Arrange the order of airway management in a client with burns.

• A. Intubate the client within 1 to 2 hours after injury. Place the client on ventilatory support. Escharotomies of the chest wall, if necessary. Extubation is indicated when edema resolves.
• B. Escharotomies of the chest wall, if necessary. Intubate the client within 1 to 2 hours after injury. Place the client on ventilatory support. Extubation is indicated when edema resolves.
• C. Extubation is indicated when edema resolves. Intubate the client within 1 to 2 hours after injury. Place the client on ventilatory support. Escharotomies of the chest wall, if necessary.
• D. Place the client on ventilatory support. Intubate the client within 1 to 2 hours after injury. Escharotomies of the chest wall, if necessary. Extubation is indicated when edema resolves.

Answer: (A)

Airway protection is the priority in burn patients because inhalation injury and facial burns can cause rapid airway edema that makes the airway hard to secure later. The best sequence is to intubate within about the first 1–2 hours after injury while the airway is still more easily managed, then provide ventilatory support as needed to maintain oxygenation and CO2 removal. If there are deep circumferential chest burns, escharotomies may be required to relieve constriction and improve chest expansion, but this is done after securing the airway and starting ventilation. Extubation should wait until edema has resolved and the patient can maintain a protected airway and adequate ventilation, to avoid the need for reintubation.