&E, the patient was alert but disorientated and moaning in pain. He was in an altered mental state with a Glasgow ABSTRACT Inhalation injury is a serious consequence of a fire or an explosion, with potential airway compromise and respiratory complications. We present a case series of five patients with inhalational burns who presented to Singapore General Hospital and discuss our approach to their early management, including early evaluation and planning for the upper and lower airway, coexisting cutaneous burns, and monitoring their ICU (intensive care unit) severity of illness, sepsis and acute respiratory distress syndrome. All five patients suffered various grades of inhalation injury. The patients were initially assessed by nasolaryngoscopy, and three patients were prophylactically intubated before being sent to the emergency operating theatre for definitive airway and burns management with fibreoptic bronchoscopy. All patients were successfully extubated and discharged stable. Various complications can arise as a result of an inhalation injury. Based on our cases and literature review, we propose a standardised workflow for patients with inhalation injury.