sindrome compartimental y embolismo
TRANSCRIPT
![Page 1: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/1.jpg)
SINDROME COMPARTIMENTAL Y EMBOLISMO
MAURICIO ALEJANDRO USME ARANGO
MEDICO RESIDENTE DEL PROGRAMA URGENCIAS Y EMERGENCIAS
UNIVERSIDAD DE ANTIOQUIA
![Page 2: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/2.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 3: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/3.jpg)
SINDROME COMPARTIMENTAL : Aumento de la presión dentro de un espacio confinado , situación que tiene el potencial de causar daño grave y permanente a los elementos contenidos en este espacio.
DEFINICION
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 4: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/4.jpg)
1881 Richard von Volkmann Efectos síndrome compartimental contractura de la mano por síndrome compartimental en antebrazo.
1914 Murphy fasciotomia
Fx tibia 6% -9% se asocian daño tejidos blandos
Luxo fractura Lisfranc se asocia a esta patologías
DEFINICION
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 5: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/5.jpg)
Síndrome compartimental : Elevación de la presión dentro de un espacio confinado.
Alteración en la relación volumen: presión del espacio.
Aumento del contenido del espacio
Disminución del volumen > contenido : > presión
Pato-fisiología del síndrome compartimental
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 6: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/6.jpg)
Quemaduras aumento permeabilidad capilar
Traumas contusos hemorragias edemas
Fracturas
Edema por reperfusion de la extremidad
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 7: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/7.jpg)
Congestión-Venosa > presión intra compartimental
Obstrucción flujo arterial por presión intra compartimental
Isquemia >edema >obstrucción > rabdomiólisis.
Daño es tiempo dependiente / presión dependiente
Skeletal Trauma , Forth Edición. Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 8: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/8.jpg)
La diferencia de menos de 30mmHg entre Art. diastólica y presión intra compartimental ppal. determinante de síndrome compartimental.
vendajes compresivos sin indicación y por tiempos prolongados
Yesos tempranos en extremidades con edema en aumento.
Pantalones neumáticos antishock
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 9: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/9.jpg)
Inicialmente los síntomas y signos pueden estar enmascarados por dolor-sangrado- síntomas distractores en caso de trauma.
DOLOR DESPROPORCIONADO A LOS HALLAZGOS CLINICOS ES EL SINTOMA MÁS IMPORTANTE DEL DESARROLLO DE UN
SINDORME COMPARTIMENTAL
Diagnostico y evaluacion
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 10: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/10.jpg)
DESPUES DE LA REDUCCION DE LA FRACTURA SIN DOLOR AUMENTO DE DOLOR DESPROPORCIONADO A LOS HALLAZGOS ??SINDROME COMPARTIMENTAL??
NO MEJORIA DEL DOLOR CON CAMBIOS DE POSICION
ENTUMECIMIENTO –HORMIGUEO –DISESTESIAS
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 11: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/11.jpg)
TENSO -PALPACION DOLOROSA
DIFERENCIAR ENTRE DOLOR DE LA FX / EDEMA PIEL BRILLANTE-AMPOLLAS
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 12: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/12.jpg)
COMPARTIMIENTOS –OCULTOS- COMO PROFUNDO DE ANTEBRAZO Y POSTERIOR DE PIERNA NO DAN TANTOS SINTOMAS EXTERNOS SOSPECHAR
EL ESTIRAMIENTO PASIVO DE LOS DEDOS CON DOLOR REFERIDO EN ALGUN COMPARTIMIENTO ES UN SIGNOS CONFIABLE DE SINDROME COMPARTIMENTAL.
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 13: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/13.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 14: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/14.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 15: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/15.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512.
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
ESCAROTOMIA EMERGENTE
![Page 16: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/16.jpg)
PULSO PRESENTE EN SINDROME COMPARTIMENTAL
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 17: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/17.jpg)
INDICE DE PRESION ARTERIAL POR DOPPLER
IPA: PA SISTÓLICA EXTREMIDAD AFECTADA
PA SISTÓLICA EXTREMIDAD SANA
Indicaciones: SOSPECHA DE DAÑO ARTERIAL
DIAGNÓSTICO: I.P.A
![Page 18: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/18.jpg)
VALOR < 0.9
Sensibilidad: 95%
Especificidad: 97%
VPN: 99%
INDICE
.PRESION.ARTERIAL
![Page 19: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/19.jpg)
APLASTAMIENTO POR PESO DORMIR ( ALCOHOL DROGAS ) MISMA POSICION
SE CONTRAINDICA LA FASCIOTOMIA
PACIENTE PARALISIS FLACIDA / ANESTESIA EXTREMIDAD DESDE
INICIO EDEMA INICIAL POCO
LIBERACION EXTREMIDAD AUMENTO
PERMEABILIDADRABDOMIOLISIS I.RENAL
SINDROME POR APLASTAMIENTO
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 20: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/20.jpg)
LA PRESION AUMENTADA DE LOS TEJIDOS ES LA CAUSA DEL SINDROME COMPARTIMENTAL
ANTE LA SOSPECHA MEDIR PRESION INTRACOMPARTIMENTAL
DOLOR A LA COMPRESION DE PIERNA –DOLOR DORSFLEXION PLANTAR -DOLOR FLEXION PLANTAR DEDOS –ANESTESIA ESPACIO INTERDIGITAL Nro 1 FASCIOTOMIA DE 4 COMPARTIMIENTOS
MEDIDA DE PRESION DE LOS TEJIDOS
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 21: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/21.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 22: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/22.jpg)
Lo principal para el dx es sospecharlo
P art diastólica diferencia <30mmHg diastólica:compartimental -cx.
EL UNICO TRATAMIENTO EFECTIVO PARA EL SINDROME COMPARTIMENTAL ES LA FASCIOTOMIA
Tratamiento del síndrome compartimental
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 23: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/23.jpg)
INICIAL
RETIRAR VENDAJES –YESOS
INMOVILIZAR CON FERULAS UNIVALVAS-BI VALVAS
NO ELEVAR LA EXTREMIDAD ( DISMINUYE PRESION ARTERIAL MEDIA EN LA EXTREMIDAD )
EXTREMIDAD A NIVEL DE LA CAMA –CORAZON
SINDROME COMPARTIMENTAL INICIAL /INCIPIENTE
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 24: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/24.jpg)
DOLOR ENVOLVENTE
PARALISIS MUSCULOS DE
LA MANO
SINDROME COMPARTIMENTAL ESTABLECIDO MANO
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 25: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/25.jpg)
RARO
TRAUMAS DIRECTOS-GRAN DAÑO DE TEJIDOS BLANDOS
SINDROME COMPARTIMENTAL ANTEBRAZO
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 26: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/26.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 27: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/27.jpg)
FASCIOTOMIA DE LA PIERNA PERIFIBULAR
DESCOMPRIMIR 4 COMPARTIMIENTOS
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 28: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/28.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 29: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/29.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 30: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/30.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 31: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/31.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 32: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/32.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 33: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/33.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 34: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/34.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 35: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/35.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 36: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/36.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 37: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/37.jpg)
Skeletal Trauma , Forth Edition Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G. Trafton, and Christian
Krettek
Chapter 17, 453-512
Copyright © 2009 by Saunders, an imprint of Elsevier Inc.
![Page 38: Sindrome compartimental y embolismo](https://reader034.vdocuments.us/reader034/viewer/2022051520/58eea5a01a28ab39238b45c3/html5/thumbnails/38.jpg)
GRACIAS