Bedside Escharotomies for Burns

Abstract

• Deep second- or third-degree circumferential burns of the neck, chest, abdomen, or extremities can cause many serious local and systemic problems.

  • Circumferential burns of the neck can cause airway obstruction.

  • Circumferential burns of the chest can decrease chest wall compliance, which can cause respiratory compromise, increased peak inspiratory pressures, hypoxia and hypercapnia, and decreased venous return to the heart, which aggravates hypotension and tachycardia.

  • Circumferential burns of the abdomen can cause intra-abdominal hypertension and abdominal compartment syndrome.

  • Circumferential burns of the extremities can cause compartment syndrome and result in sequelae ranging from acute kidney injury to permanent neuromuscular damage and limb loss.

• In severe burns requiring massive amounts of fluid resuscitation, abdominal or extremity compartment syndromes may develop independent of circumferential burns. These patients may need decompressive laparotomy or extremity fasciotomy in addition to the escharotomy. These high-risk patients should have bladder and extremity compartment pressures monitored in conjunction with clinical monitoring of urine output, abdominal exams, compartment checks, and vascular exams.