compartment syndrome

Question 1

pathophysiology

Answer 1

soft tissue injury and bleeding causes swelling

raised compartment pressure

blood vessels compressed. capillaries stopped first

decreased tissue perfusion but main artery running through still works so still pink, warm, pulse

ischaemia

cell death, more swelling. repeat

Question 2

cause

Answer 2

fracture esp tibia, forearm, elbow or femur
haemorrhage
increased fluid due to burn
swelling
tight casts
dressings
drug injections
post lithotomy positioning
prolonged immobility

Question 3

more common in high or low energy injuries

Answer 3

low as fascial compartments more likely to be intact

Question 4

can acs occur in open fractures

Answer 4

yes

Question 5

5 ps

Answer 5

first
pain out of proportion of injury
paraesthesia
paresis or paralysis

pallor
pulselessness- LAST dont wait for this

Question 6

investigations

Answer 6

pressure monitor for comatose, alcohol/drugs, distracting injuries. unable to discuss pain
difference bwteen compartment pressure and diastolic BP < 30mmHg is critical and needs fasciotomy
lower the BP higher the likelihood of ACS

Question 7

what shouldnt you do

Answer 7

elevate

Question 8

principles in decompression

Answer 8

long incision
inspect all muscles
debride
leave open
check again in 48 hours