Escharotomy: Difference between revisions
No edit summary |
No edit summary |
||
| Line 19: | Line 19: | ||
===Torso=== | ===Torso=== | ||
[[File:shield incision.JPG|thumbnail]] | |||
*Incise at ant axillary line from level of 2nd rib to 12th rib bilaterally, incising down to level of subcutaneous fat | *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 | *May have an immediate release manifested by popping sensatio | ||
| Line 24: | Line 25: | ||
===Extremities=== | ===Extremities=== | ||
[[File:feet.JPG|thumbnail]] | |||
[[File:lower extremities.JPG|thumbnail]] | |||
[[File:upper extremity.JPG|thumbnail]] | |||
*Extensive escarotomies of the limbs should be carried to thenar/hypothenar eminences for UEs, and great/little toe for LEs | *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 | *Limb escharotomies are close to superficial veins, so identify if possible | ||
| Line 34: | Line 38: | ||
**Avoid flexor surfaces of elbows, wrists and knees as shown in attached pictures | **Avoid flexor surfaces of elbows, wrists and knees as shown in attached pictures | ||
**However, it is important to release over joints due to high tension at these sites | **However, it is important to release over joints due to high tension at these sites | ||
==Complications== | ==Complications== | ||
| Line 44: | Line 46: | ||
==External Links== | ==External Links== | ||
== | ==References== | ||
*Peck, Michael. Arizona Burn Center. Escharotomy Procedures for Burn Patients. May 26, 2015. https://www.youtube.com/watch?v=puU4aDuhc0g | *Peck, Michael. Arizona Burn Center. Escharotomy Procedures for Burn Patients. May 26, 2015. https://www.youtube.com/watch?v=puU4aDuhc0g | ||
<references/> | <references/> | ||
[[Category:Procedures]] | [[Category:Procedures]] | ||
Revision as of 15:09, 17 December 2015
Indications
Escharotomy Burn 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
- Sterile prep equipment
- Scalpel in austere or ED environment without electrocautery
- Burn dressings and topical antibiotics
Procedure
- Baseline neurovascular exam with serial neurovasc checks with Dopplers and compartment pressures to assess for need to extend escharotomy and/or add fasciotomy
- Depth of incision controversial, may require as little as dermal release to complete subcutaneous release to fasciotomy
- Apply silver sulfadiazine dressings or antibiotics with petroleum gauze after escharotomy
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
- Ankles - avoid posterior to medial malleolus due to neurovasculature
- Hands and feet - incise along dorsal interossei muscles; pay close attention to DP in feet
- Joints
- Avoid flexor surfaces of elbows, wrists and knees as shown in attached pictures
- However, it is important to release over joints due to high tension at these sites
Complications
See Also
External Links
References
- Peck, Michael. Arizona Burn Center. Escharotomy Procedures for Burn Patients. May 26, 2015. https://www.youtube.com/watch?v=puU4aDuhc0g