Pressures
above 40 mm Hg necessitate escharotomy or fasciotomy
to improve tissue perfusion.
Inflexible eschar and underlying
tissue edema can also prevent chest wall motion
and thus limit ventilation In the present case, the
surgeon made upper extremity and chest incisions in an
effort to correct these problems.
In conclusion, airway management of the patient
with severe, extensive burns of the face, neck and chest
requires a coordinated effort by the entire care team.
Rapid initial assessment should guide the CRNA to move
quickly through established difficult airway maneuvers.
Initiation of a surgical tracheostomy may prove to be the
only satisfactory method of ventilation. Even with successful
ventilation, the outcome may be dismal.