UPPER AIRWAYS BURNS

DEFINITION

     Thermal or caustic burns to the pharynx, larynx or trachea.

1. Thermal Burns

• Heated gases

• pharyngeal, laryngeal, and tracheal burns are usually the worse affected area

• Direct Flame

• injuries usually confined to the face and lips

2. Caustic Burns

• acid / alkali
• intentional or accidental

CLINICAL FEATURES

1. Thermal Burns

• The initial physical findings are notoriously unreliable at ruling out burns to the airway.
• Suggestive findings are :

• history of burns in an enclosed space

• sore throat, painful swallowing

• facial, nasal or oral burns

• cough, stride or voice changes

• carbonaceous sputum or respiratory distress

2. Caustic Burns

• associated with mucous ulceration and massive o edema
• drooling
• cough, stride
• ulceration of the mouth, tongue or pharynx (may appear as white plaques)
• respiratory distress

IMPORTANT POINTS

1. The initial physical findings can be unreliable in ruling out thermal burns to the upper airway.
2. History of the circumstances of the burn is important to assess the possibility of airway burns (GE confined space, explosion, flame, steam)
3. If thermal upper airway burns are present, also consider carbon monoxide, cyanide or hydrogen sulfide poisoning from smoke inhalation.
4. If caustic burns are present, consider other ingest ants as well
5. Airway compromise can be delayed but dramatic in onset.