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Behind The Knife: The Surgery Podcast

Clinical Challenges in Burn Surgery: Inhalation Injury

Behind The Knife: The Surgery Podcast

Behind The Knife: The Surgery Podcast

Medicine, Health & Fitness, Education, Science

4.81.4K Ratings

🗓️ 1 December 2025

⏱️ 22 minutes

🧾️ Download transcript

Summary

Does soot in the airway always mean an immediate intubation? Join our Burn Team as they debunk common myths surrounding inhalation injury and distinguish true airway threats from superficial flash burns. We break down critical management strategies, from the 'HAM' protocol to ventilator management, and explain why these patients require massive fluid resuscitation. Tune in to master these high-stakes clinical decisions and ensure you are ready for your next burn patient.

Hosts:
- Kathleen Romanowski – University of California Davis Hospital, Shriners Hospital Sacramento
- Laura Johnson – Grady Memorial Hospital
- Lauren Nosanov – Grady Memorial Hospital
- Victoria Miles – Louisiana State University Health Science Center, University Medical Center New Orleans

Learning Objectives:
- Recognize the clinical features and diagnostic challenges of inhalation injury in burn patients, including differentiation from thermal airway injury and flash burns.
- Apply evidence-based criteria to guide intubation and ventilatory management, including the avoidance of unnecessary intubation.
- Implement key principles of supportive care and complication prevention, including fluid resuscitation, pharmacologic therapies, and long-term airway considerations.

References:
- Hope E Werenski, Anju Saraswat, James H Holmes, John K Bailey, Is Burn Center Admission Necessary After Home Oxygen Ignition Injury?, Journal of Burn Care & Research, 2025;, iraf189, https://doi.org/10.1093/jbcr/iraf189
- Kathleen S. Romanowski, Tina L. Palmieri, Soman Sen, David G. Greenhalgh, More Than One Third of Intubations in Patients Transferred to Burn Centers are Unnecessary: Proposed Guidelines for Appropriate Intubation of the Burn Patient, Journal of Burn Care & Research, Volume 37, Issue 5, September-October 2016, Pages e409–e414, https://doi.org/10.1097/BCR.0000000000000288 https://pubmed.ncbi.nlm.nih.gov/26284640/
- Walker PF, Buehner MF, Wood LA, Boyer NL, Driscoll IR, Lundy JB, Cancio LC, Chung KK. Diagnosis and management of inhalation injury: an updated review. Crit Care. 2015 Oct 28;19:351. doi: 10.1186/s13054-015-1077-4. PMID: 26507130; PMCID: PMC4624587. https://pubmed.ncbi.nlm.nih.gov/26507130/

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Transcript

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0:00.0

Behind the Knife.

0:24.4

This is Patrick Georgoff.

0:25.5

I want you to imagine this.

0:26.9

It's 2 a.m.

0:27.7

and you're rushing a hypotensive trauma patient to the operating room for exploration.

0:32.3

Maybe you need to go into the neck, the chest, or the abdomen.

0:35.5

Are you prepared for what you might find?

0:37.8

Trauma educational resources are extremely limited. That's why we created the trauma

0:41.4

surgery video atlas. 24 challenging scenarios with high-yield text, beautiful illustrations,

0:47.3

and stunning professional grade video that walks you through the approach and management

0:51.5

of devastating injuries in a step-by-step fashion.

0:55.7

Check out the link in the show notes. For more, there are group discounts available as well.

0:58.9

Now, enjoy the episode and dominate the day.

1:03.6

Welcome to Behind the Knife, the Surgery Podcast.

1:08.5

Today, we're diving into one of the most complex and high-staking scenarios

1:12.5

in burn care. Inhalation injury. I'm Dr. Lauren Nassanav from Grady Memorial Hospital,

1:18.5

and I'm joined today by Dr. Kathleen Romanowski from UC Davis and Shriners, Sacramento, and Dr.

1:25.1

Victoria Miles from the LSU Health and UMC, New Orleans. Today, we'll

1:31.6

tackle a clinical challenge, evaluating and managing inhalation injury, using two real-world

1:37.3

cases, discussing current evidence, and ending with a few quick take-home pearls. So let's jump right into our first case.

1:47.0

For those of you that have done any level of burn care, this should sound pretty familiar.

1:52.9

So you've got a call that we're getting a 55-year-old man with hypertension, type 2 diabetes,

...

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