Vignette Questions Flashcards
A 28-year-old male presents to the emergency department 6 hours after sustaining a tibial fracture from a motorcycle accident. He reports severe, worsening pain that is not relieved by opioid analgesics and is aggravated by passive movement of his toes. On examination, there is tense swelling in the lower leg. What is the next best step in management?
A) Supply compression via hard cast
B) Measure intracompartmental pressures
C) Repeat imaging
D) Fasciotomy
Measure intracompartmental pressures
Severe pain out of proportion and pain on passive stretching are key signs of compartment syndrome. Measurement of intracompartmental pressure is needed to confirm the diagnosis
A 40-year-old female who recently underwent a revascularization procedure for limb ischemia reports significant leg pain. The leg appears swollen, and her pain is out of proportion to the examination findings. What is the most likely diagnosis?
A) Deep venous thrombosis
B) Arterial stenosis
C) Compartment syndrome
D) Reperfusion injury
Compartment Syndrome
Post-revascularization can lead to increased blood flow into previously ischemic tissues, causing swelling and compartment syndrome. Immediate surgical decompression is necessary
A patient is found to have a compartment pressure of 35 mmHg after a crush injury to the forearm. What does this finding indicate, and what is the next step?
The pressure is high enough to compromise tissue perfusion; the next step is urgent fasciotomy.
