Normal knee radiology AP

Although escharotomy is rarely performed by emergency physicians during the initial management of burns, it is a life and limb-sparing skill important to know as a trainee and provider in emergency medicine [1,2]. There are few models made to accommodate procedural training, and the ones available are often cost-prohibitive. It is critical to have a method for learning and practicing this important procedure [3,4].

The Innovation

The homemade escharotomy kit is a low-cost, easily reproducible model that realistically simulates cutting through eschar. Learners will identify appropriate anatomic landmarks and develop the necessary surgical techniques. They will also gain familiarity with the psychomotor skills to effectively evaluate severely burned tissue and perform an escharotomy.

Target Learners

This workshop is designed for EM students, residents, and attending physicians.

Group Size

This activity can be scaled to accommodate groups of any size.

Required Materials

  • A barbeque grill
  • Per trainee
    • One skin-on chicken breast or thigh
    • Scalpel (recommend an 11 blade)
    • Gloves
    • Chux

The Technique

Model Preparation

With the grill on low heat, place chicken, non-skin side down on the grill.  Grill for 5 minutes. Turn chicken over, skin-side down.

escharotomy model

Figure 1: Chicken skin-side down on the grill.

Turn heat to high and grill for an additional 15 minutes or until chicken is charred.

escharotomy model

Figure 2: Chicken after 15 minutes of grilling. The skin side should be completely charred.

Remove from the grill and allow it to cool prior to use. After grilling, we recommend the chicken be used within a 24 hour period.

Escharotomy Simulation

escharotomy model

Figure 3: Charred chicken thighs displayed in preparation for escharotomy incision.

Working in groups of two, participants alternate practicing incisions on the model. One participant holds the chicken model, burned side up, inducing a taut surface for the proceduralist to incise. The proceduralist performs the escharotomy along the burned surface of the model with subsequent tissue release once appropriate fascial planes are fully severed.

Figure 4. One participant holds the sides tight while the other cuts.

Lessons Learned

Participants in a local trauma symposium ranging in experience level from medical students to attending physicians were involved in the above simulation. Upon completion of the lab, an anonymous post-simulation feedback survey was obtained to evaluate the impact of the model and simulation. Learners overwhelmingly enjoyed using this model, and appreciated that this model included live tissue, allowing to get a “real life” experience compared to something synthetic.

This low-cost model affordably simulates a low-incidence, life, and limb-sparing procedure with less than an hour of preparation for the lab. It allows participants to simulate and develop the necessary techniques to perform this procedure properly in an emergent setting.

Theory Behind the Innovation

Although a rare procedure, an escharotomy is an important aspect of burn resuscitation. All emergency physicians should intermittently practice and refresh their knowledge of burn management techniques. Our mission was to make a low-cost, easily replicated model so that learners could participate in a more realistic opportunity to perform the critical steps of escharotomy and increase their confidence when they must perform this procedure on a burn victim.

Don’t forget to check out more educational ideas in our IDEA series archives!

References

  1. C Caleb Butts, MD, James H Holmes, IV, MD, Jeffrey E Carter, MD, Surgical Escharotomy and Decompressive Therapies in Burns, Journal of Burn Care & Research, Volume 41, Issue 2, March/April 2020, Pages 263–269, PMID: 31504609
  2. Zhang L, Hughes PG. Escharotomy. [Updated 2019 Jun 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. PMID: NBK482120
  3. Orgill DP, Piccolo N. Escharotomy and decompressive therapies in burns. J Burn Care Res. 2009 Sep-Oct;30(5):759-68. PMID: 19692906
  4. Chapman DM, Hayden S, Sanders AB, et al. Integrating the Accreditation Council for Graduate Medical Education core competencies into The Model of the Clinical Practice of Emergency Medicine. Ann Emerg Med. 2004;43:756-769, and Acad Emerg Med. 2004;11:674-685. PMID: 15159710
Davin Barnett, DO

Davin Barnett, DO

Emergency Medicine Resident
OhioHealth/Doctors Hospital Emergency Medicine Residency
Davin Barnett, DO

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John Casey, DO, MA, FACEP

John Casey, DO, MA, FACEP

Emergency Medicine Physician
Director of Emergency Medicine Education
OhioHealth Doctors Hospital Emergency Medicine Residency
John Casey, DO, MA, FACEP

@JohnCaseyDO

Emergency Physician, foodie, soon to be supporter of another puppy, GOT junkie until the last 3 episodes, and part-time superhero...
John Casey, DO, MA, FACEP

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Andy Little, DO

Andy Little, DO

Associate Program Director, AdventHealth EM Residency
Host/Co-Founder, EM Over Easy Podcast
ALiEM Blog Editor
Andy Little, DO

@andyglittle

APD, @ouhcom grad, lover of #FOAMed, #Meded, Co-founder/Host for @emovereasy