Abdominal compartment syndrome US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Abdominal compartment syndrome. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Abdominal compartment syndrome US Medical PG Question 1: A 67-year-old woman has fallen from the second story level of her home while hanging laundry. She was brought to the emergency department immediately and presented with severe abdominal pain. The patient is anxious, and her hands and feet feel very cold to the touch. There is no evidence of bone fractures, superficial skin wounds, or a foreign body penetration. Her blood pressure is 102/67 mm Hg, respirations are 19/min, pulse is 87/min, and temperature is 36.7°C (98.0°F). Her abdominal exam reveals rigidity and severe tenderness. A Foley catheter and nasogastric tube are inserted. The central venous pressure (CVP) is 5 cm H2O. The medical history is significant for hypertension. Which of the following is best indicated for the evaluation of this patient?
- A. X-Ray
- B. Ultrasound
- C. Peritoneal lavage
- D. CT scan (Correct Answer)
- E. Diagnostic laparotomy
Abdominal compartment syndrome Explanation: ***CT scan***
- A **CT scan of the abdomen and pelvis** is the most indicated imaging modality for evaluating blunt abdominal trauma due to its high sensitivity and specificity in detecting solid organ injuries, free fluid, and active bleeding.
- Given the patient's severe abdominal pain, rigidity, and tenderness after a significant fall, a CT scan will provide detailed anatomical information crucial for guiding further management.
*X-Ray*
- An **X-ray** is useful for detecting bone fractures, but it has limited utility in assessing soft tissue and organ injuries within the abdomen.
- It would not effectively visualize internal bleeding or organ damage, which are primary concerns in this patient given the mechanism of injury and symptoms.
*Ultrasound*
- An **ultrasound (FAST exam)** is effective for rapid detection of free fluid in the abdomen (indicating bleeding or fluid leakage) and can be done at the bedside.
- However, it is operator-dependent and less sensitive than CT for identifying specific organ injuries, retroperitoneal hematomas, or the source of bleeding.
*Peritoneal lavage*
- **Diagnostic peritoneal lavage (DPL)** is an invasive procedure primarily used to detect intra-abdominal bleeding in hemodynamically unstable patients, but it has largely been replaced by ultrasound and CT in stable patients.
- While it can detect blood, it is less specific for identifying the source of bleeding and does not provide anatomical detail, and carries risks of complications like bowel perforation.
*Diagnostic laparotomy*
- **Diagnostic laparotomy** is a surgical procedure to directly visualize abdominal contents and is indicated in cases of clear signs of peritonitis, hemodynamic instability with confirmed intra-abdominal bleeding, or evisceration.
- It is an invasive intervention and would not be the initial diagnostic step in a hemodynamically stable patient without clear indication for immediate surgery.
Abdominal compartment syndrome US Medical PG Question 2: Ten days after undergoing emergent colectomy for a ruptured bowel that she sustained in a motor vehicle accident, a 59-year-old woman has abdominal pain. During the procedure, she was transfused 3 units of packed red blood cells. She is currently receiving total parenteral nutrition. Her temperature is 38.9°C (102.0°F), pulse is 115/min, and blood pressure is 100/60 mm Hg. Examination shows tenderness to palpation in the right upper quadrant of the abdomen. Bowel sounds are hypoactive. Serum studies show:
Aspartate aminotransferase 142 U/L
Alanine aminotransferase 86 U/L
Alkaline phosphatase 153 U/L
Total bilirubin 1.5 mg/dL
Direct bilirubin 1.0 mg/dL
Amylase 20 U/L
Which of the following is the most likely diagnosis?
- A. Hemolytic transfusion reaction
- B. Acalculous cholecystitis (Correct Answer)
- C. Acute cholecystitis (calculous)
- D. Small bowel obstruction
- E. Acute pancreatitis
Abdominal compartment syndrome Explanation: ***Acalculous cholecystitis***
- This patient's clinical picture of **fever**, **RUQ tenderness**, **leukocytosis**, and mildly elevated liver enzymes in the setting of recent **major surgery**, **trauma**, and **total parenteral nutrition (TPN)** is highly suggestive of **acalculous cholecystitis**.
- **Acalculous cholecystitis** often occurs in critically ill patients due to gallbladder stasis, ischemia, and inflammation, usually without the presence of stones.
*Hemolytic transfusion reaction*
- While the patient received blood transfusions, a **hemolytic transfusion reaction** typically presents with fever, chills, flank pain, and **hemoglobinuria**, none of which are explicitly mentioned.
- Liver enzyme elevations can occur, but the significant RUQ tenderness and absence of signs of hemolysis make it less likely.
*Acute cholecystitis (calculous)*
- **Acute cholecystitis with gallstones** typically presents with similar symptoms to acalculous cholecystitis (pain, fever), but requires the presence of gallstones causing obstruction.
- The clinical context of critical illness, recent surgery, and TPN use points more towards acalculous inflammation rather than stone-related disease.
*Small bowel obstruction*
- **Small bowel obstruction** would present with more pronounced **abdominal distention**, **vomiting**, and often **high-pitched bowel sounds** followed by absent sounds, which is not the primary picture here.
- Although bowel sounds are hypoactive, the focal RUQ tenderness and liver enzyme changes are not typical of a primary small bowel obstruction.
*Acute pancreatitis*
- **Acute pancreatitis** is usually characterized by **severe epigastric pain** radiating to the back, and significantly elevated **amylase** and **lipase** levels.
- The patient's amylase is normal, and lipase is not mentioned but usually tracks with amylase in pancreatitis.
Abdominal compartment syndrome US Medical PG Question 3: A 35-year-old man is brought to the emergency department from a kitchen fire. The patient was cooking when boiling oil splashed on his exposed skin. His temperature is 99.7°F (37.6°C), blood pressure is 127/82 mmHg, pulse is 120/min, respirations are 12/min, and oxygen saturation is 98% on room air. He has dry, nontender, and circumferential burns over his arms bilaterally, burns over the anterior portion of his chest and abdomen, and tender spot burns with blisters on his shins. A 1L bolus of normal saline is administered and the patient is given morphine and his pulse is subsequently 80/min. A Foley catheter is placed which drains 10 mL of urine. What is the best next step in management?
- A. Additional fluids and escharotomy (Correct Answer)
- B. Escharotomy
- C. Continuous observation
- D. Moist dressings and discharge
- E. Additional fluids and admission to the ICU
Abdominal compartment syndrome Explanation: ***Additional fluids and escharotomy***
- The patient has **circumferential full-thickness burns** on both arms (dry, nontender), which require **escharotomy** to prevent compartment syndrome and vascular compromise to the limbs.
- The **oliguria** (10 mL urine output) despite a 1L fluid bolus indicates **inadequate fluid resuscitation** from burn shock. With approximately 40% TBSA burns, the patient requires aggressive fluid resuscitation per the Parkland formula (4 mL/kg/% TBSA), which would be approximately 11 liters in the first 24 hours. Adequate resuscitation targets urine output of 0.5-1 mL/kg/hr (35-70 mL/hr for this patient).
- Both interventions are immediately necessary: fluids for burn shock and escharotomy for circumferential burns.
*Escharotomy*
- While **escharotomy** is essential for the circumferential full-thickness burns to prevent compartment syndrome, it alone will not address the **severe fluid deficit** causing oliguria and hypoperfusion.
- The low urine output reflects systemic hypovolemia from burn shock, not just local compartment issues, requiring aggressive fluid resuscitation.
*Continuous observation*
- **Continuous observation** is inappropriate given the patient's critical findings: circumferential full-thickness burns requiring urgent escharotomy and oliguria indicating inadequate resuscitation.
- Delaying escharotomy can lead to irreversible ischemic damage to the limbs, and inadequate fluid resuscitation can progress to multiorgan failure.
*Moist dressings and discharge*
- This option is completely inappropriate for a patient with **extensive deep burns** (approximately 40% TBSA) including full-thickness injuries requiring hospitalization and specialized burn care.
- Discharge would lead to severe complications including infection, inadequate fluid resuscitation, compartment syndrome, and potential limb loss.
*Additional fluids and admission to the ICU*
- While ICU admission and additional fluids are necessary components of care, this option is **incomplete** because it omits **escharotomy**, which is urgently needed for the circumferential full-thickness burns.
- Escharotomy is a time-sensitive procedure that must be performed promptly to prevent ischemic injury to the limbs from vascular compromise.
Abdominal compartment syndrome US Medical PG Question 4: A 23-year-old patient presents to the emergency department after a motor vehicle accident. The patient was an unrestrained driver involved in a head-on collision. The patient is heavily intoxicated on what he claims is only alcohol. An initial trauma assessment is performed, and is notable for significant bruising of the right forearm. The patient is in the trauma bay, and complains of severe pain in his right forearm. A physical exam is performed and is notable for pallor, decreased sensation, and cool temperature of the skin of the right forearm. Pain is elicited upon passive movement of the right forearm and digits. A thready radial pulse is palpable. A FAST exam is performed, and is negative for signs of internal bleeding. The patient's temperature is 99.5°F (37.5°C), pulse is 100/min, blood pressure is 110/70 mmHg, respirations are 12/min, and oxygen saturation is 98% on room air. Radiography of the right forearm is ordered. The patient is still heavily intoxicated. Which of the following is the best next step in management?
- A. Fasciotomy (Correct Answer)
- B. IV fluids
- C. Analgesics
- D. Pressure measurement
- E. Detoxification
Abdominal compartment syndrome Explanation: ***Fasciotomy***
- The patient exhibits classic signs of **acute compartment syndrome**, including severe pain out of proportion to injury, pain on passive stretch, pallor, decreased sensation, and cool extremity, despite a palpable pulse. These symptoms necessitate immediate surgical intervention to relieve pressure.
- A **fasciotomy** is the definitive treatment for acute compartment syndrome to prevent irreversible muscle and nerve damage, and potentially limb loss.
*IV fluids*
- While fluid resuscitation is important in trauma, the patient's current vital signs (BP 110/70 mmHg, pulse 100/min) do not indicate immediate shock requiring aggressive IV fluid administration over addressing the limb-threatening compartment syndrome.
- Prioritizing IV fluids without addressing **compartment syndrome** could lead to permanent loss of limb function.
*Analgesics*
- Administering analgesics might mask the escalating pain a key symptom of compartment syndrome, which could delay diagnosis and definitive treatment.
- While pain control is important, it should not supersede measures to prevent irreversible tissue damage.
*Pressure measurement*
- While compartment pressure measurement can confirm the diagnosis of compartment syndrome, the clinical presentation in this case is so compelling that delaying definitive treatment for pressure measurement is not the best next step.
- Clinical signs and symptoms are often sufficient for diagnosis, and surgical intervention should not be deferred pending pressure readings in clear-cut cases.
*Detoxification*
- Detoxification for alcohol intoxication is not an emergent and immediate priority in comparison to the limb-threatening condition of acute compartment syndrome.
- Addressing the **compartment syndrome** is critical for preserving limb viability, whereas detoxification can be managed once acute medical emergencies are controlled.
Abdominal compartment syndrome US Medical PG Question 5: A 43-year-old man is brought to the emergency department 30 minutes after falling from the roof of a construction site. He reports abdominal and right-sided flank pain. His temperature is 37.1°C (98.8°F), pulse is 114/min, and blood pressure is 100/68 mm Hg. Physical examination shows numerous ecchymoses over the trunk and flanks and a tender right abdomen without a palpable mass. Focused assessment with sonography for trauma (FAST) shows no intraperitoneal fluid collections. His hemoglobin concentration is 7.6 g/dL. The most likely cause of his presentation is injury to which of the following organs?
- A. Liver
- B. Kidney (Correct Answer)
- C. Stomach
- D. Small bowel
- E. Spleen
Abdominal compartment syndrome Explanation: ***Kidney***
- The patient's presentation with **flank pain**, **ecchymoses over the flank**, and **hypotension** following a fall from height is highly suggestive of **renal injury**. The absence of intraperitoneal fluid on FAST scan further supports an injury to a retroperitoneal organ like the kidney.
- The **significantly decreased hemoglobin (7.6 g/dL)** indicates substantial blood loss, which is consistent with the vascular nature of the kidney and potential for severe hemorrhage following trauma.
*Liver*
- While liver injury can cause **hypotension** and **abdominal pain** after trauma, the primary pain would typically be in the **right upper quadrant**, not specifically the flank.
- Liver injuries often result in **intraperitoneal fluid collections** (hemoperitoneum), which were explicitly absent on the FAST scan in this patient.
*Stomach*
- Stomach injuries typically result from penetrating trauma or severe blunt force, leading to **peritonitis** and potential **gastric content leakage**, which would cause diffuse abdominal pain and potentially peritonitis signs.
- It is an **intraperitoneal organ**, and injury might be seen on a FAST scan as free fluid, which is not present here.
*Small bowel*
- Small bowel injuries typically present with **diffuse abdominal pain**, **peritoneal signs**, and can lead to **sepsis** due to contamination.
- These injuries often cause **intraperitoneal fluid** or air, neither of which is reported.
*Spleen*
- Splenic injuries typically cause **left upper quadrant pain** and can lead to significant **intraperitoneal bleeding**, which would be detected by a FAST scan.
- The patient's symptoms are localized to the **right side** and flank, making splenic injury less likely.
Abdominal compartment syndrome US Medical PG Question 6: A 27-year-old-man is brought to the emergency department 30 minutes after being involved in a motorcycle accident. He lost control at high speed and was thrown forward onto the handlebars. On arrival, he is alert and responsive. He has abdominal pain and superficial lacerations on his left arm. Vital signs are within normal limits. Examination shows a tender, erythematous area over his epigastrium. The abdomen is soft and non-distended. A CT scan of the abdomen shows no abnormalities. Treatment with analgesics is begun, the lacerations are cleaned and dressed, and the patient is discharged home after 2 hours of observation. Four days later, the patient returns to the emergency department with gradually worsening upper abdominal pain, fever, poor appetite, and vomiting. His pulse is 91/min and blood pressure is 135/82 mm Hg. Which of the following is the most likely diagnosis?
- A. Abdominal compartment syndrome
- B. Aortic dissection
- C. Splenic rupture
- D. Pancreatic ductal injury (Correct Answer)
- E. Diaphragmatic rupture
Abdominal compartment syndrome Explanation: ***Pancreatic ductal injury***
- A forceful impact to the **epigastrium** (e.g., falling onto handlebars) can cause **pancreatic injury**, particularly a **ductal transection**, due to the pancreas being compressed against the vertebral column.
- Initial CT scans can be normal because the injury to the **ductal system** takes time to manifest, leading to delayed symptoms like **worsening abdominal pain, fever, vomiting**, and **poor appetite** several days later due to **pancreatitis** or a **pseudocyst** formation.
*Abdominal compartment syndrome*
- This typically presents with **acute abdominal distension**, increased intra-abdominal pressure, and organ dysfunction (e.g., oliguria, respiratory compromise), which are not described here.
- It's an immediate complication of severe trauma or fluid resuscitation, not a delayed presentation like described.
*Aortic dissection*
- Characterized by **sudden-onset, severe, tearing chest or back pain** and often involves hypertension or Marfan syndrome.
- It would manifest immediately with hemodynamic instability and distinct pain, not a delayed presentation of progressive abdominal symptoms.
*Splenic rupture*
- Often causes **left upper quadrant pain**, **Kehr's sign** (referred shoulder pain), and **hemodynamic instability** due to significant blood loss.
- While possible in trauma, a normal initial CT scan makes this less likely, and its symptoms usually appear earlier or are more severe.
*Diaphragmatic rupture*
- Can present with **dyspnea, shoulder pain**, or signs of **herniated abdominal organs** into the chest.
- It causes more immediate respiratory distress or gastrointestinal obstruction symptoms, and the abdominal symptoms described are not typical for this injury.
Abdominal compartment syndrome US Medical PG Question 7: A 68-year-old male with past history of hypertension, hyperlipidemia, and a 30 pack/year smoking history presents to his primary care physician for his annual physical. Because of his age and past smoking history, he is sent for screening abdominal ultrasound. He is found to have a 4 cm infrarenal abdominal aortic aneurysm. Surgical repair of his aneurysm is indicated if which of the following are present?
- A. Abdominal, back, or groin pain (Correct Answer)
- B. Marfan's syndrome
- C. Diameter >3 cm
- D. Smoking history
- E. Growth of < 0.5 cm in one year
Abdominal compartment syndrome Explanation: ***Abdominal, back, or groin pain***
- The presence of **abdominal, back, or groin pain** in a patient with an AAA indicates **symptomatic aneurysm**, suggesting impending rupture or expansion, which necessitates urgent surgical repair regardless of size.
- This symptom complex signifies an increased risk of complications and makes the aneurysm an **immediate threat** to life.
*Marfan's syndrome*
- While patients with **Marfan's syndrome** are at higher risk for aortic aneurysms (often in the ascending aorta), the diagnosis of Marfan's syndrome itself is not an indication for surgical repair of an infrarenal AAA; rather, specific aneurysm characteristics (e.g., size, growth rate) would determine the need for intervention.
- The presence of connective tissue disorders like Marfan's syndrome influences repair thresholds, but it is not a standalone indication for surgery in patients with an existing 4 cm infrarenal AAA.
*Diameter >3 cm*
- An aneurysm diameter of greater than 3 cm defines an abdominal aortic aneurysm, but it is **not an automatic indication for surgical repair**.
- Elective repair is generally considered for aneurysms typically greater than **5.0 to 5.5 cm in men**, or with rapid growth, or if symptomatic, but 4 cm alone is usually managed with surveillance.
*Smoking history*
- A **smoking history** is a significant risk factor for the development and progression of abdominal aortic aneurysms, as it contributes to atherosclerosis and weakening of the aortic wall.
- However, smoking history itself is **not an indication for surgical repair**; it merely highlights the patient's elevated risk for the condition and its complications.
*Growth of < 0.5 cm in one year*
- A growth rate of less than 0.5 cm in one year would be considered a **slow or stable growth rate** for an infrarenal AAA.
- Rapid growth (e.g., >0.5 cm in 6 months or >1 cm in 1 year) is an indication for surgical repair, so **slow growth actually favors continued surveillance** rather than intervention for a 4 cm aneurysm.
Abdominal compartment syndrome US Medical PG Question 8: A 36-year-old man comes to the emergency department 4 hours after a bike accident for severe pain and swelling in his right leg. He has not had a headache, nausea, vomiting, abdominal pain, or blood in his urine. He has a history of gastroesophageal reflux disease and allergic rhinitis. He has smoked one pack of cigarettes daily for 17 years and drinks an average of one alcoholic beverage daily. His medications include levocetirizine and pantoprazole. He is in moderate distress. His temperature is 37°C (98.6°F), pulse is 112/min, and blood pressure is 140/80 mm Hg. Examination shows multiple bruises over both lower extremities and the face. There is swelling surrounding a 2 cm laceration 13 cm below the right knee. The lower two-thirds of the tibia is tender to palpation and the skin is pale and cool to the touch. The anterior tibial, posterior tibial, and dorsalis pedis pulses are weak. Capillary refill time of the right big toe is 4 seconds. Dorsiflexion of his right foot causes severe pain in his calf. Cardiopulmonary examination is normal. An x-ray is ordered, which is shown below. Which of the following is the most appropriate next step in management?
- A. Above knee cast
- B. IVC filter placement
- C. Fasciotomy (Correct Answer)
- D. Low molecular weight heparin
- E. Open reduction and internal fixation
Abdominal compartment syndrome Explanation: ***Fasciotomy***
- The patient's symptoms (severe pain, swelling, pain with passive dorsiflexion, weak pulses, pale/cool skin, and prolonged capillary refill) after a traumatic injury are highly suggestive of **acute compartment syndrome**.
- **Fasciotomy** is the definitive treatment for acute compartment syndrome to relieve pressure and prevent irreversible tissue damage.
*Above knee cast*
- While a cast is used for immobilization of fractures, it would worsen **compartment syndrome** by externally compressing an already swollen limb.
- This patient has signs of compartment syndrome which requires urgent surgical decompression, not just immobilization.
*IVC filter placement*
- **IVC filter placement** is indicated for preventing pulmonary embolism in patients with deep vein thrombosis (DVT) who have contraindications to anticoagulation.
- There is no clinical evidence to suggest DVT in this patient, and the primary concern is acute compartment syndrome.
*Low molecular weight heparin*
- **Low molecular weight heparin (LMWH)** is an anticoagulant used for DVT prophylaxis or treatment.
- It is not indicated for the immediate management of acute compartment syndrome and could increase the risk of bleeding in a patient who likely needs urgent surgery.
*Open reduction and internal fixation*
- **Open reduction and internal fixation (ORIF)** is a surgical procedure to stabilize complex fractures, which may be needed later for a tibial fracture if present.
- However, the immediate priority is to address the limb-threatening acute compartment syndrome before performing definitive fracture repair.
Abdominal compartment syndrome US Medical PG Question 9: A 35-year-old man is referred to a physical therapist due to limitation of movement in the wrist and fingers of his left hand. He cannot hold objects or perform daily activities with his left hand. He broke his left arm at the humerus one month ago. The break was simple and treatment involved a cast for one month. Then he lost his health insurance and could not return for follow up. Only after removing the cast did he notice the movement issues in his left hand and wrist. His past medical history is otherwise insignificant, and vital signs are within normal limits. On examination, the patient’s left hand is pale and flexed in a claw-like position. It is firm and tender to palpation. Right radial pulse is 2+ and left radial pulse is 1+. The patient is unable to actively extend his fingers and wrist, and passive extension is difficult and painful. Which of the following is a proper treatment for the presented patient?
- A. Surgical release (Correct Answer)
- B. Botulinum toxin injections
- C. Collagenase injections
- D. Needle fasciotomy
- E. Corticosteroid injections
Abdominal compartment syndrome Explanation: ***Surgical release***
- The patient presents with classic signs of **established Volkmann's ischemic contracture** (claw-like hand, firm fibrotic tissue, limited movement, decreased radial pulse), which is the end-stage result of untreated compartment syndrome that occurred during fracture healing.
- Since this is **chronic contracture (one month post-injury)**, the appropriate surgical treatment involves **reconstructive procedures** such as muscle slide operations, tendon lengthening, tendon transfers, neurolysis, or in severe cases, free functional muscle transfer to restore hand function.
- Emergency fasciotomy would have been appropriate for **acute compartment syndrome** (within 6-8 hours of onset), but at this stage, the treatment focuses on releasing fibrotic tissue and restoring function through reconstructive surgery.
*Botulinum toxin injections*
- **Botulinum toxin** is used to relax spastic muscles in neurological conditions (e.g., cerebral palsy, stroke), but it does not address the underlying **ischemic fibrosis and muscle necrosis** of Volkmann's contracture.
- It would not improve the structural contracture or restore blood flow in this patient.
*Collagenase injections*
- **Collagenase injections** are used for localized fascial contractures like Dupuytren's contracture, where enzymatic breakdown of collagen cords can restore finger extension.
- They are ineffective for **Volkmann's contracture**, which involves widespread ischemic muscle necrosis, fibrosis, and nerve damage requiring surgical reconstruction.
*Needle fasciotomy*
- **Needle fasciotomy** is a minimally invasive technique for Dupuytren's contracture, involving percutaneous disruption of fascial cords.
- It is not suitable for **Volkmann's contracture**, which requires extensive surgical release of fibrotic muscle compartments, possible tendon transfers, and neurolysis—procedures that cannot be accomplished with needle techniques.
*Corticosteroid injections*
- **Corticosteroids** reduce inflammation in conditions like tenosynovitis or trigger finger.
- They would not address the **ischemic muscle necrosis and fibrotic contracture** in Volkmann's contracture and could potentially delay appropriate surgical treatment.
Abdominal compartment syndrome US Medical PG Question 10: Three hours later, the patient is reassessed. Her right arm is put in an elevated position and physical examination of the extremity is performed. The examination reveals reduced capillary return and peripheral pallor. Pulse oximetry of her right index finger on room air shows an oxygen saturation of 84%. Which of the following is the most appropriate next step in management?
- A. Perform fasciotomy
- B. Obtain split-thickness skin graft
- C. Decrease rate of IV fluids
- D. Perform right upper extremity amputation
- E. Perform escharotomy (Correct Answer)
Abdominal compartment syndrome Explanation: ***Perform escharotomy***
- The patient's symptoms of **reduced capillary return**, **peripheral pallor**, and **low oxygen saturation** in the setting of an elevated arm indicate **compartment syndrome** due to circumferential burn-related edema.
- **Escharotomy** is the appropriate immediate intervention to relieve pressure and restore circulation in deep circumferential burns.
*Perform fasciotomy*
- **Fasciotomy** is indicated for compartment syndrome due to **non-burn-related trauma** or other causes, where the tight fascia is the primary constricting factor.
- In burns, the **tough, inelastic eschar** itself is usually the constricting element, requiring escharotomy.
*Obtain split-thickness skin graft*
- A **split-thickness skin graft** is a reconstructive procedure performed after the burn wound has been adequately debrided and the patient is stable.
- It is not an emergent intervention to address acute limb ischemia from compartment syndrome.
*Decrease rate of IV fluids*
- While excessive fluid resuscitation can contribute to edema, the immediate and critical issue is the **compromised circulation** due to the constricting eschar, not solely fluid overload.
- Reducing IV fluids would not rapidly reverse the existing limb ischemia and could potentially lead to **hypoperfusion** if the patient is already under-resuscitated.
*Perform right upper extremity amputation*
- **Amputation** is a last resort, considered only after all attempts to salvage the limb, including escharotomy, have failed and there is irreversible tissue necrosis.
- It is not the appropriate first-line response to acute compartment syndrome from burns.
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