What is the first step in managing a severely burned right arm and hand with absent pulses?

The first step in managing a severely burned right arm and hand with absent pulses is performing an escharotomy. When a patient has sustained significant burns, especially deep partial thickness or full thickness burns, the skin can develop eschar, which is the dried, hardened tissue that forms over the wound. This process can lead to constriction of underlying structures and significantly increase the pressure within the extremity.

In cases where circulation is compromised, as indicated by absent pulses, it is crucial to relieve that pressure to restore blood flow. An escharotomy involves making incisions through the eschar to release the tension and allow for expansion of the underlying tissues. This helps to improve perfusion to the affected arm and hand.

Addressing the vascular compromise quickly is vital because prolonged ischemia can lead to irreversible tissue damage. Therefore, escharotomy is prioritized in the management of this condition to restore circulation and prevent further complications.