2. Compartment Syndrome
A condition in which increased
pressure in one of the compartments
of the body is raised to such a level
resulting in insufficient blood supply
to the tissues within that
compartment of the body.
3. NUMEROUS ETIOLIGIES
Fracture(also open #’s) IM nailing (reaming)
Arterial injury Exertional states
Blunt trauma Closure of fascial defects
Cast/dressing IV & A-lines
Post-ischemic Coag.disorders
Hyperperfusion Intraosseous infusion
Burns/electrical injuries Distorsion(ankle)
Tumour Snake bite
7. Clinical Diagnosis
The six ‘Ps’:
Pressure
Pain
Paresthesia
Paralysis
Pallor
Pulselessness
8. Pressure
Early finding
Only objective finding
Refers to palpation of compartment and its
tension or firmness
9. Pain
Out of portion to injury
Exaggerated with passive stretch
Earliest symptom but inconsistent
Not available in obtunded patient
10. Paresthesia
Early sign
Peripheral nerve tissue is more sensitive than
muscle to ischemia
Permanent damage may occur in 75 minutes
Difficult to interpret
Will progress to anesthesia if pressure not
relieved
11. Paralysis
Very late finding
Irreversible nerve and muscle damage present
Paresis may be present early
Difficult to evaluate because of pain
12. Pallor & Pulselessness
Rarely present
Indicates direct damage to vessels rather
than compartment syndrome
Vascular injury more of contributing factor to
syndrome rather than result
13. Compartment Pressure
When
Confirm clinical exam
Obtunded patient with tight compartments
Regional anesthetic
Vascular injury
Technique
Whiteside infusion
Stic technique: side port needle
Wick catheter
Slit catheter
14. Stryker Stic System
Easy to use
Can check multiple compartments
Different areas in one compartment
15. What is Critical Pressure?
>30 mm Hg as absolute number (Roraback)
16. Treatment
Lower leg to level of the heart
Remove cast
Split all dressings down to skin
17. Treatment
If concerned refer these patients early
Fasciotomy if continued clinical findings
and/or elevated compartment pressure