Compartment Syndrome

Question 1

A 28-year-old-male patient, his leg was crushed for a few hours. The patient was left unobserved in the orthepedic ward. Bloods: increased creatnin, increased urea. Urine dipstick: blood+++

Q1: Which compliations would you expect in such a patient?

Answer 1

Compartment Syndrome or Rheubdomylosis

Question 2

Q2: How would you suspect compartment syndrome?

Answer 2

Pain unpoprtionate to pt condition / swelling / Redness / Parathesia / Decrease peripheral pulsation / Pain on passive movement / Loss of 2 points tactile discrimination.

Question 2

Q4: What’s the normal compartment pressure?

Answer 2

0-15 mmHg in LL

Question 3

Q5: What would be your action if you clinically suspected compartment syndrome in the leg?

Answer 3

I will do fasciotomy after consenting pt.
by 2 incisions antrolateral and posteromedial

Question 3

Q3: The patient sustained SCI with complete loss of motor power and sensations in the LLs, how would confirm compartment syndrome? Is it necessary?

Answer 3

By measuring the compartment pressure (absolute) > 30 mmHg
Not necessary as it mainly clinical Dx.

Question 4

Q6: What will you discuss with patient before fasciotomy?

Answer 4

The procedure, the complications of (procedure and the Syndrome), and also the possibility of amputation of limb.

Question 5

Q7: What are the other areas of the body susceptible for compartment syndrome?

Answer 5

Chest / Abdomen and Forearm.

Question 6

Q8: From the patient’s history and kidney function tests (High creatinine), what do you think happened to the kidneys? Why?

Answer 6

AKI , due to renal as excissive myoglobin will cause ATN.
The patient developed severe muscle pain and dark, amber red urine. Investigations revealed a high CK levels.

Question 7

Q9: What’s your diagnosis now?

Answer 7

Rhabdomyolysis

Question 8

Q10: Can you define rhabdomyolysis? What’s myoglobin?

Answer 8

Muscle injury will lead to daeth of ms cells and lead to release of myoglobin
Myogolbin; Ptn present in straited muscles (Cardiac- Skeletal) and it’s function is binding to oxygen

Question 9

Q11: What are the known causes of rhabdomyolysis?

Answer 9

Crush injury – ischemic reperfusion injury - sever burns – hypothermia – hyperthermia – vigorous exercise -

Question 10

Q12: What’s ischemic reperfusion injury?

Answer 10

Paradoxical exacerbation of cellular function following resoration of blood flow to previously ischemic tissues. Tissue damage is multifactorial and involves releasing of oxygen species from damaged endothelial cells intiating inflammatory response, cytokines and free radicals

Question 11

Q13: What’re the expected labaratory findings associated with rhabdomyolysis?

Answer 11

High CK, Met. Acidosis, elevated LDH, Positive dipstick to myoglobinuria and absent hemoglubinuria, Electrolyte dist. ( Hyper—Kalemia/Uricemia/phosphatemia and hypoCa)

Question 12

Q14: How would manage this patient?

Answer 12

–CCRISP protocol
–Iv Fluids to get rid of myglobin UOP > 300 ml/hr
–Correct electrolyte (Hyperkalemia Specifically) By protect heart by CaGluconate and monitor with ECG and giving Insulin on dextrose5% / salbutamol. (Dialysis in Sever HyperK)
–Alkalinization of Urine by NaHCO3 to prevent cast formation and renal damage
–Diuretics like mannitol
–Regular monitoring of ECG / Electrolytes / Lactate / Urinary Myoglobin
–Defn. ttt — > Fasciotomy

Question 13

Indications for Urgent dialysis

Answer 13

• AKI not improving with ttt. - Sever HyperK. - Drug toxicity.
• Fluid Overload. - sever acidosis (Ph< 7.1) - Sever uremia