Transcript The Pressure of Compartment Syndrome

The Pressure of
Compartment Syndrome
Kathleen Byington RN BSN
MSN 621
Alverno College
Spring, 2007
How to use this Tutorial
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Objectives
• Define Compartment Syndrome and
where it can occur.
• Explain the Pathophysiology of
Compartment Syndrome.
• Identify Signs and Symptoms.
• Explain treatment for Compartment
Syndrome.
Home Page
Definition
Diagnosis
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sections
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Quiz
Pathophysiology
Quiz
Signs & Symptoms
Quiz
Treatment
Quiz
Definition
Compartment Syndrome
• A painful condition resulting from the expansion
or overgrowth of enclosed tissue (as of a leg
muscle) within its anatomical enclosure (as a
muscular sheath) producing pressure that
interferes with circulation and adversely affects
the function and health of the tissue itself.
(Merriam-Webster, 2005)
• A potentially limb-threatening complication, can
be prevented if recognized and treated early.
Definition
It can result from either internally expanding
pressure forces or externally applied forces.
• Internal pressure force causes increased
compartment contents and can be caused
from hemorrhage or edema.
• External pressure causes decreased
compartment size and can be caused by a
splint, a cast or prolonged compression to an
extremity. (NAON,2001)
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Diagnosis
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Diagnosis
Compartment
Syndrome
can be
Acute
Or
Chronic
Diagnosis
Chronic Compartment Syndrome
• Muscle pain that repeatedly occurs with vigorous
exercise and subsides with rest.
• The pain worsens as exercise continues,
ultimately restricting performance.
• There will often be swelling and abnormal
sensations in the affected limb during and
immediately after exercise. (Sports Injury Bulletin,2007)
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Diagnosis
Chronic Compartment Syndrome
• Can affect athletes of any age. Anyone
involved in a lot of running or jumping.
• Not exclusive to the lower leg. It can occur in
the arm of a weightlifter, sport climber or
motorcyclist, the forearm compartment is
usually involved.
(Sports Injury Bulletin,2007)
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Diagnosis
Acute Compartment Syndrome
• Different from Chronic in that it does not require
exertion of the muscle to incite pain, and the pain
does not subside until treated.
• It can affect any limb or muscle compartment,
including the abdomen, but it mainly occurs after
trauma to the lower leg.
• It may take several hours for acute compartment
syndrome to develop.
(POSNA, 2005)
Diagnosis
Acute Compartment Syndrome
• It can by caused by a traumatic injury, such as
a fracture of one of the long bones in the body.
• A badly bruised muscle, as when a
motorcycles falls on the leg of the rider or a
football player receives a blow to the thigh from
another player’s helmet.
• A complication after surgery.
• Blockage of circulation, such as from pressure
over a blood vessel for too long while asleep.
• A Crush injury to the foot.
(POSNA, 2005)
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Quiz
Chronic Compartment Syndrome
may affect athletes of any age even
adolescents?
True
or
False
Wrong
Try Again!!
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Correct
Chronic Compartment Syndrome
can affect
any athlete at any age.
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Quiz
Compartment Syndrome
can only
occur in the legs?
True
or
False
Wrong
Try Again!!
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Correct
Compartment syndrome
can occur in any limb or muscle
compartment,
including the abdomen.
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Pathophysiology
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Pathophysiology
Thick layers of tissue called
fascia separate
groups of muscles
in the arms and legs
from each other.
(Health-care, 2005)
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Pathophysiology
Inside each layer of fascia
is a confined space,
called a compartment,
that includes the muscle tissue,
nerves, and blood vessels.
The compartment is
surrounded by the fascia
much like wires surrounded by insulation.
(Health-care, 2005)
Pathophysiology
There are four main
compartments in
the lower leg and
three main
compartments in the
forearm.
(NAON, 2004)
Pathophysiology
Anterior
Deep posterior
Lateral
The main
compartments in the
lower leg are:
Anterior compartment
Superficial posterior
Lateral compartment
Deep posterior
compartment
Superficial posterior
compartment.
(www.nettingimages.com
Image used with permission)
(NAON, 2004)
Pathophysiology
Superficial flexor
Extensor
Deep Flexor
The Main
compartments of
the forearm are:
Superficial flexor
Deep Flexor
Extensor
(NAON, 2004)
(www.nettingimages.com
Image used with permission)
Pathophysiology
The Fascia surrounding
the compartments in the arms and legs,
do not expand,
so any swelling in a compartment will
lead to increased pressure
in that compartment,
which will compress the muscles,
blood vessels, and nerves.
(Health-care, 2005)
Pathophysiology
As nerves in
the compartment
are compressed,
sensory and motor function
decrease
and
severe
pain develops.
(Health-care, 2005)
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Pathophysiology
When the pressure in
the compartments exceeds
the capillary pressure of the tissues,
perfusion stops and the tissues become
ischemic.
The ischemia causes fluid shifts and
edema, adding to the pressure.
(Health-care, 2005)
Pathophysiology
If ischemia
continues,
muscle and nerve tissues
die,
causing permanent
loss of function.
(Health-care, 2005)
Pathophysiology
Muscle damage will be irreversible
after 4-6 hours of ischemia.
Nerve damage will be irreversible
after 12-24 hours.
(NAON, 2004)
Quiz
What separates
the groups of muscles
in the lower extremities
and forearm?
nerves
fascia
veins
arteries
Click on the your answer.
wires
Wrong
Try Again!!
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Correct
Fascia are the thick layers of tissue that
separate groups of muscles in the arms and
legs from each other.
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Quiz
The Fascia surrounding
the compartment
are flexible and will expand
with increase pressure?
True
or
False
Wrong
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Correct
The fascia is NOT flexible,
that is why you have
the increase in pressure
in the compartment.
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Quiz
How many compartments are there in
the lower extremities and forearm?
A
The lower extremities have 6 compartments and the
forearms have 12.
B
The lower extremities have 4 compartments
and the forearms has 3 compartments.
C
Both have the same number, 3 compartments.
D
I don’t remember, please link me back to the answer.
Click on the letter to answer.
Wrong
Try Again!!
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Pathophysiology
There are four main
compartments in
the lower leg and
three main
compartments in the
forearm.
Click on the Star to return to the Question.
Correct
The lower extremities have
4 compartments
and
the forearm has 3 compartments
Click on triangle to go to Next Section.
Signs & Symptoms
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Signs & Symptoms
Chronic Compartment
Syndrome:
•Onset of pain and a feeling of
“fullness” over the involved
compartments.
• There may be a feeling of
numbness in the legs/feet.
• The affected area may feel tight
and tense.
(Felton, 2003)
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Signs & Symptoms
Chronic Compartment
Syndrome:
• The symptoms occur at the
same point of time during
exercise.
• Symptoms are relieved by
rest, usually within 20 minutes
of exercise, only to reappear
with resuming exercise.
(Felton, 2003)
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Signs & Symptoms
Acute Compartment
Syndrome:
• Classic sign is PAIN. The
pain may be intensely out
of proportion to the injury,
especially if no bone is
broken.
(POSNA, 2005)
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Signs & Symptoms
Acute Compartment
Syndrome:
• There may also be a
tingling or burning
sensation in the muscle.
• The muscle may feel
tight or full.
(POSNA, 2005)
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Signs & Symptoms
Acute Compartment Syndrome:
• If the area becomes numb or paralysis sets
in, cell death has begun and efforts to
lower the pressure in the compartment may
not be successful in restoring function.
(POSNA, 2005)
Signs & Symptoms
Direct measurements of tissue pressure can be
obtained using a needle or wick catheter inserted into
the muscle compartment.
Compartment decompression is recommended when
pressures rise to 30 mmHg. (Porth, 2005)
This is a more invasive test used to determine the
pressure in the compartment.
This test is not performed by nursing.
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Quiz
Chronic compartment syndrome
usually happens
at the same time
during your workout
and
symptoms are relieved after rest.
True
or
False
Wrong
Try Again!!
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Correct
Chronic Compartment Syndrome
pain usually occurs at the same time during
every workout, and goes away with rest
and then reappears with activity again.
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Quiz
What is the classic sign of Acute
Compartment Syndrome?
A
Intense pain not proportional to the injury.
B
Tingling or burning sensation in the muscle.
C
The muscle may feel full and tense.
D
All of the Above.
Wrong
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Correct
All of the above are correct.
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Treatment
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Treatment
Chronic Compartment Syndrome:
•Avoid doing activities that cause
pain and swelling.
•Apply ice and elevating the limb
slightly.
•Taking aspirin or ibuprofen to
reduce inflammation.
(POSNA, 2005)
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Treatment
The Primary treatment for
Acute compartment syndrome
is to relieve the source of the pressure.
Loosening an external constriction, such as
removing a tight bandage or splitting a cast.
(NAON, 2004)
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Treatment
The extremity should be kept at
heart level.
Elevation above the heart decreases local
arterial perfusion and may further compromise
local blood flow. (NAON, 2004)
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Treatment
If the relief of external pressure
is not effective and
the compartment pressures stay
elevated or continue to rise,
a fasciotomy
may be necessary.
(Porth, 2005)
Treatment
Fasciotomy:
During this procedure, the fascia is incised
longitudinally and separated so that
compartment volume can expand and blood
flow can be reestablished.
Because of potential problems with wound
infection and closure, this procedure is
performed as a last resort.
(Porth, 2005)
Treatment
Early recognition is of utmost
importance.
Nurses need to maintain a high
suspicion for compartment syndrome
in order to identify it early and
implement measures to prevent
negative outcomes.
Quiz
You should elevate
the extremity above the heart
if you think your patient has
Acute Compartment Syndrome?
True
or
False
Wrong
Try Again!!
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Correct
You should NOT elevate
the extremity above the heart,
because it can decrease local arterial
perfusion.
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Quiz
Fasciotomy
is the treatment for
Chronic Compartment Syndrome?
True
or
False
Wrong
Try Again!!
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Correct
Fasciotomy
is the last resort used for
Acute Compartment
Syndrome.
Congratulations
you have completed the tutorial.
The references are on the next slide.
Or you may return to the Home page.
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References:
Felton, P. M. (2003) Chronic exertional compartment syndrome [Electronic Version] South
Florida Institute of Sports Medicine. Retrieved March 23, 2007 from
http://www.southfloridasportsmedicine.com/education_pa_12.asp
Friday, P (2007) Elseview, Inc. Images used with permission, Retrieved from
www.nettingimages.com
Health-Care (2007) What is compartment syndrome? Retrieved March 25, 2007 from
http://bone-muscle.health-cares.net/compartment-syndrome.php.
Merriam-Webster (2005) Merriam-Webster’s Medical desk dictionary (revised edition)
Springfield, Mass. Merriam-Webster Inc.
NAON (2001) Core curriculum for orthopaedic nursing (4th ed.) Pittman, New Jersey.
Anthony J. Jannetti, Inc.
NAON (2004) An introduction to orthopaedic nursing (3rd ed.) Chicago, IL. National
Association of Orthopaedic Nurses.
Porth, C. M. (2005) Pathophysiology concepts of altered health states (7th ed.) Lippincott
Williams and Wilkins.
POSNA (2005) Compartment Syndrome [Electronic Version] American Academy of
orthopaedic surgeons. Retrieved March 23, 2007 from
http://orthoinfor.aaos.org/fact/thr_report.cfm&topcategory=General
Information&Thread_ID=287
Sports Injury Bulletin (2007) Compartment syndrome: what it is, what to look out for and
how it is treated. Retrieved March 25, 2007 from
http://www.sportsinjurybulletin,com/archive/compartment-syndrome.html.