What is the other findings in patient with compartment syndrome Compartment sx findings Pain out of proportion to findings Pain with passive stretching of muscles in the affected comptmt Progressive pain ID: 180376
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Slide1
What are 3 things which present with complaints out of proportion to findings??Slide2
What is the other findings in patient with compartment syndrome?Slide3
Compartment
sx findings
Pain out of proportion to findings
Pain with passive stretching of muscles in the affected
comptmt
Progressive pain
Tension of
comptmtSlide4
Compartment syndrome
Pressure in
comptmt
increases to a level that circulation compromised re
Most commonly in lower extremity from
fxs
May occur in any
comptmt including buttock and abdomen
Initial complaint is pain
Early finding decreased peripheral sensation
Nerve tissue very senstive to ischemia(before motorSlide5Slide6Slide7
Lower leg compartments
Anterior
doriflex
Lateral
eversion
Superficial posterior
plantarflex
Deep posterior just behind tibia
Toe flexionSlide8
Outside job
Burns circumferential
Tight casts
Mast pants
Tight dressings
Compression devices malfunctionSlide9
Inside jobs
Fractures most common cause
Tib
fib 36%;
supracondyar;radius/ulnar
Pts on
coumadin
with traumaIV drug abuse
IV infiltration, IO
infil
: IM injection; arterial injecAttempts at cannulation veins in pt on anticoag
Lithotomy
position
Orif
post
sx
hemorrhageSlide10
Inside jobs (cont)
Comatose patient not moving-
OD,etoh
Buttock; extremities; high pressures
Vigorous exercise
Envenomation
Hemorrhage from large
vx
injury
Rhabdo
Gastroc/baker cyst rupturesRevasc and reperfusionCrush and direct blow to comptmtSlide11
Nontraumatic
cs
longer delay in diagnosis
Delay more than 6 hrs in
dx
and
fasciotomy leads to permanent weaknessSlide12
Should leg be elevated?
Elevation of limb is
contraind
b/c
it decreases arterial blood flow & narrows A-V gradient
Immobilize lower leg with ankle in slight plantar flex decreasing deep post
comptmt prSlide13Slide14
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%.Slide15Slide16Slide17Slide18
Ischemia that lasts 4 hours leads to significant
myoglobinuria
The 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;?bicarbSlide19
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 flagsSlide20
“5 P’s of pain, pressure,
pulselessness
, paralysis,
paresthesia
and pallor” are more indicative of arterial injury or occlusion
Hypotensive
develop
cs earlier Lower
icp
threshold for
fasciotomy with hypotense ptSlide21
can get burned on measuring pressures in lower leg as there are 4 compartments to measure
vigourous
prolonged exercise can cause
rhabdo
but
dont
forget to check for compartment
overdose patients do not move for extended period: if lying supine check buttock for pain and tension; also check
extremites
if a developing compartment syndrome is suspected, place the affected limb or limbs at the level of the heart.-Slide22
Using the Stryker
Instructions with kit are relatively easy
Or go to you tube
Assemble prefilled syringe, needle and cork and attach unit by cork to box
Zero device at angle planning to enter skin
Purge system by squirting out saline and get wait till 00 reading
Go into ant
compt
just lat to
prox
third of tibiaSlide23
Entering skin with 1
st
pop and 2
nd
pop thru fascia
Go into
comptmt
about 1cm total about 3 cmInject < 0.3cc saline to equilibrate with the tx
Pressure goes way up and comes down
When levels off-take reading
May squeeze calf or dorsflex ankle to see if pressure changes confirming you are in compt