escharotomy incisions
DESCRIPTION
Escharotomy incisionsHatem AlsrourKing Saud UniversityCollege of NursingTRANSCRIPT
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Escharotomy incisions
Hatem alsrour
King Saud UniversityCollege of Nursing
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Escharotomy
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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.
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Escarotomy # 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.
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indication
To decrease elevated intrathoracic or tissue pressure in the presence of:
1-circumferential full-thickness burns to the chest, which mechanically constrict and compromise respiration.
2-circumferential or electrical burns to the extremities causing loss of distal pulses, impaired capillary filling, paresthesias or motor weakness, cyanosis of distal uninjured skin, or tense edema with rigid muscle compartments.
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3 -loss of distal Doppler pulses indicates the need for escharotomy of the extremity.
4 -tissue pressure exceeding 30 mm Hg, which indicates a need for escharotomy or fasciotomy.
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CONTRAINDICATIONS AND CAUTIONS
1 -Failure to perform emergency escharotomy may result in the inability to ventilate lung parenchyma, loss of
neuromuscular function, or ischemic tissue injury .
2-This procedure may cause significant blood loss in the patient already predisposed to hypovolemic shock.
3-These new open wounds further predispose the patient to infection and sepsis.
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4-underlying tissues may be damaged if procedures are incorrectly performed.
5-If compartmental pressures do not decrease after escharotomy, a fasciotomy must be performed in the operating room.
6-Improper technique or locations of the incisions may damage nerves.
7-Prophylactic antibiotics are strongly discouraged to prevent the development of resistant bacterial strains.
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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.
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PATIENT PREPARATION
1 -Remove all constricting clothing and jewelry.
2 -Elevate the burned extremity slightly above the level of the heart.
3 -Administer analgesics.
4 -Administer tetanus prophylaxis as indicated.
5 -Place the patient in a supine anatomic position, unless contraindicated by other injuries or conditions.
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PROCEDURAL STEPS
1 -Drape below and around the surgical area.
2 -Anesthetize with local anesthetic infiltration.
3 -Incise indicated areas:
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.
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Chest Incisions
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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.
4-Reassess respiratory function and distal circulatory status.5 -Apply direct pressure, cautery, clamps, or thrombin to all
bleeding areas.
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PROCEDURAL STEPS
6 -Reassess hematocrit, and consider blood administration if necessary.
7 -Apply dressings to reduce the potential for infection.
8 -keep the affected extremities elevated, and monitor distal pulses frequently.
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COMPLICATIONS
1 -Wound infection.
2 -Sepsis.
3 -Blood loss.
4 -Nerve or vessel damage.
5 -Inadequate decompression may lead to tissue necrosis, myoglobinuria, renal failure, hyperkalemia, and acidosis.
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PATIENT TEACHING
1 -This procedure will decrease the pain as it relieves the tissue pressure.
2 -Care will be taken to help these wounds heal with as little scarring as possible.
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Escharotomy
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Escharotomy
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Some things to remember…
Invasive Procedure…
Pain Control
Topical Antibiotics
Dressings: keep the wounds clean & dry
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Thank you