Breathing

A major burn may compromise breathing in a number of ways:

• produce a restrictive defect of thoracic wall movement
• directly damage the alveoli to reduce gaseous exchange
• produce a systemic inflammatory response with mediator damage to the lungs as seen with ARDS

The initial examination must be systematic:

• look at the whole patient:
  • cyanosis if oxygen deprived
  • cherry pink hue in carbon monoxide poisoning
• expose the chest:
  • look for adequate, symmetrical excursion
  • look for a circumferential burn to the chest in all groups and to the abdomen in young children who largely ventilate with the diaphragm; escharotomy may be required
• percuss for the degree of resonance - often a pneumothorax is missed in the multiply injured
• listen for breath sounds
• count the respiratory rate; tachypnoea may be an early sign of compromise in the obtunded

Always administer 100% oxygen. If the patient is not breathing, too exhausted to breath adequately, or at risk of occluding their airway then consider intubation and ventilation. For other considerations with respect to breathing in the patient with concomitant trauma, see the submenu.