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COMPARTMENT SYNDROME

COMPARTMENT SYNDROME. Cindy Fehr Malaspina University-College BSN Nursing Program Nursing 335 – Fall 2005. Diagram Source: Nursing 1999 , June, p. 33. Definition. Area of body where muscles, blood vessels, nerves may be compressed within tissue like fascia or bone

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COMPARTMENT SYNDROME

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  1. COMPARTMENT SYNDROME Cindy Fehr Malaspina University-College BSN Nursing Program Nursing 335 – Fall 2005 Diagram Source: Nursing 1999, June, p. 33

  2. Definition • Area of body where muscles, blood vessels, nerves may be compressed within tissue like fascia or bone • Occurs when extremely high pressures build in confined space • Caused by anything at ’s compartment size (external or internal compression forces) • Can occur anywhere in body but most often in lower leg or forearm

  3. Categories of Etiologies • Decreased Compartment Size • Caused by restrictive dressings, splints or casts, excessive traction, premature closure of fascia • Increased Compartment Content • Bleeding or swelling within compartment • Can also result from interstitial IV into compartment • Externally Applied Pressure • Constrictive dressing, prolonged compression from lying on limb

  4. Compartments of the lower leg; Source: Emergency Nurse (2004)12(2), 33

  5. Pathophysiology • elevation of interstitial pressure in closed fascial compartment (limited space) that results in microvascular compromise • Capillary blood perfusion  which prevents adequate circulation & compromises tissue viability metabolic demands not met  ischemia & anaerobic metabolism  histamine release by affected muscles   edema &  perfusion • as duration & magnitude of interstitial pressure increases, myoneural function is impaired & necrosis of soft tissues eventually develops • Left untreated  nerve & muscle function loss, infection, myoglobinuria, renal failure, amputation

  6. Compartment Syndrome/Edema-Ischemia CycleSource: Orthopaedic Nursing, 2001, 20(3), 17.

  7. Types • Acute • Most severe • Often requires immediate surgical intervention • Symptoms present usually within 6-8 hrs of injury but can take as long as 2 days • Caused by external or internal forces secondary to trauma of muscle compartment • External pressure ’s compartment size while internal pressure ’s compartment contents which results in tissue necrosis • Associated with ’ing pain disproportionate to type of injury • Deep, unrelenting pain; throbbing & localized • Pain with passive stretch • Numbness & tingling or paresthesias in affected limb

  8. Types cont. • Chronic or Exertional • With exercise & overuse of muscle groups  inflammation & swelling which  intracompartmental pressures  aching pain, tight squeezing sensation but usually relieved by rest • Most frequently in young, active individuals • c/o aching, tightness, cramping in affected limb, localized to affected compartment & often bilaterally • Symptoms often disappear with rest

  9. Types cont. • Crush Syndrome • From prolonged compression of skeletal muscle or severe soft tissue crush trauma  bleeding, edema, fluid shifts contribute to injury • Multi-compartmental involvement results in systemic effect of severe muscle ischemia  muscle necrosis and/or infarction • Leads to muscle infarction, myoglobinemia, rhabdomyolysis

  10. Assessment & Interventions • Always compare injured limb in comparison to uninjured limb • Early recognition imperative • Assessing 6 P’s • Pain •  with passive motion, stretching of compartment • Usually first sign, but can be impaired by analgesics •  with elevation of extremity • Often narcotics ineffective in relieving pain • Paresthesias • One of first signs  sensory deficit in affected compartment area • Subtle tingling or burning sensation leading to numbness (hypoesthesia) • Loss of differentiation between sharp & dull (loss of two-point discrimination)

  11. Assessment & Interventions • Pressure • Limb (over compartment affected) will feel tense, skin tight and shiny • Paralysis • Late sign • Sometimes unable to move limb distal to injury d/t compression of nerves • can start as weakness in active movement of joint distal to injury • Pallor • Late sign • Color pale & dusky, limb cool to touch & cap refill > 3 sec • Pulselessness • Very late sign

  12. Assessment & Interventions cont. • Diagnostic Evaluation • Variety of compartment pressure monitors • Needle inserted into affected compartment & pressure measured in milimeters of mercury (mmHg) • Normal compartment pressure = 0-8 mm Hg; pressure 30-40 mm Hg = damage to blood vessels & nerves in compartment; pressure > 65 mm Hg = tissue ischemia & necrosis in compartment •  pressure affects nerves more severely than muscle • Compartment ischemia > 4-12 hrs can cause permanent muscle damage • MRI to assess chronic muscle density changes • Lab findings •  WBC & ESR  d/t severe inflammatory response •  urine myoglobin  muscle necrosis and protein loss •  serum K+  cell damage •  Serum pH  acidosis

  13. Assessment & Interventions cont. • Treatment • Relieve source of pressure & restore perfusion; loosen external devices, debride eschar, fasciotomy (incision thru skin into fascia of muscle compartment  allow tissue expansion, restore blood flow) • Extremity elevated to level of heart  higher than heart restricts blood flow further • Absolutely NO ICE  vasoconstrict and  ischemia • Adequate hydration  maintain mean arterial pressure for tissue perfusion • Manage pain to minimize vasoconstriction d/t effects of SNS

  14. Fasciotomy Source: Orthopaedic Nursing, 2001, 20(3), 20.

  15. Source: Orthopaedic Nursing, 2001, 20(3), 17.

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