compartment syndrome 3

8/12/2019 Compartment Syndrome 3

1/15

COMPARTMENT SYNDROME

Cindy FehrMalaspina University-College

BSN Nursing Program

Nursing 335Fall 2005

Diagram Source: Nursing 1999, June, p. 33


2/15

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


3/15

Categories of Etiologies

1. Decreased Compartment Size

Caused by restrictive dressings, splints or casts,

excessive traction, premature closure of fascia

2. Increased Compartment Content Bleeding or swelling within compartment

Can also result from interstitial IV into compartment

3. Externally Applied Pressure Constrictive dressing, prolonged compression from

lying on limb


4/15

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


5/15

Pathophysiology

elevation of interstitial pressure in closed fascialcompartment (limited space) that results inmicrovascular compromise

Capillary blood perfusion which prevents adequatecirculation & compromises tissue viabilitymetabolic

demands not met ischemia & anaerobic metabolismhistamine release by affected muscles edema &perfusion

as duration & magnitude of interstitial pressure

increases, myoneural function is impaired & necrosis ofsoft tissues eventually develops

Left untreated nerve & muscle function loss, infection,myoglobinuria, renal failure, amputation


6/15

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


7/15

Types

Acute

Most severe Often requires immediate surgical intervention

Symptoms present usually within 6-8 hrs of injury butcan take as long as 2 days

Caused by external or internal forces secondary totrauma of muscle compartment

External pressure s compartment size while internalpressure s compartment contents which results intissue necrosis

Associated with ing pain disproportionate to type ofinjury

Deep, unrelenting pain; throbbing & localized

Pain with passive stretch

Numbness & tingling or paresthesias in affected limb


8/15

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


9/15

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 necrosisand/or infarction

Leads to muscle infarction, myoglobinemia,

rhabdomyolysis


10/15

Assessment & Interventions

Always compare injured limb in comparison to uninjured

limb Early recognition imperative

Assessing 6 Ps

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)


11/15

Assessment & Interventions

Pressure

Limb (over compartment affected) will feel tense, skin tightand 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


12/15

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


13/15

Assessment & Interventions cont.

Treatment

Relieve source of pressure & restore perfusion;

loosen external devices, debride eschar, fasciotomy

(incision thru skin into fascia of muscle compartmentallow 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


14/15

Fasciotomy

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


15/15

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

compartment syndrome 3

Documents