Compartment syndrome Flashcards
What is compartment syndrome?
critical pressure increase within a confined compartmental space
What are the common sites that are affected by compartment syndrome?
Leg, thigh, forearm, foot, hand and buttock
When does compartment syndrome usually occur?
high energy trauma, crush injuries, fractures with vascular injury, iatrogenic injury, tight casts, saints, DVT, post reperfusion injury
Why is an increase in fluid in a fascial compartments an issue?
they are closed and cannot be distended so this will cause in increase in intra-compartmental pressure
When there is a pressure increase what will happen to the veins in compartments?
They will become compressed, causing an increase in hydrostatic pressure within them and then fluid moves down its gradient from the veins and into the compartment, increasing the compartment pressure more
What happens due to the transversing nerves being compressed in compartment syndrome?
sensory and motor defect in the distal distribution, paraesthesia
What happens once the intra-compartmental pressure reaches diastolic pressure in compartment syndrome?
Arterial inflow will be compromised causing ischaemic (cool, pale, pulseless and paralysed distal limb)
What are the clinical features of compartment syndrome?
severe pain, disproportionate to the injury which is no improved with analgesia, pain is made worse by passively stretching the muscle bellies of the muscles transversing the affected fascial compartment, parasthesia distally, tense, not swollen, acute arterial insufficiency
What are the 5Ps of acute arterial insufficiency?
pain, pallor, perishingly cold, paralysis and pulselessness
What are the investigations for compartment syndrome?
clinical based on symptoms, into compartmental pressure monitor if uncertain and in patients who are unconscious, CK level thats high may occur
What is the management of compartment syndrome?
immediate surgery via urgent fasciotomies
What should be done before surgery for compartment syndrome?
keep the limb at a neutral level, high flow oxygen, blood pressure with crystalloids, remove all dressings, splints and casts, analgesia
Why is the fasciotomy left open to be looked at 24-48hours later?
to assess for any dead tissue which will need debridement
What are some renal complications of compartment syndrome?
Rhabdomyolysis or repercussion injury
