Airway maintenance

Airway maintenance is the first stage in management of the major burn. At all times the cervical spine must be maintained in a neutral position with either constant manual support or a hard collar, sand bags and tape over the frontal region of the head.

If the patient cannot talk, the airway may not be patent. Immediate measures include:

• look inside the mouth - note any foreign bodies, evidence of a burn or inhalation injury:
  • oedema
  • blistering
  • black, sooty deposits
• remove any obstruction with a sweep of the finger forward or, if available, use the suction of a Yankauer tube
• open the airway with a chin lift or jaw thrust manoeuvre avoiding excessive flexion or extension of the cervical spine
• secure the airway if the patient is having difficulty maintaining e.g. due to facial or pharyngeal burns; measures include:
  • Guedel airway
  • nasopharyngeal airway
  • endotracheal tube
  • emergency cricothyroidotomy

Once the airway is secure, give 100% oxygen at 8 litres per minute. See the submenu for further airway management.

Wheezing may respond to inhaled bronchodilators. If a major upper or lower airway burn is suspected, consider elective intubation and ventilation before the patient's condition deteriorates.