PowerPoint Presentation
What are 3 things which present with complaints out of
proportion to findings??
What is the other findings in patient with compartment
syndrome?
Compartment sx findingsPain out of proportion to findings Pain
with passive stretching of muscles in the affected
comptmtProgressive painTension of comptmt
Compartment syndromePressure in comptmt increases to a level
that circulation compromised reMost commonly in lower extremity
from fxsMay occur in any comptmt including buttock and
abdomenInitial complaint is painEarly finding decreased peripheral
sensationNerve tissue very senstive to ischemia(before motor
Lower leg compartmentsAnterior
doriflexLateraleversionSuperficial posteriorplantarflexDeep
posterior just behind tibiaToe flexion
Outside jobBurns circumferentialTight castsMast pantsTight
dressingsCompression devices malfunction
Inside jobsFractures most common causeTib fib 36%;
supracondyar;radius/ulnarPts on coumadin with traumaIV drug abuseIV
infiltration, IO infil: IM injection; arterial injecAttempts at
cannulation veins in pt on anticoagLithotomy positionOrif post sx
hemorrhage
Inside jobs (cont)Comatose patient not moving-OD,etohButtock;
extremities; high pressuresVigorous exerciseEnvenomationHemorrhage
from large vx injuryRhabdoGastroc/baker cyst rupturesRevasc and
reperfusionCrush and direct blow to comptmt
Nontraumatic cs longer delay in diagnosisDelay more than 6 hrs
in dx and fasciotomy leads to permanent weakness
Should leg be elevated?Elevation of limb is contraind b/c it
decreases arterial blood flow & narrows A-V gradientImmobilize
lower leg with ankle in slight plantar flex decreasing deep post
comptmt pr
All bandages and casts must be removed Releasing 1 side of a
plaster cast can reduce compartment pressure by 30%, bivalving can
produce an additional 35% reduction,[44] and complete removal of
the cast reduces the pressure by another 15%for a total decrease of
85% from baseline.[53] Cutting undercast padding (Webril, Kendall
Healthcare Products Co) may decrease compartmental pressure by
10-30%.
Ischemia that lasts 4 hours leads to significant
myoglobinuriaThe combination of hypovolemia, acidemia, and
myoglobinemia may cause acute renal failure.Patients who survive
almost always recover renal function, even those patients who
require prolonged hemodialysis.IV fluids;?bicarb
CS is a potentially devastating diagnosis with its tendency to
damage nerves, muscles and vasculature. Fasciotomy is the only
treatment option for ACS. Comptmt sx develops over time so that
serial measurements may be necessaryTib/fib fxs and pts on anticoag
with trauma are red flags
5 Ps of pain, pressure, pulselessness, paralysis, paresthesia
and pallor are more indicative of arterial injury or
occlusionHypotensive develop cs earlier Lower icp threshold for
fasciotomy with hypotense pt
can get burned on measuring pressures in lower leg as there are
4 compartments to measurevigourous prolonged exercise can cause
rhabdo but dont forget to check for compartmentoverdose patients do
not move for extended period: if lying supine check buttock for
pain and tension; also check extremitesif a developing compartment
syndrome is suspected, place the affected limb or limbs at the
level of the heart.-
Using the StrykerInstructions with kit are relatively easy Or go
to you tubeAssemble prefilled syringe, needle and cork and attach
unit by cork to boxZero device at angle planning to enter skinPurge
system by squirting out saline and get wait till 00 readingGo into
ant compt just lat to prox third of tibia
Entering skin with 1st pop and 2nd pop thru fasciaGo into
comptmt about 1cm total about 3 cmInject < 0.3cc saline to
equilibrate with the txPressure goes way up and comes downWhen
levels off-take readingMay squeeze calf or dorsflex ankle to see if
pressure changes confirming you are in compt
