Compartment Syndrome Fat Embolism Syndrome Flashcards
ORTHOPAEDICS
What is Compartment Syndrome?
Pressure in soft tissue compartment exceeds capillary pressure (30 mmHg)
Compartment syndrome can lead to muscle and nerve damage if not treated promptly.
What are the clinical signs of Compartment Syndrome?
- Pain out of proportion to the injury not responding to analgesia
- Pain on passive stretch of the muscles in the affected compartment
- Parasthesia followed by anaesthesia
- A tensely swollen soft tissue compartment
These signs help differentiate compartment syndrome from other conditions.
What does pulselessness indicate in the context of Compartment Syndrome?
Signs of arterial injury NOT compartment syndrome
Pulselessness, palor, poikilothermia, and paralysis are indicators of arterial injury.
How can intra-compartmental pressures be monitored?
- Commercially available compartment pressure monitors
- Whiteside’s technique
Monitoring pressures can be crucial in patients with decreased consciousness.
What is the pre-operative management for Compartment Syndrome?
- Fluid resuscitation to maintain prefusion pressure
- Remove constrictive bandages / split plaster
- Elevate limb to level of the heart
- Prepare patient for theatre
Pre-operative management is essential to optimize the patient’s condition before surgery.
What is the surgical management for Compartment Syndrome?
Fasciotomy of all compartments in the involved segment
This procedure relieves pressure and prevents tissue damage.
What characterizes Fat Embolism Syndrome?
- ARDS (Acute respiratory distress syndrome)
- Encephalopathy
- Petechiae
- DIC (Diffuse intravascular coagulopathy)
Fat embolism syndrome is a serious condition that can occur after fractures.
What are the two theories regarding the causes of fat embolism?
- Mechanical theory: embolism is caused by droplets of bone marrow fat released into venous system
- Metabolic theory: stress from trauma causes changes in chylomicrons which result in formation of fat embolism
Both theories help explain the pathogenesis of fat embolism syndrome.
What is the typical patient profile for Fat Embolism Syndrome?
Young active patients (10-40 years of age) with single or multiple long bone fractures
It usually occurs 12-72 hours after fracture or fracture-fixation.
What are common clinical symptoms of Fat Embolism Syndrome?
- Hypoxia (tachypnoea and eventually full-blown ARDS)
- CNS depression (confusion)
- Petechial rash (conjunctival and skin of the axilla or upper trunk)
These symptoms are critical for timely diagnosis.
What is the most important lab test for diagnosing Fat Embolism Syndrome?
Arterial blood gas
PaO2 < 60 mmHg and PaCO2 initially decreased due to tachypnoea later increases are key findings.
What radiological findings can be seen in Fat Embolism Syndrome?
- X-ray changes (late) = ‘snowstorm’ appearance or non-specific infiltrates bilateral
- CT chest
- MRI brain confirms diagnosis
Radiological findings support the clinical diagnosis but are not the primary diagnostic tool.
What is the treatment approach for Fat Embolism Syndrome?
Supportive management
There is no specific treatment available; management focuses on supportive care.
What are key management strategies for Fat Embolism Syndrome?
- Immediate transfer to High-care or ICU
- Fluid resuscitation
- Supplemental oxygen or mechanical ventilation
- Immobilize/stabilize fracture
These strategies aim to stabilize the patient and manage symptoms effectively.
What is the aim of early fracture immobilization and stabilization?
To decrease the severity of the inflammatory response as a result of the fracture
Proper management can prevent complications associated with fat embolism syndrome.
