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COMPARTMENT SYNDROME. Cindy Fehr Malaspina University-College BSN Nursing Program Nursing 335 – Fall 2005. Diagram Source: Nursing 1999 , June, p. 33. Definition. Area of body where muscles, blood vessels, nerves may be compressed within tissue like fascia or bone

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compartment syndrome

COMPARTMENT SYNDROME

Cindy Fehr

Malaspina University-College

BSN Nursing Program

Nursing 335 – Fall 2005

Diagram Source: Nursing 1999, June, p. 33

definition
Definition
  • Area of body where muscles, blood vessels, nerves may be compressed within tissue like fascia or bone
  • Occurs when extremely high pressures build in confined space
  • Caused by anything at ’s compartment size (external or internal compression forces)
  • Can occur anywhere in body but most often in lower leg or forearm
categories of etiologies
Categories of Etiologies
  • Decreased Compartment Size
    • Caused by restrictive dressings, splints or casts, excessive traction, premature closure of fascia
  • Increased Compartment Content
    • Bleeding or swelling within compartment
    • Can also result from interstitial IV into compartment
  • Externally Applied Pressure
    • Constrictive dressing, prolonged compression from lying on limb
pathophysiology
Pathophysiology
  • elevation of interstitial pressure in closed fascial compartment (limited space) that results in microvascular compromise
  • Capillary blood perfusion  which prevents adequate circulation & compromises tissue viability metabolic demands not met  ischemia & anaerobic metabolism  histamine release by affected muscles   edema &  perfusion
  • as duration & magnitude of interstitial pressure increases, myoneural function is impaired & necrosis of soft tissues eventually develops
  • Left untreated  nerve & muscle function loss, infection, myoglobinuria, renal failure, amputation
types
Types
  • Acute
    • Most severe
    • Often requires immediate surgical intervention
    • Symptoms present usually within 6-8 hrs of injury but can take as long as 2 days
    • Caused by external or internal forces secondary to trauma of muscle compartment
    • External pressure ’s compartment size while internal pressure ’s compartment contents which results in tissue necrosis
    • Associated with ’ing pain disproportionate to type of injury
    • Deep, unrelenting pain; throbbing & localized
    • Pain with passive stretch
    • Numbness & tingling or paresthesias in affected limb
types cont
Types cont.
  • Chronic or Exertional
    • With exercise & overuse of muscle groups  inflammation & swelling which  intracompartmental pressures  aching pain, tight squeezing sensation but usually relieved by rest
    • Most frequently in young, active individuals
    • c/o aching, tightness, cramping in affected limb, localized to affected compartment & often bilaterally
    • Symptoms often disappear with rest
types cont9
Types cont.
  • Crush Syndrome
    • From prolonged compression of skeletal muscle or severe soft tissue crush trauma  bleeding, edema, fluid shifts contribute to injury
    • Multi-compartmental involvement results in systemic effect of severe muscle ischemia  muscle necrosis and/or infarction
    • Leads to muscle infarction, myoglobinemia, rhabdomyolysis
assessment interventions
Assessment & Interventions
  • Always compare injured limb in comparison to uninjured limb
  • Early recognition imperative
  • Assessing 6 P’s
    • Pain
      •  with passive motion, stretching of compartment
      • Usually first sign, but can be impaired by analgesics
      •  with elevation of extremity
      • Often narcotics ineffective in relieving pain
    • Paresthesias
      • One of first signs  sensory deficit in affected compartment area
      • Subtle tingling or burning sensation leading to numbness (hypoesthesia)
      • Loss of differentiation between sharp & dull (loss of two-point discrimination)
assessment interventions11
Assessment & Interventions
  • Pressure
    • Limb (over compartment affected) will feel tense, skin tight and shiny
  • Paralysis
    • Late sign
    • Sometimes unable to move limb distal to injury d/t compression of nerves
    • can start as weakness in active movement of joint distal to injury
  • Pallor
    • Late sign
    • Color pale & dusky, limb cool to touch & cap refill > 3 sec
  • Pulselessness
    • Very late sign
assessment interventions cont
Assessment & Interventions cont.
  • Diagnostic Evaluation
    • Variety of compartment pressure monitors
      • Needle inserted into affected compartment & pressure measured in milimeters of mercury (mmHg)
      • Normal compartment pressure = 0-8 mm Hg; pressure 30-40 mm Hg = damage to blood vessels & nerves in compartment; pressure > 65 mm Hg = tissue ischemia & necrosis in compartment
      •  pressure affects nerves more severely than muscle
      • Compartment ischemia > 4-12 hrs can cause permanent muscle damage
    • MRI to assess chronic muscle density changes
    • Lab findings
      •  WBC & ESR  d/t severe inflammatory response
      •  urine myoglobin  muscle necrosis and protein loss
      •  serum K+  cell damage
      •  Serum pH  acidosis
assessment interventions cont13
Assessment & Interventions cont.
  • Treatment
    • Relieve source of pressure & restore perfusion; loosen external devices, debride eschar, fasciotomy (incision thru skin into fascia of muscle compartment  allow tissue expansion, restore blood flow)
    • Extremity elevated to level of heart  higher than heart restricts blood flow further
    • Absolutely NO ICE  vasoconstrict and  ischemia
    • Adequate hydration  maintain mean arterial pressure for tissue perfusion
    • Manage pain to minimize vasoconstriction d/t effects of SNS
fasciotomy
Fasciotomy

Source: Orthopaedic Nursing, 2001, 20(3), 20.