Page 57 - PJ MED OPS Handbook 8th Ed

• For missions where the patient is expected to reach definitive care in excess of 24 hours post
injury, silver nylon dressing covered by Kerlex can be used.
• Silverlon can be left in place for 3–5 days as long as the wound is clean when the Silverlon is
applied.
○ Moisten (do not soak) Silverlon dressings with sterile or potable water every 6 hours.
○ The outer gauze dressings should be changed, leaving the Silverlon in place, sooner than
3 days if they become saturated with exudate or otherwise dirty.
○ If the patient develops any evidence of infection, the Silverlon must be removed and the
wound inspected sooner than 3–5 days.
○ The Silverlon can be removed and cleaned in sterile, or at least clean uncontaminated,
water and reused for up to 5 days.

Escharotomy

WARNING Do not attempt these procedures if not trained or qualified. NOT ALL PJs are taught,
or qualified, to perform this procedure. Pararescue Medical Directors will authorize prop-
erly trained Pararescuemen to perform this procedure.

NOTE: Escharotomy and fasciotomy incisions are different, do not confuse them.

Indications: Relief of circulatory and/or respiratory compromise due to circumferential full thick-
ness burns. This procedure is rarely required in the field, but has been performed by PJs.
Equipment:
• Scalpel
• Sterile gloves and sterile dressing
• Hemostatic gauze for bleeding

Procedure:
1. Irrigate and debride as needed. Outline where escharotomy is to be performed.
2. Perform procedural sedation (dissociation) with ketamine 100mg IV/IO. This will provide approx-
imately 10 minutes of sedation and can be repeated as required to successfully complete the
procedure. Versed 2mg IV/IO should be administered for significant patient agitation as sedation
wanes = emergence phenomenon.
3. Sterile prep of incision area. Perform procedure under as sterile/aseptic conditions as able.
4. Using scalpel, cut through eschar until subcutaneous tissue is exposed. Will appear as fatty tis-
sue. Subcutaneous tissue will often protrude through incision when adequate depth is reached
and eschar will separate.
5. Continue line of incision extending entire length of eschar on opposite sides of extremity or
chest (posterior/anterior or lateral/medial), being careful NOT to CUT into UNDERLYING FASCIA
(fibrous tissue layer) or muscle. Only cut through the visible scar tissue of the skin.

Chapter 6. Surgical and Medical Procedures n 55