Goal: Avoid airway obstruction due to inhalation injury or burn-induced swelling.

- Patients with smoke inhalation injury may present with a range of symptoms in terms of severity.
- Patients with severely symptomatic smoke inhalation injury (e.g., respiratory distress, stridor) require immediate definitive airway (cuffed tube in trachea) because they are at risk of immediate airway loss. Oxygenate and ventilate.
- All patients with burns covering >40% TBSA should be intubated because total-body swelling will tend to obstruct the airway. Patients with facial burns around the mouth may require intubation (Figure 1).
- Best: Rapid-sequence intubation by skilled provider, followed by continuous sedation and airway maintenance, supplemental oxygen, portable ventilator.
- Better: Cricothyroidotomy followed by continuous sedation and airway maintenance, supplemental oxygen via an oxygen concentrator, portable ventilator.
- Minimum: Cricothyroidotomy, ketamine, ambu bag with positive end-expiratory pressure (PEEP) valve.