A 35-year-old man is brought to the emergency department with circumferential full-thickness burns involving both upper limbs sustained in an industrial fire. On examination, the burned skin is leathery and insensate, and the radial pulses are progressively weakening. What is the most appropriate immediate intervention?
- A Emergency fasciotomy under general anaesthesia
- B High-dose intravenous corticosteroids
- C Escharotomy at the bedside without anaesthesia ✓
- D Doppler ultrasound to confirm vascular compromise before any procedure
Correct answer: C. Escharotomy at the bedside without anaesthesia
Explanation
Circumferential full-thickness burns produce a rigid eschar that can cause vascular compromise distal to the burn. Escharotomy is performed urgently at the bedside without anaesthesia because full-thickness burns are insensate. Incisions are made through the eschar down to subcutaneous fat to restore perfusion. Fasciotomy is reserved for deep muscle compartment syndrome, not circumferential burn eschar. Waiting for Doppler or steroids would risk limb ischemia.
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.