Burns and Burn Injury Q 98 - Gyan Darpan : Learning Portal
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Wednesday 30 March 2022

Burns and Burn Injury Q 98

What clinical manifestation indicates that an escharotomy is needed on a circumferential extremity burn?
    A. The burn is full thickness rather than partial thickness.
    B. The client is unable to fully pronate and supinate the extremity.
    C. Capillary refill is slow in the digits and the distal pulse is absent.
    D. The client cannot distinguish the sensation of sharp versus dull in the extremity.

Correct Answer: C. Capillary refill is slow in the digits and the distal pulse is absent.

Circumferential eschar can act as a tourniquet when edema forms from the fluid shift, increasing tissue pressure, and preventing blood flow to the distal extremities, and increasing the risk for tissue necrosis. This problem is an emergency and, without intervention, can lead to loss of the distal limb. This problem can be reduced or corrected with an escharotomy.

Option A: The American Burn Association recommends burn center referrals for patients with full-thickness burns. Patients being transferred to burn centers do not need extensive debridement or topical antibiotics before transfer.
Option B: Once established, burn contractures can be treated with serial splinting, release of contracting bands with Z-plasties, incision, and skin grafting or excision, and resurfacing with skin grafts or flaps, local rotation flaps, use of tissue expanders, or with free flap reconstruction.
Option D: After a deep burn injury, cutaneous nerve regeneration will occur with the migration of new nerve fibers from the wound bed or from the collateral sprouting of nerve fibers from adjacent uninjured areas. This nerve regeneration process is imperfect. It was reported that 71% of extensively burned victims suffer from abnormal sensations and 36% from chronic pain. Recent studies on rats have shown that vagus nerve stimulation improved thermal injury-induced shock symptoms.

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