A 40-year-old man sustains 35% TBSA deep circumferential burns to both upper limbs and the anterior trunk after an industrial fire. Four hours post-injury, the right upper limb becomes cold with absent radial pulse and delayed capillary refill. Oxygen saturation probe fails to read on the fingers. What is the immediate next step?

• A Administer intravenous heparin 5000 units
• B Elevate the limb and apply topical silver sulfadiazine
• C Perform urgent escharotomy of the right upper limb ✓
• D Obtain urgent CT angiography of the right upper limb

Explanation

Circumferential deep burns form a rigid, non-elastic eschar that acts as a tourniquet. When it compromises circulation (cold limb, absent pulse, failed SpO2 reading), urgent escharotomy is required to release the constriction. It must be performed at the bedside without waiting for imaging. The incision goes through eschar into subcutaneous fat down to the muscle fascia.

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.