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

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

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

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

  2. What is the other findings in patient with compartment syndrome?

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

  4. 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

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

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

  7. 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

  8. 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

  9. Nontraumaticcs longer delay in diagnosis • Delay more than 6 hrs in dx and fasciotomy leads to permanent weakness

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

  11. 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%.

  12. 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

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

  14. “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

  15. 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.-

  16. 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

  17. Entering skin with 1st pop and 2nd pop thru fascia • Go into comptmt about 1cm total about 3 cm • Inject < 0.3cc 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

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