A 45-year-old woman with 55% TBSA full thickness circumferential burns of both lower limbs has been adequately resuscitated per formula. Twelve hours post-burn, her feet are cold, capillary refill is absent, and Doppler signals are lost in both dorsalis pedis arteries. What is the correct intervention?

• A Increase the fluid rate by 50% and observe for another six hours
• B Immediate escharotomies of both limbs ✓
• C Immediate fasciotomies of all four compartments of both legs
• D Heparin infusion for suspected arterial thrombosis

Explanation

Circumferential full thickness eschar acts like a tourniquet as oedema accumulates beneath it, and loss of Doppler signals or capillary refill despite adequate resuscitation is an absolute indication for escharotomy, releasing the constricting burned skin along the limb. Fasciotomy is reserved when muscle compartment pressures remain elevated after escharotomy or with electrical and crush injuries. Escalating fluids risks fluid creep and pulmonary oedema without relieving the constriction.

Reference: Schwartz's Principles of Surgery, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.