A 34-year-old woman sustains full-thickness circumferential burns to her right forearm and hand 6 hours ago. She reports progressive numbness and tingling in the fingers. The hand is cool, tense and shiny, capillary refill is delayed, and Doppler signals are absent over the digital arteries. The next most appropriate step is:

• A Elevate the limb and apply silver sulfadiazine cream
• B Increase the rate of fluid resuscitation by 50 percent
• C Longitudinal escharotomy of the forearm and hand ✓
• D Fasciotomy of all forearm compartments only

Explanation

A circumferential full-thickness eschar acts as a tourniquet as underlying oedema accumulates. Loss of Doppler signals, coolness and paraesthesia indicate compromised circulation and mandate longitudinal escharotomy through the burnt skin, performed along the midlateral and midmedial lines avoiding major vessels and nerves. Raising fluids worsens oedema. Fasciotomy alone is insufficient because the constriction lies in the eschar itself, though fasciotomy is added if muscle compartments are involved.

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.