Compartment Syndrome Flashcards Preview

Surgery Rotation > Compartment Syndrome > Flashcards

Flashcards in Compartment Syndrome Deck (24):
1

What is compartment syndrome?

- compartmental hypertension caused by edema, resulting in muscle necrosis of the lower extremity, often seen in the calf; patient may have a distal pulse.

2

What complication after prolonged ischemia to the lower extremity must be treated immediately?

- compartment syndrome

3

What is the treatment for compartment syndrome?

- opening compartments via bilateral calf-incision fasciotomies of all four compartments in the calf within 4 hours.

4

What must be looked for postoperatively after reperfusion of a limb?

- compartment syndrome, hyperkalemia, renal failure from myoglobinuria, MI

5

Why does tissue swelling from reperfusion to the leg cause compartment syndrome?

- because the leg is separated into compartments by unyielding fascia and the increased intracompartmental pressure results in decreased capillary flow, ischemia, and myonecrosis

6

At what intracompartmental pressure does myonecrosis occur?

- 30 mm Hg

7

What are the signs/symptoms of compartment syndrome?

- SYMPTOMS: pain out of proportion, especially after passive flexing/extension of the foot, paralysis, paresthesias
- SIGNS: cyanosis or pallor, hypoesthesia (decreased sensation to two-point discrimination), firm compartment
*PULSES ARE PRESENT in most cases because systolic pressure is much higher than the minimal 30 mm Hg needed for the syndrome!

8

Can a patient have a pulse and compartment syndrome?

YES!

9

How is the diagnosis of compartment syndrome made?

- history/suspicion, compartment pressure measurment

10

What is the chief concern following tibial fractures?

- compartment syndrome

11

What are the causes of compartment syndrome?

- fractures, vascular compromise, reperfursion injury, compressive dressings; can occur after any musculoskeletal injury.

12

What are the common causes of forearm compartment syndrome?

- supracondylar humerus fracture, brachial artery injury, radius/ulna fracture, crush injury.

13

What is Volkmann's contracture?

- final sequela of forearm compartment syndrome; CONTRACTURE of the forearm flexors from replacement of dead muscle with fibrous tissue.

14

What is the most common site of compartment syndrome?

- calf (four compartments: anterior, lateral, deep posterior, superficial, posterior compartments)

15

What 4 situations should immediately alert one to be on the lookout for a developing compartment syndrome?

1. supracondylar elbow fractures in children
2. proximal/midshaft tibial fractures
3. electrical burns
4. arterial/venous disruption

16

What are the 4 possible complications of compartment syndrome?

1. muscle necrosis
2. nerve damage
3. contractures
4. myoglobinuria

17

What is the initial treatment of the orthopedic patient developing compartment syndrome?

- bivalve and split casts, remove constricting clothes/dressings, place extremity at heart level.

18

What is ABDOMINAL compartment syndrome?

- increased intra-abdominal pressure usually seen after laparotomy or after massive IVF resuscitation (e.g. BURN patients).

19

What are the signs/symptoms of ABDOMINAL compartment syndrome?

- tight distended abdomen
- decreased urine output
- increased airway pressure
- INCREASED INTRA-ABDOMINAL PRESSURE

20

How do you measure intra-abdominal pressure?

- via intrabladder pressure (Foley catheter hooked up to manometry after instillation of 50-100 cc of water).

21

What is normal intra-abdominal pressure?

- less than 15 mm Hg

22

What intra-abdominal pressure indicates need for treatment?

- greater than 25 mm Hg, especially if signs of compromise

23

What is the treatment of ABDOMINAL compartment syndrome?

- release the pressure by placing drain and/or decrompressive laparotomy (leaving fascia open).

24

What is a "Bogata Bag"?

- sheet of plastic (empty urology irrigation bag or IV bag) used to temporarily close the abdomen to allow for more intra-abdominal volume.