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Compartment Syndrome

Compartment Syndrome. IN EMS. Who Cares?. Bandaging Splinting Trauma IV’s Tourniquets Edema Exercise. What is it?. Compartment syndrome is increased tissue pressure within a closed space, resulting in tissue ischemia. Any pressure that causes ischemia.

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Compartment Syndrome

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  1. Compartment Syndrome IN EMS

  2. Who Cares? • Bandaging • Splinting • Trauma • IV’s • Tourniquets • Edema • Exercise

  3. What is it? • Compartment syndrome is increased tissue pressure within a closed space, resulting in tissue ischemia. • Any pressure that causes ischemia. • Can cause muscle damage, nerve damage, and tissue necrosis.

  4. What Happens • Increased Pressure causes blood vessels to collapse, which causes ischemia, which causes tissue damage and eventually death.

  5. History • Richard VonVolkman first described Compartment syndrome in 1872. • In 1941 two doctors, Bywaters, and Beall studied the effects of crush injuries on victims of the London Blitz.

  6. Signs and Symptoms • Decreased Pulses distal to affected area. • Pain in affected area • Tingling • Numbness • Swelling and tenderness of skin below injury. • Hypotension • In trauma

  7. Signs and Symptoms • Look for the five P’s of Ischemia • Pain • Paresthesias (tingling) • Paralysis • Pallor • Pulselessness

  8. Trauma Intensive muscle use Burns Blood clots Casts Tourniquets Sitting for long periods Snakebite Inflammation Edema/swelling CHF Seizures Causes

  9. Causes • Trauma • Main cause of compartment syndrome • 64% of confirmed cases • Anything that causes swelling • Crush injuries • Long bone fractures • Traction splints

  10. Causes • Tamponade • Pressure from the outside can cause increased internal pressure • Tourniquets • Bandages to tight • Mass Pants • Casts and Splints/edema

  11. Causes • Increased Fluid Content/Inflamation • Burns • Infiltrated IV Sites • Especially in patients taking blood-thinners. • Hemorrhage • trauma • Snakebites

  12. Complications • Nerve Damage • Infection • Loss of Extremity • Necrosis • Blood Clots • Death

  13. Volkmann’s Contracture • Lack of blood flow damages nerves and muscle causing them to shorten and become permanently contracted.

  14. Complications Continued • Be careful with entrapments and positional causes of Compartment syndrome • Use caution when relieving pressure • Acidosis • Thrombosis • Sepsis • Toxins

  15. Precautions in EMS • Tourniquet • Bandaging • CHF/edema • Internal Bleeding • Broken femur • Abdominal trauma/bleeding • Any bleeding into body cavities • Entrapment

  16. Treatment in the Field • Apply Oxygen • Keep extremities level with body • Do not elevate • Establish IV access • Watch for hypovolemia • Treat inflammation/edema • Diesel

  17. Hospital Treatments • Fasciotomy • Opening wound to relieve pressure • Thrombolitics • Hyperbaric Oxygen • New studies show that Hyperbaric oxygen increases tissue perfusion. Decreasing amount of tissue damage.

  18. Fasciotomy

  19. References • www.emedicine.htm • www.aha_comprtsd_sma.htm • Critical Care Medicine. 28(6):1747-1753, June 2000.Ertel, Wolfgang MD; Oberholzer, Andreas MD; Platz, Andreas MD; Stocker, Reto MD; Trentz, Otmar MD • Department of Surgery, Denver Health Medical Center and University of Colorado Health Sciences Center, 80204, USA. • Merck Research Laboratories, Merck Manual of Diagnosis and Therapy Eighteenth Edition, Whitehouse Station, NJ, 2008

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