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COMPARTMENT SYNDROME

6/25/2018

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Authored by Dr. Angie Rombola

Background:
  • Occurs when high compartment pressure prevent adequate perfusion
  • Irreversible muscle and nerve damage after 4-6 hrs
  • Most commonly: lower leg (40%)
  • Can occur anywhere skeletal muscle is surrounded by fascia (forearm, thigh, hand, foot, buttock)
Mechanism:
  • Fractures (69%)
    • Increased incidence with openfractures
    • Tibial fracture (most common)
  • Soft tissue injury 
    • Crush Injuries
    • Contusions
    • Burns
    • Prolonged limb compression 
  • External compression 
    • Tight casts, dressings
  • Vascular
    • Hemorrhage
  • Ischemic-reperfusion injury 
    • Arterial injury 
 
Clinical Features: 
  • Common
    • Pain out of proportion (earliest)
    • Pain with passive stretch (most sensitive)
    • Rapidly increasing & tense swelling
  • Paresthesias (early)
    • Uncommon
    • Decreased sensation
    • Motor weakness (late)
    • Pulselessness (uncommon)
Diagnosis:
  • Primarily a clinical diagnosis
  • Measure of tissue pressures is confirmatory 
  • Measuring compartment pressure indicated in polytrauma, sedated/AMS patients
Compartment Pressure:
  • Intra-compartment pressure: > 30mm Hg
  • Delta pressure (DBP – compartment p) < 30 mmHg
    • Better measurement
    • Helps avoid unnecessary fasciotomies 
Management:
  • Remove external compressive wrappings
  • Address underlying cause
  • Surgical consult for fasciotomy
  • Supplemental Oxygen
  • Correct hypotension
  • Reverse patients on anticoagulants
4 Compartments of the lower leg
  • Anterior
  • Lateral
  • Superficial posterior
  • Deep posterior 

  • Need to measure all 4 compartments 
 

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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Prospective Visiting Students
    • UNC/Wake Forest Students
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction