Compartment syndrome Flashcards
definition of compartment syndrome
high interstitial pressure in closed osteofascial compartment -> microvascular compromise (ie restriction of cap flow)
Most common causes of compartment syndrome
- fractures
- soft tissue injury
- trauma -> vascular compromise
- extremity compression
- reperfusion to chronically ischemic extremities
- burns
- fluid extrevasation/aggressive fluid resus
- sports
- intra-abdominal bleeding
- malignancy
path of compartment syndrome
haemorrhage or damage that leads to oedema in the cpmpartment
-> increased pressure
-> restrict cap flow
-> tissue necrosis
sx
- RFs(as aetiology)
- pain - out of proportion to the exam
- muscle tightness/pressure
- parasthesia
- paresis
Ix for compartment syndrome
measure the compartment pressure - use needle connected to a transducer
calculate the differential pressure (diastolic - compartment) if less than 30 -> then fasciotomy
absolute compartment pressure of >40 is diagnostic
Creatine kinase
urine myoglobin
Mx of compartment syndrome
- remove occlusive dressing
- fasciotomy within 6hrs
- amputation if necrosis - MDT decision
complications of compartment syndrome
limb loss
phantom pain after amputation
AKI
sensory deficits - sign of nerve ischemia
wound infection
motor deficits
psychological effects
volkmann’s ischemic contracture (forearm)
mx of chronic compartment syndrome
reduce the offending sport, and take NSAIDs
follow physio
fasciotomy if necessary
amputation
normal pressure in limbs
12-18mmHg
what is abdominal compartment syndrome and complications
normal pressure 0-5mmHg
can lead to multi-organ failure and death
diagnostic criteria include an intra-abdominal pressure of >20mmHg with evidence of multi-organ failure
measured with transducer connected to urinary catheter
mx of abdominal compartment syndrome
relieve pressure with laparotomy
causes of abdominal compartment syndrome
retroperitoneal bleeding
reperfusion injury
bowel obstruction
