MSKS Clinical Lecture 2_Rhabdomyolysis and Compartment Syndrome Flashcards
What causes rabdomyolysis?
▸ #1. Direct damage to the skeletal muscle ▸ #2 Depletion of ATP within the myocyte
What clinical presentation should make you suspiciouse of rhabdomyolysis?
▸ Myalgias/muscle pain ▸ Weakness ▸ Red or brown urine ▸ Obvious traumatic injury or other primary problem ▸ Drug or alcohol overdose ▸ Prolonged immobilization ▸ Compartment syndrome ▸ Statin medication
What is the main diagnostic criteria of rabdomyolysis?
Creatine Kinase levels. They will typically be elevated to 5 times normal
What are the main complications of rabdomyolysis
▸ Acute kidney injury/kidney failure (due to accumulation of myoglobin in the nephrons) ▸ Electrolyte and metabolic derangements (hyperkalemia) ▸ Compartment syndrome ▸ Disseminated intravascular coagulation
What is the quick and dirty way to determine if there is myoglobin in the urine. If urine is possitive for myoglobin what do you do.
Dip the urine. If it is possitive for blood, look at it under the microscope. If there is no blood cells in the urine, it is probably myoglobin interacting with the dip stick (it will mimic the presentation of hemoglobin). Hydrate the patient to flush myoglobin from the nephrons and prevent kidney toxicity.
Why is hyperkalemia dangerouse?
elevated K levels can lead to arrhythmias
How do arrhythmias manifest on an ekg?
Earliest change is peaking of T waves, with increasing potassium levels you see widening of QRS complexes, P wave flattens and may disappear, in severe cases a sine wave pattern leads to asystole/heart stops beating
What are the most common causes of compatment syndrome?
▸ Bleeding/vascular injury ▸ Trauma, fracture, crush ▸ Intensive use of muscle, exercise, seizure, ▸ Burns, thermal, electrical ▸ Complication of Orthopedic surgery ▸ Snakebite ▸ Tight cast, tourniquet, dressings or splint ▸ Lying on a limb
What is the best early sign of compartment syndrome?
Pain that is out of proportion with physical findings
What are the 5 P’s of compartment syndrome?
▸ Pain ▸ Paresthesia ▸ Pallor ▸ Pulselessness ▸ Paralysis
When is does compartment pressure become concerning?
Pressure greater than 30 mm Hg is concerning or difference between diastolic BP and compartment pressure is < 30 mm
What is a vlokmanns contracture? What causes it? What is it associated with?
It is loss of use of the hand. It is caused by untreated compartment syndrome that leads to nerve damage and atrophy of forearm muscles. it is associated with damage to the brachial artery in a supracondular fracture.
