• What are 3 things which present with
complaints out of proportion to findings??
• What is the other findings in patient with
compartment syndrome?
Compartment sx findings
• Pain out of proportion to findings
• Pain with passive stretching of muscles in the
affected comptmt
• Progressive pain
• Tension of comptmt
Compartment syndrome
• Pressure in comptmt increases to a level that
circulation compromised re
• Most commonly in lower extremity from fxs
• May occur in any comptmt including buttock and
abdomen
• Initial complaint is pain
• Early finding decreased peripheral sensation
• Nerve tissue very senstive to ischemia(before
motor
Lower leg compartments
• Anterior
– doriflex
• Lateral
– eversion
• Superficial posterior
– plantarflex
• Deep posterior just behind tibia
• Toe flexion
Outside job
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Burns circumferential
Tight casts
Mast pants
Tight dressings
Compression devices malfunction
Inside jobs
• Fractures most common cause
– Tib fib 36%; supracondyar;radius/ulnar
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Pts on coumadin with trauma
IV drug abuse
IV infiltration, IO infil: IM injection; arterial injec
Attempts at cannulation veins in pt on anticoag
Lithotomy position
Orif post sx hemorrhage
Inside jobs (cont)
• Comatose patient not moving-OD,etoh
– Buttock; extremities; high pressures
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Vigorous exercise
Envenomation
Hemorrhage from large vx injury
Rhabdo
Gastroc/baker cyst ruptures
Revasc and reperfusion
Crush and direct blow to comptmt
• Nontraumatic cs longer delay in diagnosis
• Delay more than 6 hrs in dx and fasciotomy
leads to permanent weakness
Should leg be elevated?
• Elevation of limb is contraind b/c it decreases
arterial blood flow & narrows A-V gradient
• Immobilize lower leg with ankle in slight
plantar flex decreasing deep post comptmt pr
• All bandages and casts must be removed
• Releasing 1 side of a plaster cast can reduce
compartment pressure by 30%,
• bivalving can produce an additional 35% reduction,[44]
• and complete removal of the cast reduces the pressure
by another 15%
• for a total decrease of 85% from baseline.[53]
• Cutting undercast padding (Webril, Kendall Healthcare
Products Co) may decrease compartmental pressure by
10-30%.
• Ischemia that lasts 4 hours leads to significant
myoglobinuria
• The combination of hypovolemia, acidemia,
and myoglobinemia may cause acute renal
failure.
• Patients who survive almost always recover
renal function, even those patients who
require prolonged hemodialysis.
• IV fluids;?bicarb
• CS is a potentially devastating diagnosis with
its tendency to damage nerves, muscles and
vasculature.
• Fasciotomy is the only treatment option for
ACS.
• Comptmt sx develops over time so that serial
measurements may be necessary
• Tib/fib fxs and pts on anticoag with trauma
are red flags
• “5 P’s of pain, pressure, pulselessness,
paralysis, paresthesia and pallor” are more
indicative of arterial injury or occlusion
• Hypotensive develop cs earlier
• Lower icp threshold for fasciotomy with
hypotense pt
• can get burned on measuring pressures in lower
leg as there are 4 compartments to measure
• vigourous prolonged exercise can cause rhabdo
but dont forget to check for compartment
• overdose patients do not move for extended
period:
• if lying supine check buttock for pain and tension;
also check extremites
• if a developing compartment syndrome is
suspected, place the affected limb or limbs at the
level of the heart.-
Using the Stryker
• Instructions with kit are relatively easy
• Or go to you tube
• Assemble prefilled syringe, needle and cork
and attach unit by cork to box
• Zero device at angle planning to enter skin
• Purge system by squirting out saline and get
wait till 00 reading
• Go into ant compt just lat to prox third of tibia
• Entering skin with 1st pop and 2nd pop thru
fascia
• Go into comptmt about 1cm total about 3 cm
• Inject < 0.3cc saline to equilibrate with the tx
• Pressure goes way up and comes down
• When levels off-take reading
• May squeeze calf or dorsflex ankle to see if
pressure changes confirming you are in compt