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Inhalation Injury Early Intubation — RACP Adult Medicine MCQ

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ModerateRespiratoryInhalation Injury Early IntubationRACP Adult Medicine

A 30-year-old man in a house fire has facial burns, singed nasal hairs, carbonaceous sputum, and a hoarse voice. GCS is 15. SpO₂ 96%. He has no stridor currently but his voice is becoming increasingly hoarse. COHb is 20%. What is the most appropriate airway management?

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Correct answer: C — Endotracheal intubation (RSI)

Inhalation injury with progressive hoarseness despite current GCS 15 and SpO₂ 96% requires EARLY intubation. Airway oedema from thermal/chemical injury progresses rapidly and can make delayed intubation impossible. Do NOT wait for stridor (late sign indicating >50% airway narrowing). Intubate early while anatomy is still recognisable. Signs: facial burns, carbonaceous sputum, hoarseness, singed nasal hairs, soot in oropharynx. Elevated COHb confirms smoke inhalation.

Reference: ANZBA – 2024 – Burns; ATLS 10th Ed