Step 2

Pulmonary 4

41- year-old woman is brought to the emergency department after a fire at the apartment building where she lives. She was trapped for several minutes by the fire and had to be rescued by fire fighters. She complains of pain in her face, neck and arms. Her only medical problem is GERD. Temperature is 37.4C (99 F), blood pressured is 138/80mmHg, pulse is 125/min, and respirations are 20/min. Pulse oximetry is 100% on a nonrebreather mask. She is awake, alert, and oriented. There are some superficial partial-thickness burns to the patient’s face, anterior neck, and bilateral upper extremities. Her hair is singed. Her voice is normal, her lungs are clear, and no stridor is present. Pulses are normal. Carboxyhemoglobin level is 15%. Intravenous fluids and opioids are administered.

What is the best next step in management of this patient?

  • A) Perform bedside fiberoptic laryngoscopy
  • B) Perform bedside tracheostomy
  • C) Perform immediate orotracheal intubation
  • D) Wean oxygen to maintain oxygen saturation < 92%
  • E) Apply bilevel non-invasive positive airway pressure (NIPPV)


Marina Tawadrous


Dr. Raj Dasgupta