F - Wk9 Acute Compartment Syndrome

Question 1

Whats Acute compartment syndrome?

Answer 1

1. Rapid increase in pressure within an enclosed compartment: contains muscles, nerves & BVs surrounded by a layer of fibrous connective tissue = fascia
2. fascia not elastic -> can’t stretch much
3. pressure within these compartments rises -> cuts off normal blood flow -> hypoxia and ischemia -> tissue damage

Question 2

What are the causes of acute compartment syndrome?

Answer 2

1. most common cause = bleeding within the compartment
   - long bone fractures eg tibia
   - penetrating injuries
2. limb compression
   - from a crush injury or severe contusion
3. severe circumferential burns
   - can cause tissue edema
4. reperfusion injury in clients who experience prolonged tissue hypoxia
   - sudden restoration of blood supply -> massive inflammation & edema

Question 3

What are the risk factors of acute compartment syndrome?

Answer 3

1. Severe trauma, penetrating injury, motor vehicle crash, or burn injury
2. receive massive IV fluids
   - extravasate and infiltrate into the tissue
3. Bleeding disorders
   - at increased risk of bleeding
   - hemophilia,
   - anticoagulation therapy, like warfarin
4. compression from external factors
   - eg: constrictive bandages, casts, and tight dressings.

Question 4

WHAT are the symptoms of acute compartment syndrome?

Answer 4

6 P’s

1. Pain out of proportion
2. Paresthesia / “pins & needles”
   - numbness + swollen and very stiff

If not promptly treated, may develop:
3. Pallor
4. Pulselessness
- distal arterial pulses become very weak or even absent
5. Poikilothermia
- coolness of the affected area

6. Paralysis
   - rare
   - extensive damage to both muscles & nerves

Question 5

What are the complications of ACS?

Answer 5

1. necrosis and gangrene
   - can occur when normal blood flow is not established in time
   - necrotic tissue is more susceptible to become infected
2. rhabdomyolysis / muscle destruction -> muscle scarring & contractures that restrict movement
   - myoglobin is released from the destroyed muscle cells into the bloodstream & filtered out by the kidneys
   - can also casue acute kidney injury
3. irreversible nerve damage -> permanent motor & sensory deficits

Question 6

How to diagnose ACS & rhabdomyolysis?

Answer 6

Acute compartment syndrome:
1. CBC
- shows elevated WBCs
- elevated erythrocyte sedimentation rate when thrs an infection

Rhabdomyolysis:
1. lab: elevated levels of creatine kinase & myoglobin
2. urinalysis can show tea-colored urine due to high levels of myoglobin

Question 7

What are the treatment options for acute compartment syndrome?

Answer 7

needs prompt action
1. surgery: fasciotomy
- skin and fascia are cut open, relieving the pressure & reestablishing normal blood flow
2. if tissue is already necrotic & gangrenous limb should be amputated