COMPARTMENT SYNDROME
Don R. Fishman, MD
Trauma Medical Director
Overland Park Regional Medical Center
COMPARTMENT SYNDROME
A condition in which increased pressure within
a limited space compromises circulation and
function of the tissues within that space.
(Matsen, 1980)
COMPARTMENT SYNDROME
Lower leg
Thigh
Abdomen
Arm
Eye
Skull
COMPARTMENT SYNDROME
Pathophysiology
normal compartment pressure = normal
venous pressure (8-15 mmHg)
Anything that raises the pressure in the
limited space
COMPARTMENT SYNDROME
Causes
fractures
crush
vascular injury
burns
exercise
volume loading
bleeding/hematomas
dvt
casts
snakebite
COMPARTMENT SYNDROME
Signs and Symptoms
The 4 “P”s
pain
pallor
pulselessness
paralysis
COMPARTMENT SYNDROME
Compartment syndromes can be hard to
diagnose on clinical exam alone. A high
clinical suspicion is necessary.
mechanism of injury
injuries
resuscitation volume
space in question
COMPARTMENT SYNDROME
Physical exam is unreliable
When in question, measure the pressure!
different devices and techniques
manometry
Stryker
bladder pressure
ICP monitor
tonometry
COMPARTMENT SYNDROME
Prevention
maintain vascular inflow
appropriate resuscitation
elevation
treat hypotension
COMPARTMENT SYNDROME
Prevention
paracentesis
enema
gastric decompression
COMPARTMENT SYNDROME
Treatment
Muscle (including abdomen)compartments
fasciotomy
Eye
lateral canthotomy
Skull
osmotic diuresis
hyperventilation
evacuation w/wo craniectomy
COMPARTMENT SYNDROME
Pitfalls
relying on PE
delayed fasciotomy with clinical evidence
inadequate fasciotomy
extremity elevation
relying on pulse oximetry or presence of
pulses
COMPARTMENT SYNDROME
Rhabdomyolysis
Due to injury/death of muscle tissue
Myoglobin release
Local effects
tissue edema
Systemic effects
acute kidney injury
COMPARTMENT SYNDROME
Rhabdomyolysis
Clinical suspicion
measure CPK (5000)
check urine color
measure myoglobin level
be aware of hyperkalemia
COMPARTMENT SYNDROME
Rhabdomyolysis
fasciotomy
debridement
maintain urine output >100cc/hr
osmotic diuresis
? Alkalinization of urine
treat hyperkalemia
COMPARTMENT SYNDROME
Rhabdomyolysis
Pitfalls
inadequate suspicion/late recognition
inadequate debridement
furosemide
dehydration