What are 3 things which present with complaints

• What are 3 things which present with complaints out of proportion to findings? ?

• What is the other findings in patient with compartment syndrome?

Compartment sx findings • Pain out of proportion to findings • Pain with passive stretching of muscles in the affected comptmt • Progressive pain • Tension of comptmt

Compartment syndrome • Pressure in comptmt increases to a level that circulation compromised re • Most commonly in lower extremity from fxs • May occur in any comptmt including buttock and abdomen • Initial complaint is pain • Early finding decreased peripheral sensation • Nerve tissue very senstive to ischemia(before motor

Lower leg compartments • Anterior – doriflex • Lateral – eversion • Superficial posterior – plantarflex • Deep posterior just behind tibia • Toe flexion

Outside job • • • Burns circumferential Tight casts Mast pants Tight dressings Compression devices malfunction

Inside jobs • Fractures most common cause – Tib fib 36%; supracondyar; radius/ulnar • • • Pts on coumadin with trauma IV drug abuse IV infiltration, IO infil: IM injection; arterial injec Attempts at cannulation veins in pt on anticoag Lithotomy position Orif post sx hemorrhage

Inside jobs (cont) • Comatose patient not moving-OD, etoh – Buttock; extremities; high pressures • • Vigorous exercise Envenomation Hemorrhage from large vx injury Rhabdo Gastroc/baker cyst ruptures Revasc and reperfusion Crush and direct blow to comptmt

• Nontraumatic cs longer delay in diagnosis • Delay more than 6 hrs in dx and fasciotomy leads to permanent weakness

Should leg be elevated? • Elevation of limb is contraind b/c it decreases arterial blood flow & narrows A-V gradient • Immobilize lower leg with ankle in slight plantar flex decreasing deep post comptmt pr

• All bandages and casts must be removed • Releasing 1 side of a plaster cast can reduce compartment pressure by 30%, • bivalving can produce an additional 35% reduction, [44] • and complete removal of the cast reduces the pressure by another 15% • for a total decrease of 85% from baseline. [53] • Cutting undercast padding (Webril, Kendall Healthcare Products Co) may decrease compartmental pressure by 10 -30%.

• Ischemia that lasts 4 hours leads to significant myoglobinuria • The combination of hypovolemia, acidemia, and myoglobinemia may cause acute renal failure. • Patients who survive almost always recover renal function, even those patients who require prolonged hemodialysis. • IV fluids; ? bicarb

• CS is a potentially devastating diagnosis with its tendency to damage nerves, muscles and vasculature. • Fasciotomy is the only treatment option for ACS. • Comptmt sx develops over time so that serial measurements may be necessary • Tib/fib fxs and pts on anticoag with trauma are red flags

• “ 5 P’s of pain, pressure, pulselessness, paralysis, paresthesia and pallor” are more indicative of arterial injury or occlusion • Hypotensive develop cs earlier • Lower icp threshold for fasciotomy with hypotense pt

• can get burned on measuring pressures in lower leg as there are 4 compartments to measure • vigourous prolonged exercise can cause rhabdo but dont forget to check for compartment • overdose patients do not move for extended period: • if lying supine check buttock for pain and tension; also check extremites • if a developing compartment syndrome is suspected, place the affected limb or limbs at the level of the heart. -

Using the Stryker • Instructions with kit are relatively easy • Or go to you tube • Assemble prefilled syringe, needle and cork and attach unit by cork to box • Zero device at angle planning to enter skin • Purge system by squirting out saline and get wait till 00 reading • Go into ant compt just lat to prox third of tibia

• Entering skin with 1 st pop and 2 nd pop thru fascia • Go into comptmt about 1 cm total about 3 cm • Inject < 0. 3 cc saline to equilibrate with the tx • Pressure goes way up and comes down • When levels off-take reading • May squeeze calf or dorsflex ankle to see if pressure changes confirming you are in compt