Escharotomy Incisions

King Saud University College of Nursing

Escharotomy incisions Hatem alsrour

Escharotomy

objectives .What is meaning escharotomy # .Know the indication of escharotomy # .Know the contraindication of escharotomy # Know the equipment and how patient # .preparation Know the procedure steps and the # .complications

Escarotomy

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Escarotomies are not commonly performed in the # emergency department but may be necessary in the critically burned patient before admission or transfer. # Needed when there is a full thickness burn involving the extremities or chest. # Eschar is tough and rigid tissue that forms as a result of thermal or chmical burns

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As edema forms in the injured extremity after the # burn, the eschar restricts outward expansion the tissue

The outcome is increased interstitial pressure that rises to the # . point that vascular flow is compromised Incising the eschar allows return of flow and prevents # . further ischemic injury

indication To decrease elevated intrathoracic or tissue pressure in the :presence of circumferential full-thickness burns to the chest, which-1 .mechanically constrict and compromise respiration

circumferential or electrical burns to the extremities causing-2 loss of distal pulses, impaired capillary filling, paresthesias or motor weakness, cyanosis of distal uninjured skin, or tense .edema with rigid muscle compartments

loss of distal Doppler pulses indicates the need for -3 .escharotomy of the extremity tissue pressure exceeding 30 mm Hg, which indicates a need -4 .for escharotomy or fasciotomy

CONTRAINDICATIONS AND CAUTIONS Failure to perform emergency escharotomy may result in the -1 inability to ventilate lung parenchyma, loss of . neuromuscular function, or ischemic tissue injury This procedure may cause significant blood loss in the patient-2 . already predisposed to hypovolemic shock

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These new open wounds further predispose the patient to-3 infection and sepsis

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underlying tissues may be damaged if procedures are-4 incorrectly performed

If compartmental pressures do not decrease after escharotomy,-5 .a fasciotomy must be performed in the operating room Improper technique or locations of the incisions may damage-6 .nerves Prophylactic antibiotics are strongly discouraged to prevent the-7 .development of resistant bacterial strains

EQUIPMENT .Sterile gown, mask, and gloves for all team members * .)Local anesthetic infiltration ) optional in deep, insensate burns * .Doppler to assess pulses * Sterile scalpel * .Cautery, thrombin, and hemostats * .Sterile dressing and bandages * .Antimicrobial creams *

PATIENT PREPARATION .Remove all constricting clothing and jewelry -1 Elevate the burned extremity slightly above the level of the -2 .heart .Administer analgesics -3 .Administer tetanus prophylaxis as indicated -4 Place the patient in a supine anatomic position, unless -5 .contraindicated by other injuries or conditions

PROCEDURAL STEPS .Drape below and around the surgical area -1 .Anesthetize with local anesthetic infiltration -2 :Incise indicated areas -3 a- Chest: * Along the anterior axillary aspects of the chest .extending from the clavicle to the costal margin Make a second incision transverse across the chest at the level * .of the diaphragm .Cut through the eschar but not into the subcutaneous tissue * The incision should cause the eschar to gap, thus releasing * .pressure

Chest Incisions

PROCEDURAL STEPS b- Neck: Posteriorly and laterally to avoid major vessels in the .neck c- Upper extremities: Medial and lateral aspects of arms avoiding .the radial nerve d- hand: Doral aspect of the hands and along the palmar crease .and medial and lateral aspects of the digits e- Legs: Midmedial and midlateral incision; toes in a similar .manner to the fingers .Reassess respiratory function and distal circulatory status-4 Apply direct pressure, cautery, clamps, or thrombin to all -5 .bleeding areas

PROCEDURAL STEPS Reassess hematocrit, and consider blood administration if -6 .necessary .Apply dressings to reduce the potential for infection -7 keep the affected extremities elevated, and monitor distal -8 .pulses frequently

COMPLICATIONS .Wound infection -1 .Sepsis -2 .Blood loss -3 .Nerve or vessel damage -4 Inadequate decompression may lead to tissue necrosis, -5 .myoglobinuria, renal failure, hyperkalemia, and acidosis

PATIENT TEACHING This procedure will decrease the pain as it relieves the tissue -1 .pressure Care will be taken to help these wounds heal with as little -2 .scarring as possible

Escharotomy

Escharotomy

Some things to remember…  Invasive  Pain

Procedure…

Control

 Topical

Antibiotics

 Dressings:

keep the wounds clean & dry

Thank you