Escharotomy: Difference between revisions
(Created page with "==Indications== *Circumferential eschar with one of the following: **Circumferential torso - restricted ventilation **Circumferential extremities - vascular compromise *Immed...") |
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==Contraindications== | ==Contraindications== | ||
*No absolute contraindications; irreversible gangrenous limb may be futile | |||
*Elevated IRN: not a contraindication. Give vitamin K, FFP as needed | *Elevated IRN: not a contraindication. Give vitamin K, FFP as needed | ||
*Skin infection: not a contraindication | *Skin infection: not a contraindication | ||
Revision as of 17:25, 18 February 2015
Indications
- Circumferential eschar with one of the following:
- Circumferential torso - restricted ventilation
- Circumferential extremities - vascular compromise
- Immediate escharotomy if compartment pressure > 30 mmHg
- Elevate limb and optimize fluid status
Contraindications
- No absolute contraindications; irreversible gangrenous limb may be futile
- Elevated IRN: not a contraindication. Give vitamin K, FFP as needed
- Skin infection: not a contraindication
- Thrombocytopenia: not a contraindication. Give platelets.
Equipment Needed
Procedure
- Baseline neurovascular exam with serial neurovasc checks with Dopplers and compartment pressures to assess for need to extend escharotomy and/or add fasciotomy
Torso
- Incise at ant axillary line from level of 2nd rib to 12th rib bilaterally, incising down to level of subcutaneous fat
- May have an immediate release manifested by popping sensatio
- Join these two incisions transversely
Extremities
- Extensive escarotomies of the limbs should be carried to thenar/hypothenar eminences for UEs, and great/little toe for LEs
- Limb escharotomies are close to superficial veins, so identify if possible
- Digital escharotomies should be performed by hand surgeon if at all possible
- Restricted perfusion (focal)
- Perform along midlateral portion of fingers/toes, extremities if no pulse by doppler