2020 Volume 71 Issue 1 Pages 27-32
In the acute phase of treating burn patients, assessing the presence of inhalation injury is an important factor to determine the therapeutic strategy. We suspect an inhalation injury when singed nasal vibrissae or soot in the upper airway is present, and checking the upper airway using a fiberscope is the most reliable examination to make the diagnosis. However, even when there are no typical signs suggestive of inhalation injury, at times, gradual worsening of the pharyngolaryngeal edema can cause upper airway obstruction leading to an emergency tracheal intubation, so careful observation at a high care unit is essential. We report such a case caused by exposure to high-temperature ethylene glycol. At first, there were no typical signs or symptoms of inhalation injury during the examination in the emergency room. However, within 10 hours after admission, late-onset regional pharyngolaryngeal edema causing upper airway obstruction occurred, and emergency tracheal intubation was performed. Seven days after intubation, pharyngolaryngeal edema improved, and the patient was successfully extubated. Our case patient's late-onset upper airway obstruction was caused not only by the immediate edema from the inhalation injury, but also by fluid shift after the facial and cervical burn. The regional edema that we observed may be related to the low tissue pressure of the pharyngolaryngeal mucous membrane, since we could observe a clear border between the edematous and non-edematous regions. Without question, patients with signs or symptoms of inhalation injury require tracheal intubation to keep the airway intact. However, even when there are no typical signs or symptoms of inhalation injury on the initial examination, we should be cautious of late-onset pharyngolaryngeal edema caused by fluid shift from the facial and cervical burn. Close and careful observation after a facial and cervical burn injury is highly recommended.
