Jul 24, 2026 · 46 min · 12 segments
There is more to airway burns than thermal injury. Cody and Josh are going to unpack that idea.
Yeah.
Yeah.
So how we're teaching it is obviously we're looking for a patient that's been in a compartment.
Most likely your patients that are in the open air are not going to suffer from airway burns because there wasn't a closed container to force this up.
thermal and gas energy into the airways, but a closed compartment.
So a house fire, car fire, confined space, something like that, where there's been a thermal event, explosion, house fire, building fire, cooking fire, whatever it is.
But so you have a thermal event and then you're looking for some clinical signs and symptoms, maybe some So around the mouth, around the nose, the nares, maybe some burned nostril hair.
If you look in the nostrils, if they've got a beard or a mustache like myself and Cody, if they're missing part of their mustache, if they're missing part of their mustache from said fire, that's probably a good sign that they got a real good thermal hit to the face and the nose.
And then looking for hoarseness, looking for trouble breathing, dyspnea, decreasing O2 saturation, a whole long list of things, but not everyone presents that way.
Not everyone in a closed compartment in a house fire is going to have to worry about a thermal injury to their lungs.
They could be looking at something else.
But it's the other stuff that might make our trigger for innovation if we're able to do RSI and vent after that, that we don't talk about a whole lot, but makes a lot of sense when we do dive into it.
Yeah, we keep the conversation pretty limited to need to be intubated because of airway swelling.
And I don't think that's incorrect, but it does leave a gap.
Yeah.
It was really interesting to me to see this, that the highest predictive value for the requirement for intubation for a burn patient was accessory muscle use.
In the, what was it, the Onishi? I hope I'm saying it right.
100%, 100% of the patients that were exhibiting accessory muscle use required intubation versus only 30% of those with singed nasal hair.
I mean...
When we get into it, that makes sense because there's some processes at play that are not so much just thermal
impingement.
So perfect you said that because in that particular paper, more patients who did not have singed nasal hair were intubated than those that did have singed nasal hair.
What about large surface area burns? Like you don't see a whole lot going on in the face, but they've got pretty significant greater than 20, 30% over the rest of their body.
Yeah.
Yeah.
So how we're teaching it is obviously we're looking for a patient that's been in a compartment.
Most likely your patients that are in the open air are not going to suffer from airway burns because there wasn't a closed container to force this up.
thermal and gas energy into the airways, but a closed compartment.
So a house fire, car fire, confined space, something like that, where there's been a thermal event, explosion, house fire, building fire, cooking fire, whatever it is.
But so you have a thermal event and then you're looking for some clinical signs and symptoms, maybe some So around the mouth, around the nose, the nares, maybe some burned nostril hair.
If you look in the nostrils, if they've got a beard or a mustache like myself and Cody, if they're missing part of their mustache, if they're missing part of their mustache from said fire, that's probably a good sign that they got a real good thermal hit to the face and the nose.
And then looking for hoarseness, looking for trouble breathing, dyspnea, decreasing O2 saturation, a whole long list of things, but not everyone presents that way.
Not everyone in a closed compartment in a house fire is going to have to worry about a thermal injury to their lungs.
They could be looking at something else.
But it's the other stuff that might make our trigger for innovation if we're able to do RSI and vent after that, that we don't talk about a whole lot, but makes a lot of sense when we do dive into it.
Yeah, we keep the conversation pretty limited to need to be intubated because of airway swelling.
And I don't think that's incorrect, but it does leave a gap.
Yeah.
It was really interesting to me to see this, that the highest predictive value for the requirement for intubation for a burn patient was accessory muscle use.
In the, what was it, the Onishi? I hope I'm saying it right.
100%, 100% of the patients that were exhibiting accessory muscle use required intubation versus only 30% of those with singed nasal hair.
I mean...
When we get into it, that makes sense because there's some processes at play that are not so much just thermal
impingement.
So perfect you said that because in that particular paper, more patients who did not have singed nasal hair were intubated than those that did have singed nasal hair.
What about large surface area burns? Like you don't see a whole lot going on in the face, but they've got pretty significant greater than 20, 30% over the rest of their body.
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