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Compartments, the Stryker, & You Consensus is P compartment > 30 mm Hg likely requires intervention ΔP = (DBP – P compartment ) measure of P perfusion.

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Presentation on theme: "Compartments, the Stryker, & You Consensus is P compartment > 30 mm Hg likely requires intervention ΔP = (DBP – P compartment ) measure of P perfusion."— Presentation transcript:

1 Compartments, the Stryker, & You Consensus is P compartment > 30 mm Hg likely requires intervention ΔP = (DBP – P compartment ) measure of P perfusion Pts w/ P compartment 30) –Keeping extremity level w/ heart decreases limb MAP w/o increasing P compartment Ischemic injury is basis for CS –Supplement O 2 to increase pPO 2 –6 hrs ischemic time is currently accepted upper viability limit Myonecrosis assoc. w/ CS s/p envenomation is multifactorial fasciotomy may not prevent myonecrosis aggressive Rx w/ antivenom decreases limb hypoperfusion –consider delayed fasciotomy, if at all

2 Possible Etiologies Increased contents –Hematoma –Trauma fracture envenomation burns –Increased use exercise tetany seizure eclampsia –Edema nephrotic syndrome ischemia-reperfusion injury –Iatrogenic Orthopedic surgery Intraarterial drug injection Decreased volume –Hematoma –Trauma crush injury & entrapment compression during sleep/intoxication –Iatrogenic prolonged lithotomy MAST, casts, splints, dressings excessive traction in line tight closure of fascial defect IV infiltration

3 CompartmentSensoryMotorPainful Passive Motion Tenseness Forearm Dorsal Volar --- Ulnar / Median N. Digit Extension Digit Flexion Digit Extension Dorsal Forearm Volar Forearm Hand Interosseus---InterosseiAdd/Abduct MCPsDorsal Hand btwn MCPs Upper Arm Flexor Extensor Ulnar / Median N. Radial N. Biceps / Dist. Flexors Triceps / Forearm Ext. Elbow Extension Elbow Flexion Anterior Upper Arm Posterior Upper Arm Leg Anterior Sup. Posterior Deep Posterior Deep Peroneal N. --- Posterior Tibial N. Toe Ext. / Tib ant. Soleus / Gastroc. Toe Flex. / Tib post. Toe Flexion Foot Dorsiflexion Toe Extension Ant. Leg Calf Dist. Med. Leg (btwn Tib. & Achilles tendon) GlutealSciatic (rare) Gluteals, piriformis, tensor fascia lata Hip FlexionButtock FootDigital NervesFoot IntrinsicsToe Flex. / Ext.Dorsal / Plantar Foot

4 Open sterile assembly Place needle on tapered end of well chamber and syringe on opposite side Place assembly into monitor, clear side of well chamber up

5 Purge assembly of air –Injecting NS w/ Stryker at 45 0 Zero unit in position in which measurement will be taken Sterile prep of site Infiltrate local superficially Enter compartment perpendicularly, level w/ heart Inject ~ 0.3 of 1 cc saline Read measurement on display when equilibrates Re-Zero unit for each new measurement

6 Volar Compartment: btwn PL tendon & radial surface of ulna; depth 1-2 cm Enter compartments at junction of proximal & middle thirds of forearm

7 Dorsal Compartment: 1-2 cm lat to posterior aspect of ulna; depth 1-2 cm Mobile Wad Compartment: lateral to radius; depth cm

8 Enter compartments at junction of proximal & middle thirds of lower leg Lateral compartment: posterior border of fibula; depth cm

9 Deep posterior compartment: posterior to medial border of tibia in direction of posterior border of the fibula; depth 2-4 cm Superficial posterior compartment: posteriorly directly over center of gastrocnemius; depth cm

10 Anterior compartment: 1 cm lateral to anterior tibial border; depth 1-3 cm CompartmentContentsEvaluation AnteriorDeep Peroneal N. Anterior Tibial Art. Dorsal Flex. Ankles & Toes Sensation at 1 st dorsal web space DP Pulse LateralSuperficial Peroneal (fibular) N. Foot Everters Sensation at dorsal foot Superficial posterior Sural N. Plantar Flex. of Ankle Sensation to lat. portion of inf. 1/3 of leg, lat. portion of 5 th digit Deep posterior Tibial N. Posterior Tibial & Peroneal Art. Plantar Flex. of toes Sensation to plantar foot PT Pulse

11 Additional Compartments Foot –Medial, Lateral, Interosseous Gluteal –18-G spinal needle –Depth 4-8 cm –Insert perpendicularly at point of max. tenderness

12 Improvised mercury or saline/sterile H 2 O manometers may also be zeroed & used to measure P compartment –Convert mmHg  cm H 2 O & back! References: –JR Roberts and J Hedges, eds. Clinical Procedures in Emergency Medicine, 4 th ed. Saunders; October 24, –CB Custalow. Color Atlas of Emergency Department Procedures, 1 st ed. Saunders; August 27, 2004.


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