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Chapter 25. Airway Management for the Burn Patient

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Factors associated with challenges in airway management in patients with acute burns include

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A. hypovolemia

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B. inhalational injury

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C. airway edema

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D. mechanical effects of burns to the face, neck, and thorax

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E. all of the above

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(E) Hypovolemia is commonly associated with burns and exacerbation of the cardiovascular effects from administration of induction agents, paralytics, and positive pressure can produce profound hypotension and PEA. Inhalational injury complicates the decision of when to intubate and has significant effects on oxygenation and ventilation. Airway edema associated with direct injury as well as resuscitation is one of the critical factors that can make airway management difficult in the burn patient. The mechanical effects of burns to the face, neck, and thorax are critical components to airway management, effecting access to the mouth and larynx, as well as ventilation even with an endotracheal tube in place. Escharotomy to the torso (and sometimes the neck) need to be considered if ventilation becomes restricted due to contracture or loss of compliance of the burned skin.

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The approach to airway evaluation and management in the burn patient should include

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A. the standard approach to airway evaluation and management

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B. intubation for all patients who present with burn injuries

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C. consideration for potential for coexisting toxicological injuries

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D. a completely unique approach

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E. A and C only

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(E) The standard approach to airway management outlined in this book is a necessary foundation from which to address airway management in the burn patient. While it is important to recognize patients in whom inhalational injury and progression of disease are likely and intubate them early, some patients will not require intubation. Burn management requires awareness of the airway effects of inhalational injury, external burns, and the potential for toxicological injury. A unique approach to airway management is not required, as the standard approach is a great platform on which to begin to address the airway issues in the burn patient.

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Burns to the face, neck, and torso can

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A. make BMV more difficult

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B. make EGD placement more difficult

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C. make laryngoscopy and endotracheal tube placement more challenging

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D. make surgical airway more challenging

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