A 35-year-old man with 50% TBSA full-thickness burns involving both arms has circumferential eschars. Twelve hours after adequate fluid resuscitation, his right hand becomes cold, capillary refill is delayed, and the radial pulse is weak despite normal urine output. What is the correct intervention?
- A Increase the rate of intravenous fluids
- B Escharotomy of the right upper limb ✓
- C Immediate fasciotomy of the forearm compartments
- D Apply silver sulfadiazine cream and elevate the limb
Correct answer: B. Escharotomy of the right upper limb
Explanation
A circumferential full-thickness eschar acts like a tourniquet as underlying oedema accumulates, producing vascular compromise of the limb. Loss of pulses or capillary refill is an indication for escharotomy, a longitudinal incision through the eschar into subcutaneous tissue, done usually without anaesthesia because the burn is insensate. Fasciotomy is needed only when deeper muscle compartments are involved, typically in electrical or crush injury. Escalating fluids alone will not relieve the constriction.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.