Perform hand hygiene and apply sterile gown, mask, and gloves

   1. Verify the patient's identity in accordance with institution policy.
   2. Obtain and record vital signs (including pulse oximetry).
   3. Assess circulation, sensation, and movement (CSMs) using the 8 Ps: pain (administer analgesics as                   indicated and prescribed), pallor (i.e., color), pulses (i.e., circulation), paresthesias (i.e., sensation), paralysis        (i.e., movement), puffiness (i.e., edema), position (i.e., angulation), and pressure (i.e., tense compartment).
   4. Note chest expansion and diaphragmatic excursion.
   5. Record compartment pressure(s) if intracompartmental pressure monitoring is being performed in the patient.
   6. Call or participate in a "time out" before initiating an invasive procedure, in accordance with institutional policy.
   7. Remove all constricting clothing and jewelry.
   8. Elevate the burned extremity slightly above the level of the heart.
   9. Administer analgesics and sedatives as prescribed.
  10. Administer tetanus prophylaxis as indicated.
  11. Place the patient in a supine anatomic position unless contraindicated by other injuries or conditions.
  12. Drape below and around the surgical area.
  13. The physician or advanced practice nurse anesthetizes the skin with local anesthetic infiltration or regional           nerve block.
  14. The physician or advanced practice nurse incises indicated areas. The incision should be through the eschar         but not into the subcutaneous tissue.1 The incision should cause the eschar to gap, thus releasing pressure.
  15. Reassess respiratory function and distal circulatory status.
  16. Assist the physician or advanced practice nurse with application of direct pressure, cautery, clamps, or               application of thrombin to all bleeding areas.
  17. Reassess hematocrit, and consider blood administration if necessary.
  18. Apply dressings to reduce the potential for infection.
  19. Keep the affected extremities elevated, and monitor distal pulses frequently.
  20. Reassess, as indicated:

    * Pain status
    * CSMs
    * Compartment pressure(s)
    * Edema
    * Chest expansion and diaphragmatic excursion
    * Watch for ongoing bleeding.

Discard supplies; remove gown, mask, and gloves; and perform hand hygiene.
Document the procedure in the patient's record.