What is the priority for a circumferential burn with decreased pulses?

• A. Prepare for escharotomy
• B. Elevate limb and apply ice
• C. Start broad-spectrum antibiotics
• D. Schedule surgery in 24 hours

Answer: (A)

When a circumferential burn tightens as edema forms, the eschar can act like a tourniquet, squeezing vessels and cutting off blood flow. The immediate priority is to relieve that external pressure with an escharotomy, which cuts through the burned skin and eschar along the limb to reopen the constricted compartments and restore perfusion. Without this decompression, ongoing ischemia can lead to muscle necrosis and nerve injury, even if other steps are taken.

Elevating the limb or applying ice doesn’t address the underlying restriction and can cause further tissue damage or vasoconstriction. Starting broad-spectrum antibiotics doesn’t relieve the mechanical compression that’s causing the reduced pulses. Scheduling surgery in 24 hours is too late when there’s evidence of compromised perfusion. If needed, fasciotomy may be considered later if pulse and compartment pressures don’t improve after escharotomy, but opening the eschar is the urgent first move.