Compartment SyndromeCompartment Syndrome

IN EMSIN EMS

Who Cares?Who Cares?

BandagingBandaging SplintingSplinting TraumaTrauma IV’sIV’s

TourniquetsTourniquets EdemaEdema ExerciseExercise

What is it?What is it?

Compartment syndrome is increased Compartment syndrome is increased tissue pressure within a closed tissue pressure within a closed space, resulting in tissue ischemia. space, resulting in tissue ischemia. Any pressure that causes ischemia.Any pressure that causes ischemia.

Can cause muscle damage, nerve Can cause muscle damage, nerve damage, and tissue necrosis.damage, and tissue necrosis.

What HappensWhat Happens

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

HistoryHistory

Richard VonVolkman first described Richard VonVolkman first described Compartment syndrome in 1872.Compartment syndrome in 1872.

In 1941 two doctors, Bywaters, and In 1941 two doctors, Bywaters, and Beall studied the effects of crush Beall studied the effects of crush injuries on victims of the London injuries on victims of the London Blitz. Blitz.

Signs and SymptomsSigns and Symptoms

Decreased Pulses Decreased Pulses distal to affected area.distal to affected area.

Pain in affected areaPain in affected area TinglingTingling NumbnessNumbness Swelling and Swelling and

tenderness of skin tenderness of skin below injury.below injury.

Hypotension Hypotension In trauma In trauma

Signs and SymptomsSigns and Symptoms

Look for the five P’s of IschemiaLook for the five P’s of Ischemia PainPain Paresthesias (tingling)Paresthesias (tingling) ParalysisParalysis PallorPallor PulselessnessPulselessness

Causes Causes

TraumaTrauma Intensive muscle Intensive muscle

useuse Burns Burns Blood clotsBlood clots CastsCasts Tourniquets Tourniquets

Sitting for long Sitting for long periodsperiods

Snakebite Snakebite InflammationInflammation Edema/swelling Edema/swelling

CHFCHF SeizuresSeizures

CausesCauses

TraumaTrauma Main cause of compartment syndromeMain cause of compartment syndrome

64% of confirmed cases64% of confirmed cases Anything that causes swellingAnything that causes swelling

Crush injuries Crush injuries Long bone fracturesLong bone fractures

Traction splintsTraction splints

CausesCauses

TamponadeTamponade Pressure from the outside can cause Pressure from the outside can cause

increased internal pressureincreased internal pressure Tourniquets Tourniquets Bandages to tightBandages to tight Mass PantsMass Pants Casts and Splints/edemaCasts and Splints/edema

CausesCauses

Increased Fluid Content/InflamationIncreased Fluid Content/Inflamation BurnsBurns Infiltrated IV SitesInfiltrated IV Sites

Especially in patients taking blood-thinners.Especially in patients taking blood-thinners. HemorrhageHemorrhage

traumatrauma Snakebites Snakebites

ComplicationsComplications

Nerve DamageNerve Damage InfectionInfection Loss of ExtremityLoss of Extremity NecrosisNecrosis Blood ClotsBlood Clots DeathDeath

Volkmann’s ContractureVolkmann’s Contracture

Lack of blood flow Lack of blood flow damages nerves damages nerves and muscle and muscle causing them to causing them to shorten and shorten and become become permanently permanently contracted.contracted.

Complications ContinuedComplications Continued

Be careful with entrapments and Be careful with entrapments and positional causes of Compartment positional causes of Compartment syndromesyndrome

Use caution when relieving pressureUse caution when relieving pressure AcidosisAcidosis ThrombosisThrombosis SepsisSepsis

Toxins Toxins

Precautions in EMSPrecautions in EMS

Tourniquet Tourniquet Bandaging Bandaging

CHF/edemaCHF/edema Internal BleedingInternal Bleeding

Broken femur Broken femur Abdominal Abdominal

trauma/bleedingtrauma/bleeding Any bleeding into Any bleeding into

body cavities body cavities EntrapmentEntrapment

Treatment in the FieldTreatment in the Field

Apply OxygenApply Oxygen Keep extremities Keep extremities

level with bodylevel with body Do not elevateDo not elevate

Establish IV access Establish IV access Watch for Watch for

hypovolemiahypovolemia Treat Treat

inflammation/edemainflammation/edema DieselDiesel

Hospital TreatmentsHospital Treatments

FasciotomyFasciotomy Opening wound to Opening wound to

relieve pressurerelieve pressure ThromboliticsThrombolitics Hyperbaric OxygenHyperbaric Oxygen

New studies show New studies show that Hyperbaric that Hyperbaric oxygen increases oxygen increases tissue perfusion. tissue perfusion. Decreasing amount Decreasing amount of tissue damage.of tissue damage.

FasciotomyFasciotomy

References References

www.emedicine.htmwww.emedicine.htm www.aha_comprtsd_sma.htmwww.aha_comprtsd_sma.htm Critical Care Medicine. 28(6):1747-1753, June 2000.Critical Care Medicine. 28(6):1747-1753, June 2000.

Ertel, Wolfgang MD; Oberholzer, Andreas MD; Platz, Ertel, Wolfgang MD; Oberholzer, Andreas MD; Platz, Andreas MD; Stocker, Reto MD; Trentz, Otmar MDAndreas MD; Stocker, Reto MD; Trentz, Otmar MD

Department of Surgery, Denver Health Medical Center and Department of Surgery, Denver Health Medical Center and University of Colorado Health Sciences Center, 80204, USA.University of Colorado Health Sciences Center, 80204, USA.

Merck Research Laboratories, Merck Manual of Diagnosis Merck Research Laboratories, Merck Manual of Diagnosis and Therapy Eighteenth Edition, Whitehouse Station, NJ, and Therapy Eighteenth Edition, Whitehouse Station, NJ, 20082008