Presentation on theme: "What are 3 things which present with complaints out of proportion to findings??"— Presentation transcript:
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
Inside jobs Fractures most common cause – Tib fib 36%; supracondyar;radius/ulnar 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 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, and complete removal of the cast reduces the pressure by another 15% for a total decrease of 85% from baseline. 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 1 st pop and 2 nd 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