Post on 21-Dec-2015
transcript
Who Cares?Who Cares?
BandagingBandaging SplintingSplinting TraumaTrauma IV’sIV’s
TourniquetsTourniquets EdemaEdema ExerciseExercise
What is it?What is it?
Compartment syndrome is increased Compartment syndrome is increased tissue pressure within a closed tissue pressure within a closed space, resulting in tissue ischemia. space, resulting in tissue ischemia. Any pressure that causes ischemia.Any pressure that causes ischemia.
Can cause muscle damage, nerve Can cause muscle damage, nerve damage, and tissue necrosis.damage, and tissue necrosis.
What HappensWhat Happens
Increased Pressure causes blood Increased Pressure causes blood vessels to collapse, which causes vessels to collapse, which causes ischemia, which causes tissue ischemia, which causes tissue damage and eventually death.damage and eventually death.
HistoryHistory
Richard VonVolkman first described Richard VonVolkman first described Compartment syndrome in 1872.Compartment syndrome in 1872.
In 1941 two doctors, Bywaters, and In 1941 two doctors, Bywaters, and Beall studied the effects of crush Beall studied the effects of crush injuries on victims of the London injuries on victims of the London Blitz. Blitz.
Signs and SymptomsSigns and Symptoms
Decreased Pulses Decreased Pulses distal to affected area.distal to affected area.
Pain in affected areaPain in affected area TinglingTingling NumbnessNumbness Swelling and Swelling and
tenderness of skin tenderness of skin below injury.below injury.
Hypotension Hypotension In trauma In trauma
Signs and SymptomsSigns and Symptoms
Look for the five P’s of IschemiaLook for the five P’s of Ischemia PainPain Paresthesias (tingling)Paresthesias (tingling) ParalysisParalysis PallorPallor PulselessnessPulselessness
Causes Causes
TraumaTrauma Intensive muscle Intensive muscle
useuse Burns Burns Blood clotsBlood clots CastsCasts Tourniquets Tourniquets
Sitting for long Sitting for long periodsperiods
Snakebite Snakebite InflammationInflammation Edema/swelling Edema/swelling
CHFCHF SeizuresSeizures
CausesCauses
TraumaTrauma Main cause of compartment syndromeMain cause of compartment syndrome
64% of confirmed cases64% of confirmed cases Anything that causes swellingAnything that causes swelling
Crush injuries Crush injuries Long bone fracturesLong bone fractures
Traction splintsTraction splints
CausesCauses
TamponadeTamponade Pressure from the outside can cause Pressure from the outside can cause
increased internal pressureincreased internal pressure Tourniquets Tourniquets Bandages to tightBandages to tight Mass PantsMass Pants Casts and Splints/edemaCasts and Splints/edema
CausesCauses
Increased Fluid Content/InflamationIncreased Fluid Content/Inflamation BurnsBurns Infiltrated IV SitesInfiltrated IV Sites
Especially in patients taking blood-thinners.Especially in patients taking blood-thinners. HemorrhageHemorrhage
traumatrauma Snakebites Snakebites
ComplicationsComplications
Nerve DamageNerve Damage InfectionInfection Loss of ExtremityLoss of Extremity NecrosisNecrosis Blood ClotsBlood Clots DeathDeath
Volkmann’s ContractureVolkmann’s Contracture
Lack of blood flow Lack of blood flow damages nerves damages nerves and muscle and muscle causing them to causing them to shorten and shorten and become become permanently permanently contracted.contracted.
Complications ContinuedComplications Continued
Be careful with entrapments and Be careful with entrapments and positional causes of Compartment positional causes of Compartment syndromesyndrome
Use caution when relieving pressureUse caution when relieving pressure AcidosisAcidosis ThrombosisThrombosis SepsisSepsis
Toxins Toxins
Precautions in EMSPrecautions in EMS
Tourniquet Tourniquet Bandaging Bandaging
CHF/edemaCHF/edema Internal BleedingInternal Bleeding
Broken femur Broken femur Abdominal Abdominal
trauma/bleedingtrauma/bleeding Any bleeding into Any bleeding into
body cavities body cavities EntrapmentEntrapment
Treatment in the FieldTreatment in the Field
Apply OxygenApply Oxygen Keep extremities Keep extremities
level with bodylevel with body Do not elevateDo not elevate
Establish IV access Establish IV access Watch for Watch for
hypovolemiahypovolemia Treat Treat
inflammation/edemainflammation/edema DieselDiesel
Hospital TreatmentsHospital Treatments
FasciotomyFasciotomy Opening wound to Opening wound to
relieve pressurerelieve pressure ThromboliticsThrombolitics Hyperbaric OxygenHyperbaric Oxygen
New studies show New studies show that Hyperbaric that Hyperbaric oxygen increases oxygen increases tissue perfusion. tissue perfusion. Decreasing amount Decreasing amount of tissue damage.of tissue damage.
References References
www.emedicine.htmwww.emedicine.htm www.aha_comprtsd_sma.htmwww.aha_comprtsd_sma.htm Critical Care Medicine. 28(6):1747-1753, June 2000.Critical Care Medicine. 28(6):1747-1753, June 2000.
Ertel, Wolfgang MD; Oberholzer, Andreas MD; Platz, Ertel, Wolfgang MD; Oberholzer, Andreas MD; Platz, Andreas MD; Stocker, Reto MD; Trentz, Otmar MDAndreas MD; Stocker, Reto MD; Trentz, Otmar MD
Department of Surgery, Denver Health Medical Center and Department of Surgery, Denver Health Medical Center and University of Colorado Health Sciences Center, 80204, USA.University of Colorado Health Sciences Center, 80204, USA.
Merck Research Laboratories, Merck Manual of Diagnosis Merck Research Laboratories, Merck Manual of Diagnosis and Therapy Eighteenth Edition, Whitehouse Station, NJ, and Therapy Eighteenth Edition, Whitehouse Station, NJ, 20082008