Compartment Syndrome Flashcards
What is compartment syndrome?
Where the pressure within a fascial compartment is abnormally elevated, cutting off the blood flow to the contents of that compartment
What is fascia?
A sheet of strong, fibrous connective tissue that encases the contents of the compartment
Unable to stretch or expand
What is a fascial compartment?
Muscles, nerves and blood vessels surrounded by fascia
Which areas are most commonly affected by compartment syndrome?
Lower leg
Forearm
Hand
Foot
Thigh
What are some causes?
Bone fractures
Crush injuries
Haemorrhage
Burns
Post lithotomy
Vascular reperfusion of acutely ischaemic limb
What are the 5 Ps?
Pain- disproportionate to the injury and worsened on passive stretch
Paraesthesia
Pale
Pressure
Paralysis- late
What is meant by disproportionate pain?
Pain doesn’t match injury
So severe that pain meds don’t work
Describe the progressive damage in ACS
- Nerve
- Muscle
- Artery
- Vein
- Skin
How long does it take for irreversible muscle damage?
6-8 hours
What is meant by critical pressure in ACS?
Difference between compartment pressure and diastolic BP <30mmmHg
Threshold for fasciotomy
What is the management for ACS?
Escalate to orthopaedic registrar or consultant
Remove any external dressings or bandages
Avoid hypotension
Elevate leg to heart level
Emergency fasciotomy- within 6 hours
What is fasciotomy?
Surgically cut through fascia down the entire length of the compartment and release the pressure
Compartment explored to identify and debride any necrotic muscle tissue
Wound left open and covered with a dressing
Wound can be gradually closed which can take several weeks
What is required if the wound cannot be closed around the compartment?
Skin graft
