Compartment Syndrome | Cheat Sheet

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

304

Pages:

5
Author:

Mariam A. A.

Compartment Syndrome Definition Increased pressure within muscular compartment compresses nerves, vessels and muscles within compartment life threatening emergency Locations Lower legs Most common Anterior compartment syndrome of the LL is the most common Management: fasciotomy Arms Common Feet Hand Thighs Gluteal region Causes External compression Internal compression Long bone fractures Most common From oedema and hematoma Burn oedema (soft tissue) Reperfusion syndrome with an ischemiaperfusion oedema (soft tissue) Application of constrictive bandage/case before stopping limb swelling Traumatic Causes Oedema from venomous animal bites (soft tissue) Tourniquets (soft tissue injury) Esp. snakes Burn eschars Extravasation of IV infusion Repetitive muscle use E.g. seizures or excessive running (soft tissue injury) Crush injury (soft tissue) Increased capillary permeability (soft tissue) Non-traumatic Causes Prolonged poor limb positioning (soft tissue E.g. stroke injury) Soft tissue infection Immobilised patients Coagulopathies spontaneous bleeding (soft tissue) Clinical Features Early features Late features Neurological deficits Paraesthesia Sensory deficits Muscle weakness/paralysis Perfusion impairment Pain out of proportion to injury extent Absent/weak distal pulses Worse with passive extension/stretching Cold extremity or cyanosis Soft tissue swelling Look for the 6Ps of acute limb ischemia Tight woodlike muscles Pain Reduced ROM Pallor Paraesthesia Paralysis Pulselessness Poikilothermia Assessment 6Ps Neurological exam Passive stretching – worsens pain Most sensitive sign MSK Reduced ROM Investigations Labs Assess for rhabdomyolysis and crush syndrome Imaging No role in diagnosing compartment syndrome Show presence of fractures and soft tissue injuries X-rays to identify fractures Ultrasound with or without doppler to rule out DVT Compartment pressure measurement Not needed for diagnosis if the clinical pressure is strong The needle technique Management Attend to anything life-threatening ABCDE Supportive Remove constrictive dressings, splint and dervices IV fluids Systemic analgesia Place limb at level of the heart Reduce displaced fracture Give oxygen Frequent monitoring of compartment and neurological status Surgical management Indications: for suspected or confirmed cases Producers: Fasciotomy Skin and fascia incision relives compartment pressure and restores perfusion Urgently performed prevents irreversible injury Escharotomy incision of circumferential compressing burn eschar Fibulectomy removal of fibula decompresses all four compartments of the leg Complications Rhabdomyolysis with crush syndrome Kidney failure Amputation Death Nerve damage Volkmann’s contracture – read more on this Infection Muscle damage and dysfunction Prognosis Less than 4 to 6 hours almost complete recovery 6 to 12 hours first necroses 12 or more hours little or no return to function