Behind The Knife: The Surgery Podcast1 Dec 2025

Clinical Challenges in Burn Surgery: Inhalation Injury

Does soot in the airway always mean an immediate intubation? Join our Burn Team as they debunk common myths surrounding inhalation injury and distinguish true airway threats from superficial flash burns. We break down critical management strategies, from the 'HAM' protocol to ventilator management, and explain why these patients require massive fluid resuscitation. Tune in to master these high-stakes clinical decisions and ensure you are ready for your next burn patient.

Hosts:
- Kathleen Romanowski – University of California Davis Hospital, Shriners Hospital Sacramento
- Laura Johnson – Grady Memorial Hospital
- Lauren Nosanov – Grady Memorial Hospital
- Victoria Miles – Louisiana State University Health Science Center, University Medical Center New Orleans
Learning Objectives:
- Recognize the clinical features and diagnostic challenges of inhalation injury in burn patients, including differentiation from thermal airway injury and flash burns.
- Apply evidence-based criteria to guide intubation and ventilatory management, including the avoidance of unnecessary intubation.
- Implement key principles of supportive care and complication prevention, including fluid resuscitation, pharmacologic therapies, and long-term airway considerations.

References:
- Hope E Werenski, Anju Saraswat, James H Holmes, John K Bailey, Is Burn Center Admission Necessary After Home Oxygen Ignition Injury?, Journal of Burn Care & Research, 2025;, iraf189, https://doi.org/10.1093/jbcr/iraf189
- Kathleen S. Romanowski, Tina L. Palmieri, Soman Sen, David G. Greenhalgh, More Than One Third of Intubations in Patients Transferred to Burn Centers are Unnecessary: Proposed Guidelines for Appropriate Intubation of the Burn Patient, Journal of Burn Care & Research, Volume 37, Issue 5, September-October 2016, Pages e409–e414, https://doi.org/10.1097/BCR.0000000000000288 https://pubmed.ncbi.nlm.nih.gov/26284640/
- Walker PF, Buehner MF, Wood LA, Boyer NL, Driscoll IR, Lundy JB, Cancio LC, Chung KK. Diagnosis and management of inhalation injury: an updated review. Crit Care. 2015 Oct 28;19:351. doi: 10.1186/s13054-015-1077-4. PMID: 26507130; PMCID: PMC4624587. https://pubmed.ncbi.nlm.nih.gov/26507130/

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