from chemical burns should be removed quickly from the causative chemical
agent and the burns should be irrigated with copious amounts of water.
IV. Immediate Resuscitative Measures
A. Airway
Securing a patient’s airway should be a priority in any injured patient.
Patients suspected of having inhalation injury should be admitted for close
monitoring such as those trapped in a house fire with excessive smokes and
fumes or those with facial burns, singed hairs and carbonaceous sputum.
Inhalation injury, implicated in approximately 50% of all deaths from burn injury,
has become one of the more frequent causes of death in this population. The
pathophysiology of inhalation injuries arises from the thermal and chemical
injury to the supraglottic region as well as tracheobronchial and parenchymal
damage caused by the chemical and particulate constituents of smoke. This
damage usually leads to sloughing of the airway mucosa, resulting in bleeding
and formation of obstructing clots and casts. Suspect inhalation injury in
patients presenting with evidence of respiratory distress (shortness of breath,
hoarseness, wheezing, or carbonaceous sputum), abnormal mental status, or
evidence of facial burns accompanied by signed nasal hairs/eyebrows or the
presence of soot. These patients, more often than not, require intubation. The
gold standard for diagnosing inhalation injury is fiberoptic bronchoscopy.
Bedside bronchoscopic examination of the airway allows direct visualization of