Compartment Syndrome

1
Compartment Syndrome

• Kyle Miller

2
Compartment Syndrome

• Definition
• Compartment Syndrome involves the compression of
  nerves and blood vessels within an enclosed
  space. This leads to impaired blood flow and
  muscle and nerve damage.

3

• Causes
• Thick layers of tissue called fascia separate
  groups if muscles in the arms and legs from each
  other. Inside each layer of fascia is a confined
  space, called a compartment. This includes
  muscle tissue, nerves and blood vessels. This is
  much like wires surrounded by insulation.

4

• Unlike a balloon, fascia do not expand, so any
  swelling in a compartment will lead to increasing
  pressure in that compartment. This will compress
  the muscles, blood vessels and nerves. If this
  pressure is high enough, blood flow to the
  compartment will be blocked. This can lead to
  permanent injury to the muscle and nerves. If it
  lasts long enough, the limb may die and need
  amputation.

5

• Swelling leading to compartment syndrome is
  associated with high-energy trauma, such as a car
  accident or even surgery. It may also occur from
  tight bandages or from a cast. Pressure will
  build up and cause compartment syndrome. Chronic
  compartment syndrome can be caused by repetitive
  activities like running or cycling that increase
  pressure only during those activities.
• Compartment syndrome is most common in the lower
  leg and forearm, but can also occur in the foot,
  thigh and upper arm.

6
SYMPTOMS

• The main symptom of compartment syndrome is
  severe pain that does not respond to elevation or
  medication. In a more advanced case, there may
  be decreased sensation, weakness and paleness of
  the skin.

7

• Overuse
• Local Tissue Swelling
• Tight Compartment
• Decreased Blood Supply
• More Tissue Swelling
• Cycle repeats itself

8
Diagnosis

• Pressure testing of the muscle.
• Insertion of small plastic catheter into the skin
  of the affected muscle to measure pressure.
• Patient engages in the pain inducing activity
  while recording of compartment pressure is
  recorded.
• Reproduction of symptoms associated with
  pressures above the certain value confirms the
  diagnosis.

9
TREATMENT

• Correction of biomechanical abnormalities.
• Soft tissue therapy.
• Usually surgery. Long incisions are made in the
  fascia to release the pressure.
• Incisions generally left open to prevent pressure
  rebuilding.
• Skin grafts may be required to close the wound.

10
Prognosis

• If pressure release is accomplished promptly, the
  outlook is very good for muscle and nerve
  recovery.
• The overall outlook is determined by the injury
  that lead to the syndrome.
• If diagnosis is delayed, there may be permanent
  nerve and muscle damage and loss of muscle
  function. This is more common when a person has
  been heavily sedated and incapable of
  complaining. Permanent nerve injury can occur
  after only 12-24 hours of compression.

11
Complications

• Dramatic function impairment.
• In more severe cases, limbs may have to be
  removed because the muscles in the compartment
  have died from lack of oxygen.

12
PREVENTION

• Always be aware of this condition so early
  diagnosis can prevent complications.
• If placed in a cast, be aware of the risk of
  increased swelling so they contact a health care
  provider immediately if they have increased pain
  under the cast, despite elevation and pain
  medication.

13
Abdominal Compartment Syndrome

• Pressure inside the abdominal compartment can
  increase as a result of the build up of blood,
  fluid or edema in the critically ill, trauma, and
  post operative patients.
• Accumulation of fluid can be the result of
  traumatic injury, bowel ischemia or infarction or
  gastrointestinal hemorrhage.
• The build up can result in abdominal bleeding,
  cirrhosis, profound hypothermia, pancreatitis and
  fluid resuscitation in severe sepsis are other
  possible causes.
• When pressure inside the abdominal compartment
  overcomes the pressure inside the capillaries
  perfusing the organs of the abdomen, ischemia and
  infarction of these organs can occur.

14
Adverse Effects of Increased Abdominal Pressure

• Oliguria (urine output) due to renal ischemia.
• Increased peak airway pressures due to
  restriction and elevation of the diaphragm.
• Hypotension and decreases CO as a result of
  decreased venous return, increased ventricular
  wall tension and intra-abdominal volume loss.

15

• GI bleeding due to ischemia of the bowel.
• Impaired distal extremity circulation secondary
  to pressure on the aorta.
• With concurrent head injury, the ICP can be
  elevated, along with decreased cerebral perfusion
  pressure.
• When a patient develops a distended and taunt
  abdomen, the measurement of abdominal compartment
  pressure can help with early recognition of organ
  dysfunction.

16
Sources

• http//ccforum.com/content/4/1/23
• Merck Manual eighteenth edition,2006
• Paramedic Care, Bledsoe Porter and Cherry, 2006
• www.med.umich.edu/ccmu/acs.htm
• www.rice.edu
• www.nlm.nih.gov

17
(No Transcript)