• Primary Threat: Inhalation of hot smoke, steam, or gases from a fire is the most deadly threat in the early stages of burn injury. It causes burns to the mucous membranes of the respiratory tract and rapid swelling, which may completely block the airway within hours.
•  Warning Signs: Patients with burns to the face or neck, injuries in confined spaces, or carbon particles in the mouth/nose, or those with hoarse voices, are at high risk.
• Management: The medical team will take prompt action to perform "preventive intubation" to establish an open airway before swelling obstructs it. This is the first step in life-saving intervention.

• Potential Threat: Even if the airway is clear, the patient may still be unable to breathe effectively. This can result from two issues: (1) inflammation and swelling of the lungs caused by inhalation injury; (2) severe "circumferential eschar" (hard skin) around the chest that restricts the chest wall’s movement during breathing.
• Management: For patients with breathing difficulties due to circumferential eschar, the physician will immediately perform an "escharotomy"—a procedure where the hardened eschar around the chest is incised along both sides of the thorax to release pressure and allow the lungs to expand. This emergency life-saving procedure can be performed at the bedside in the ICU.

• Core Mission: The second fatal threat in burn injuries is "shock." Extensive burns lead to the loss of the skin barrier, causing large amounts of fluid (tissue fluid) to leak out in the first 24 hours, resulting in a drastic drop in blood pressure and organ failure.
• Management 1: Fluid resuscitation is crucial in burn treatment. The physician will use the "Parkland Formula" to accurately calculate the amount of fluid needed in the first 24 hours based on the patient's weight and burn surface area (%TBSA). Large amounts of IV fluids will be given to stabilize blood pressure and urine output.
• Management 2: In cases where circumferential eschar around the limbs causes vascular compression, leading to ischemia and necrosis, the physician will closely monitor pulses and perform "escharotomy" if necessary to salvage the limbs.

• The patient's consciousness level (GCS score) will be assessed, and other causes such as carbon monoxide poisoning or head trauma will be ruled out.

• Exposure: All remaining clothing and chemicals on the patient must be removed to stop the burning process and assess the full extent and depth of the burns.
• Environment: Burn victims lose the insulating function of their skin and are at high risk of "hypothermia." Therefore, after wound debridement, they must be immediately covered with clean, warm dressings, and the room temperature should be maintained between 28–32°C using heating lamps and warming blankets.

• Eschar Removal (Escharectomy): For second-degree burns and deeper injuries, the skin can no longer regenerate on its own. The patient will be taken to the operating room for "debridement surgery" to remove all necrotic eschar tissue layer by layer until healthy, bleeding tissue is exposed.

• Skin Grafting: Once the wound is clean, it must be covered as soon as possible to prevent infection.

• Autograft: The first choice is to use the patient’s own healthy skin (such as from the scalp or thighs), as it provides permanent coverage.

• Allograft: If the burn area is too large for autografts, "allografts" (cadaveric skin) from the National Skin Bank play a vital role as "temporary biological dressings" to protect the wound, reduce infection, and allow time for autograft healing.