Decompression not escharotomy in acute burns

Burd, Andrew; Noronha, Frederick V.; Ahmed, Kawser; Chan, Jimmy Yu‐Wai; Ayyappan, T.; Ying, S.Y; Pang, Polly

doi:10.1016/j.burns.2005.11.017

Cited by 50 publications

(15 citation statements)

References 18 publications

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“…This treatment algorithm resulted in no long‐term deficit in those falling outside the criteria for escharotomy. Conversely, significant negative outcomes have resulted from delay in escharotomy or inadequate decompression through incorrect technique . Early intervention is key to preventing permanent deficit, before the loss of peripheral pulses, when significant damage may have already occurred …”

Section: Discussionmentioning

confidence: 99%

“…Conversely, significant negative outcomes have resulted from delay in escharotomy or inadequate decompression through incorrect technique. [9][10][11] Early intervention is key to preventing permanent deficit, before the loss of peripheral pulses, when significant damage may have already occurred. [9][10][11][12] Escharotomies were appropriately performed by GSA-HEMS in eight cases, often by physicians performing the procedure for the first time.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11] Early intervention is key to preventing permanent deficit, before the loss of peripheral pulses, when significant damage may have already occurred. [9][10][11][12] Escharotomies were appropriately performed by GSA-HEMS in eight cases, often by physicians performing the procedure for the first time. No complications arose, although follow up was limited to 24 h. GSA-HEMS has developed a dedicated training curriculum that includes eye, life-and limb-saving procedures.…”

Section: Discussionmentioning

confidence: 99%

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A review of the burns caseload of a physician‐based helicopter emergency medical service

Hall

Burns

2017

Emerg Medicine Australasia

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A review of the burns caseload of a physician‐based helicopter emergency medical service

Hall

Burns

2017

Emerg Medicine Australasia

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“…Assessment of capillary refill as well as Doppler signals of digital arteries, palmar arches, and plantar arches of affected limbs should be performed frequently as part of clinical surveillance [50,111]. Finally, tissue pressure measurements can be checked, and if found to be >30-40 mmHg, this would also be an indication for urgent escharotomy [112,113]. Burn care providers must remember that the determination to perform an escharotomy can (and often should) be made using clinical exam as the primary decision tool.…”

Section: Post-acute Resuscitation Periodmentioning

confidence: 99%

Burn Shock and Resuscitation: Many Priorities, One Goal

Sojka¹,

Krakowski²,

Stawicki³

2020

Clinical Management of Shock - The Science and Art of Physiological Restoration

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Burn injuries come in a wide variety of presentations, depending on the size and depth of the thermal insult, concurrent traumatic or inhalation injury, as well as the associated physiological response of the burn victim. To minimize patient morbidity and reduce mortality, prompt recognition and tailored treatment strategies are critically important. As the percentage of total body surface area (TBSA) burned increases so do the body's physiologic response and the associated complexity of management. Understanding the pathophysiology of burn injury allows the practitioner to optimize and individualize burn patient management-a component of care critical to limiting wound progression and improving outcomes. Burn patient care starts with an accurate and thorough burn patient evaluation conducted in person by an experienced provider. For burns >10-15% TBSA, prompt initiation of fluid resuscitation greatly impacts clinical outcomes. Several formulae have been published to guide crystalloid and/or colloid fluid resuscitation in the setting of burn shock. Other important considerations include ambient temperature control, early enteral nutritional support, vitamin and mineral supplementation, assessment for inhalation injury, glycemic control, early recognition of potential complications of large volume resuscitation, potential need for cardiovascular support, and early wound excision and coverage. Burn patients often require multidisciplinary teams to manage the physical, social, and psychological effects associated with their injury. Dedicated burn centers are the ideal places for meeting the complex needs of each burn patient.

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“…He considers that decompression is a process, in a continuum which requires assessment, measurements and monitoring which may lead to a number of interventions, and that escharotomy should be performed appropriately, possibly evolving to deeper, muscle fascia release. Also, he calls attention to the fact that decompression must be also sought clinically, ranging from accurate placement of bandages (non-constricting) to avoiding fluid overload [5].…”

mentioning

confidence: 99%

Escharotomies, Fasciotomies and Carpal Tunnel Release in Burn Patients - Review of the Literature and Presentation of an Algorithm for Surgical Decision Making

Piccolo¹,

Piccolo²,

Piccolo³

et al. 2007

Handchir Mikrochir plast Chir

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Escharotomies are usually performed in patients with circumferential third degree burns of the extremities or anterior trunk. Fasciotomies are recommended for patients who sustained high voltage (or associated crush) injuries, with entrance or exit wounds in one or more extremities. Carpal tunnel release is practiced routinely in some services for cases of electrical injury. We have reviewed the literature which provides relatively little information as to when should these procedures actually be performed and what would happen if they were not done. We present a series of patients treated at our institution when an algorithm was used for surgical decision making as to when (or not) to operate (perform an escharotomy, a fasciotomy or a carpal tunnel release), based on clinical signs and monitoring alternatives, using the oximeter and the Doppler flowmeter. 13 938 burn patients were treated at our institution during the year of 2005. Of these, 571, with an average of 22.3 % TBSA, were treated as inpatients. Of these, 58 (10.3 %) had circumferential or electrical burns of one or more extremities. Patients were monitored hourly from admission and decision to operate was based on clinical signs and in absent or below 90 % oximetry, regardless of Doppler flow signs. 68 % were males, 6 (11.3 %) patients had immediate escharotomies, while 4 (7.5 %) had immediate fasciotomies. 2 of these patients were operated regardless of positive Doppler sign but no oximetry. All patients recovered oximetry over 90 % immediately after the operations. 3 patients had negative Doppler sign but oximetry > 90 % and were not operated. 3 patients had carpal tunnel releases based on oximetry < 90 % and symptoms of compression of the median nerve. Patients who were not operated fared well with no signs or symptoms of impairment of circulation or nerve damage up to their 3 and 6 months reevaluations.

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Decompression not escharotomy in acute burns

Cited by 50 publications

References 18 publications

A review of the burns caseload of a physician‐based helicopter emergency medical service

A review of the burns caseload of a physician‐based helicopter emergency medical service

Burn Shock and Resuscitation: Many Priorities, One Goal

Escharotomies, Fasciotomies and Carpal Tunnel Release in Burn Patients - Review of the Literature and Presentation of an Algorithm for Surgical Decision Making

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