This case was written by Dr. Rob Woods. Rob is an Associate Professor of Emergency Medicine at the University of Saskatchewan. He works clinically in Adult and Pediatric EM, as well as doing Transport Medicine with STARS. He is the FRCPC Residency Program Director as well as the Program Director for the Clinician Educator Diploma Program at the University of Saskatchewan.
Why it Matters
Inhalational injury are time-sensitive emergencies that can result in upper airway obstruction from thermal injury with acute airway edema and laryngospasm. Early intubation is indicated in suspected inhalational injury. Concomitant trauma and toxicological illness also needs to be considered and ruled out in these patients.
Goals of care discussions can be difficult at the best of times, but healthcare providers in the Emergency Department must be prepared to initiate these challenging discussions even when faced with a life-threatening conditions to prevent patient harm from over-aggressive treatment. Providers must manage their team to provide simultaneous patient care and facilitate goals of care discussions with family and other substitute decision makers.
EMS was called to an Assisted Living Centre after a 70-year old resident accidentally lit herself on fire after trying to smoke a cigarette. She was on fire for several minutes before staff arrived and were able to extinguish the fire. The patient conscious but confused on EMS arrival. She has burns to her upper chest and face and is wheezy throughout all her lung fields. Her family is driving to the ED with her advanced directive.
A 70-year old female is brought to the ED after lighting herself on fire while trying to light a cigarette. She will have a 15% TBSA burn (upper anterior chest and neck only) with inhalational injury. Preparation for intubation should be an early priority. Her prognosis is poor but survivable and it will be key to discuss goals of care with the family before proceeding with intubation and further burn care. A difficult intubation should be anticipated but is not encountered in this case.