importance not to neglect the possibility of other injuries from the burn mechanism, or associated injuries, which may also require emergent treatment and stabilization Finally, patients with ocular area burns will need specialized ophthalmology consultation for evaluation of corneal involvement Management Airway The inhalation of hot gases can burn the upper airway, leading to progressive edema and airway obstruction Children with burns of the face, singed facial hairs, or hoarseness are at high risk, but airway burns can also occur in the absence of these signs Edema of the burned airway will worsen over the first 24 to 48 hours Knowledge of the time course of airway swelling justifies endotracheal intubation for subtle signs of airway compromise that occur shortly after the injury Early intubation may circumvent a difficult intubation later in the course of a child with severe pharyngeal and airway edema Endotracheal tubes of smaller diameter than expected for age should be available in anticipation of a narrowed airway Cuffed tubes are preferred to accommodate the potential for changing airway edema over the course of the recovery Children who have jumped or fallen in house fires, been burned in motor vehicle accidents, or been burned by explosions are at risk for other traumatic injuries, and cervical spine precautions should be maintained during management of their airways Furthermore, children with severe burns may have depressed levels of consciousness for many reasons and airway obstruction from the loss of pharyngeal tone is not uncommon Breathing A rapid assessment of ventilation includes respiratory effort, chest expansion, breath sounds, and color Pulse oximetry is useful, but patients with significant levels of carboxyhemoglobin will look pink and have “normal” oxygen saturation as measured by a pulse oximeter Children with severe burn injury should receive 100% supplemental oxygen Blood gases with co-oximetry should be obtained promptly Venous or arterial gases can be used, although arterial samples are preferred for hemodynamically unstable patients and to best assess degree of acidosis