T&O: Compartment syndrome

Question 2

What are the five signs of compartment syndrome?

Answer 2

5Ps. —> Pain, Pallor, Parasthesia, Pulselessness, Paralysis

Question 3

What can be involved in aetiology of compartment syndrome?

Answer 3

Reduced compartment size e.g. Tight dressing/cast. Increased compartment content e.g. fracture (increase bleeding) or trauma/burns (increase capillary permeability)

Question 4

What is most common cause of compartmnt syndrome?

Answer 4

Fracture

Question 5

How is compartment syndrome diagnosed in a traumatised limb?

Answer 5

History, check for 6Ps when examining the limb (tight compartment, shiny), do compartment pressure measurement, CK, myoglobin

Question 6

What clincial parameters do you see in compartment syndrome?

Answer 6

Pain, exaggerated by stretch, parasthesia and pressure. These are the first three you see out of 6Ps

Question 7

What is difference between spinal and epidural analgesia?

Answer 7

Spinal - injection that starts within mins and lasts 2-3 hours.
Epidural - cannula type medication can be given over longer time 24-48hrs

Question 8

A pt has compartment syndrome. What analgesia should you be aware of that a pt may be on?

Answer 8

Epidural analgesia, long acting nerve blocks or controlled IV opiate analgesia as can mask compartment syndrome

Question 9

How is pressure measured in suspected compartment syndrome?

Answer 9

Stryker STIC monitor

Question 10

A pt has a fracture which has been fixed. They now have compartment symdrome and you are going to measure the compartment pressure. How far away from the fracture can you insert the monitor?

Answer 10

Up to 5cm, as further distance affects pressure measurements. Usually within 5cm of fracture site

Question 11

How is compartment syndrome managed?

Answer 11

Based on clinical suspicion. Ensure they have normal Bp. IV crystalloid fluids to improve perfusion of limb. Remove any bandages, cast. Keep limb at a neutral level (don’t elevate or lower). High flow 02. Use ice packs. IV opiate analgesia for symptoms. Organise theatre asap for fasciotomy.

Question 12

Define a fasciotomy

Answer 12

Cut skin subcutaneously, cut through fascia to relieve pressure of muscle

Question 13

What is a contraindication of a fasciotomy?

Answer 13

Compartment syndrome over 24hours as muscle and nerves are both damaged. No point now as muscle is dead - can lead to systemic effects.

Question 14

What are 4 fascial compartments in leg?

Answer 14

Lateral, posterior superficial, posterior deep, anterior

Question 15

What are three fascial compartments of forearm?

Answer 15

Posterior, anterior and lateral

Question 16

Within how many hours after confirmed compartment syndrome can you carry out a fasciotomy?

Answer 16

Within 8 hours. After this, need supportive treatment for acute renal failure. If more than 12 hours, need to leave skin intact and do a later reconstruction.

Question 17

What is main complication of fasciotomy?

Answer 17

Altered sensation within margin of the wounds

Question 18

What is usual presentation of chronic compartment syndrome?

Answer 18

Pain, parasthesia over 20-30 mins of exercise, symptoms go away after 15mins rest. Younger patient

Question 19

What is compartment syndrome?

Answer 19

Critical pressure within a confined compartmental space.

Question 20

Why is compartment syndrome so serious?

Answer 20

• Fasical compartments can not be distended —> vascular injury causes pressure to increase in the compartment
• —> this increases hydrostatic pressure in veins as they are compressed —> this forces fluid out the veins —> nerves traversing get compressed —> compartment pressure then reaches diastolic BP so arterial inflow is compromised = get ischaemia.

Question 21

How does compartment syndrome present?

Answer 21

• Within hours of high energy trauma with vascular injury or surgery.
• Pain experienced is disproportionate to the injury. The compartment may feel tense. Parasthesia. Stretching compartment affected will worsen pain.
• If there is arterial insufficiency, there will be the 6Ps - pain, pallor, perishingly cold, parasthesia, pulselessness, paralysis (v late).

Question 22

How is compartment syndrome managed?

Answer 22

• Remove cast, splints, dressings.
• **Immediate fasciotomy !!!! **
• Give analgesia.
• Keep limb neutral.
• Improve O2 delivery, augment BP with a fluid bolus.

Question 23

Name a complication of compartment syndrome

Answer 23

Rhabdomyolysis, repercussion injury, check kidney function as good damage kidneys.