Surgery>>>>>Burns
Question 6#

Three hours after a burn injury that consisted of circumferential, third -degree burns at the wrist and elbow of the right arm, a patient loses sensation to light touch in his fingers. Motor function of his digits, however, remains intact. The most appropriate treatment for this patient now would consist of:

A. Elevation of the extremity, Doppler ultrasonography every 4 hours, and if distal pulses are absent 8 hours later, immediate escharotomy
B. Palpation for distal pulses and immediate escharotomy if pulses are absent
C. Doppler ultrasonography for assessment of peripheral flow and immediate escharotomy if flow is decreased
D. Immediate escharotomy under general anesthesia from above the elbow to below the wrist on both medial and lateral aspects of the arm

Correct Answer is C

Comment:

Third-degree burn injuries are characterized by almost complete loss of elasticity of the skin. Thus, as soft tissue swelling progresses, neurovascular compromise may occur. Failure to recognize this problem may result in the loss of distal extremities. The most reliable signs of decreased peripheral blood flow in burned patients are slow capillary refill as observed in the nail beds, the onset of neurologic deficits, and decreased or absent Doppler ultrasonic pulse detection. When vascular impairment is diagnosed, immediate escharotomies are indicated. Anesthesia is not required for escharotomy-the burn area is insensate because skin nerve endings are destroyed by third-degree burns.