Extremity Burns

Burned extremities are vulnerable to injury from postburn swelling.

Goal: Prevent and manage swelling (edema) of burned extremities to prevent long-term damage.

- Best: Elevate burned extremities above heart level. Encourage patient to exercise burned extremities to decrease edema. Monitor peripheral pulses on all burned extremities hourly, using a Doppler flowmeter if available. If the peripheral pulses are diminished or absent and evacuation will be delayed, perform escharotomies of circumferential burns to restore blood flow (Appendix A). Be prepared to stop bleeding with combat gauze, electrocautery, or tourniquet as needed. Anticipate blood loss and prepare for blood transfusion.

*Obtain teleconsultation.

- Better: Consider doing escharotomies for circumferential full thickness (3rd degree) burns of an extremity if extremity is edematous, you are unable to palpate distal pulses, and evacuation will be delayed. Anticipate blood loss and prepare for blood transfusion.

*Obtain teleconsultation.

- Minimum: Triage patient to more rapid evacuation if extremity is edematous and you are unable to palpate distal pulses. Elevate burned extremities above heart level and have patient exercise or provide passive range of motion (PROM) to burned extremities to mobilize edema. Provide pain control to enable PROM.