A14 A 48-year-old woman is rescued from a house fire during
which she was trapped in a smoke-filled bedroom for 30
minutes. On arrival in the Emergency Room, she has
marked facial burns and a hoarse voice but no stridor. She
is expectorating carbonaceous sputum, appears confused
and has a cherry-red visage. Which statement is FALSE?
a. Early intubation is advisable.
b. A significant thermal injury to the trachea is likely.
c. Lavage with sodium bicarbonate 1.4% has a role in the
management of this patient.
d. Lung function is likely to worsen over the next 12 hours.
e. A cherry red visage has several causes other than carbon monoxide
poisoning.



A14 B
Inhalational injury has three mechanisms: thermal injury to the upper
airway, smoke inhalation causing chemical pneumonitis to the lower
airways, and systemic absorption of toxins (principally carbon monoxide
and cyanide).

Hoarseness and facial burns are signs of upper airway
thermal injury to the pharynx and glottic area.

Pharyngeal oedema is likely
to increase rapidly especially once fluid resuscitation is commenced, and
early intubation is advised.

Most of the heat from hot gas inhalation is
dissipated in the upper airways, so thermal injury below the glottis is
unusual. 

Sodium bicarbonate lavage of the bronchial tree may be
performed following intubation to neutralise acidic deposits and remove
soot contamination, although evidence for the effectiveness of this therapy
is lacking.

Lung function usually worsens over a period of hours following
inhalational injury.

A cherry red visage is a non-specific sign of carbon
monoxide poisoning, and there are many other causes of facial flushing
including alcohol, emotion and heat, all of which are associated with burns
injuries.