Massive tissue edema after thermal injury is a wellrecognized
entity. Although this process is responsible
for the patient’s large fluid needs during resuscitation,
there have been no effective treatment modalities introduced
into clinical care to control the degree of edema
formation.11 Histamine is most likely to be the primary
mediator responsible for the early phase of increased
microvascular permeability seen immediately after a
burn injury.
Flame burns are often associated with inhalation
injury.6 Vigilant attention should be given to the airway
of the burned patient to ensure that it is patent and that
oxygenation and ventilation are optimized. Table 4 lists
the airway interventions that we performed in caring for
this patient. The ASA Difficult Airway Algorithm is an
established guide to managing patients who are difficult
to mask ventilate, intubate, or both.