Acute injuries found in the primary and secondary survey should be addressed in accordance with standard trauma protocols. In evaluating a patient for non-burn trauma, avoid becoming distracted by the burns.

Perform a rapid airway assessment and obtain a definitive airway if needed. Immediate intubation may not be necessary in less severely burned casualties, thereby allowing time to complete the primary survey and prepare for controlled intubation.

Indications for endotracheal intubation include coma or depressed mental status with Glasgow Coma Scale (GCS) <8, symptomatic inhalation injury, deep facial or neck burns, and burns of ≥ 40% TBSA.

NOTE: Edema after burns or inhalation injury causes supraglottic airway devices such as laryngeal mask airways to be ineffective.

- Use a large-bore endotracheal tube (ETT), especially if inhalation injury is suspected. Size 8 ETT or larger is preferred for adults. The larger ETT facilitates subsequent bronchoscopy and pulmonary toilet and decreases the risk of later airway occlusion due to casts comprised of blood, mucus, and debris.