In this short video, we will be demonstrating the diagnosis of inhalation injury using fiberoptic bronchoscopy. This is a young male patient who was involved in a house fire and sustained burns to his face, trunk, and bilateral upper extremities. At the scene, he was noted to have altered mental status and signs of respiratory distress. On arrival to the hospital due to the high suspicion for inhalation injury, he was prophylactically intubated to secure his airway and placed on mechanical ventilation. Due to elevated carbon monoxide, he is placed on 100% oxygen. On arrival to the burn unit, a confirmatory bronchoscopy was performed as part of our standard workup. The bronchoscope is advanced through the endotracheal tube using an adapter that allows continuous ventilation during the procedure. The patient's vital signs are monitored continuously and appropriate sedation is administered. The end of the tube is visualized, and beyond this, we see the crina. Thick copious carbonaceous deposits are noted along with erythematous and friable mucosa. We then inspect the right and left main stem bronchi to document these findings and the procedure is completed. The most well-known scale to describe the severity of inhalation injury was developed by Endorff and Gamelli, which you see here. This goes from 0 to 4 and is based on the physical findings observed during the procedure. In this case, due to the degree of friability and carbonaceous deposits, this was determined to be a severe inhalation injury.

inhalation injury

fiberoptic bronchoscopy

burn victim

respiratory distress

Endorff and Gamelli scale