T&O: Compartment syndrome Flashcards
What are the five signs of compartment syndrome?
5Ps. —> Pain, Pallor, Parasthesia, Pulselessness, Paralysis
What can be involved in aetiology of compartment syndrome?
Reduced compartment size e.g. Tight dressing/cast. Increased compartment content e.g. fracture (increase bleeding) or trauma/burns (increase capillary permeability)
What is most common cause of compartmnt syndrome?
Fracture
How is compartment syndrome diagnosed in a traumatised limb?
History, check for 6Ps when examining the limb (tight compartment, shiny), do compartment pressure measurement, CK, myoglobin
What clincial parameters do you see in compartment syndrome?
Pain, exaggerated by stretch, parasthesia and pressure. These are the first three you see out of 6Ps
What is difference between spinal and epidural analgesia?
Spinal - injection that starts within mins and lasts 2-3 hours.
Epidural - cannula type medication can be given over longer time 24-48hrs
A pt has compartment syndrome. What analgesia should you be aware of that a pt may be on?
Epidural analgesia, long acting nerve blocks or controlled IV opiate analgesia as can mask compartment syndrome
How is pressure measured in suspected compartment syndrome?
Stryker STIC monitor
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?
Up to 5cm, as further distance affects pressure measurements. Usually within 5cm of fracture site
How is compartment syndrome managed?
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.
Define a fasciotomy
Cut skin subcutaneously, cut through fascia to relieve pressure of muscle
What is a contraindication of a fasciotomy?
Compartment syndrome over 24hours as muscle and nerves are both damaged. No point now as muscle is dead - can lead to systemic effects.
What are 4 fascial compartments in leg?
Lateral, posterior superficial, posterior deep, anterior
What are three fascial compartments of forearm?
Posterior, anterior and lateral
Within how many hours after confirmed compartment syndrome can you carry out a fasciotomy?
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.
What is main complication of fasciotomy?
Altered sensation within margin of the wounds
What is usual presentation of chronic compartment syndrome?
Pain, parasthesia over 20-30 mins of exercise, symptoms go away after 15mins rest. Younger patient
What is compartment syndrome?
Critical pressure within a confined compartmental space.
Why is compartment syndrome so serious?
- 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.
How does compartment syndrome present?
- 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).
How is compartment syndrome managed?
- Remove cast, splints, dressings.
- **Immediate fasciotomy !!!! **
- Give analgesia.
- Keep limb neutral.
- Improve O2 delivery, augment BP with a fluid bolus.
Name a complication of compartment syndrome
Rhabdomyolysis, repercussion injury, check kidney function as good damage kidneys.
