Compartment Syndrome Flashcards
Define Compartment Syndrome
Compartment syndrome is defined as a critical pressure increase within a confined compartmental space.
Compartment Syndrome 5 P’s
P – Pain “disproportionate” to the underlying injury, worsened by passive stretching of the muscles
P – Paresthesia
P – Pale
P – Pressure (high)
P – Paralysis (a late and worrying feature)
how to distinguish compartment syndrome from acute limb ischaemia
Intact pulses
the key characteristic of compartment syndrome
Disproportionate pain: pain medications i.e. morphine are not effective
compartment syndrome Sx
- Severe pain
- pain worse on passice movement
- Tightness or Fullness
- Parasthaesia (burning pain, pain/needles)
Compartment syndrome causes
- high-energy trauma
- crush injuries
- fractures that cause vascular injury
- post-reperfusion swelling
- iatrogenic vascular injury
- tight casts or splints
- DVT
compartment syndrome pathophysiology
increase in the intra-compartmental pressure
- reduced blood flow –> become ischaemic
- compression of veins –> raised in hydrostatic pressure fluid moving out of the vein into the compartment
comparment syndrome Ix
- intra-compartmental pressure monitor
- elevated CK level
compartment syndrome Mx
urgent fasciotomy
Actions for compartment syndrome prior to surgery
- Keep the limb at a neutral level with the patient (do not elevate or lower)
- Improve oxygen delivery with high flow oxygen
- Augment blood pressure with bolus of intravenous crystalloid fluids. This transiently improves perfusion of the affected limb
- Remove all dressings / splints / casts, down to the skin (no layers of any dressing must be left circumferentially)
- Treat symptomatically with opioid analgesia (usually intravenous)
why is incision left open adter fasciotomy
assess for any dead tissue that needs to be debrided
which part of the body system needs monitoring after fasciotomy
UEs: renal function for potential rhabdomyolysis / reperfusion injury
