Transcript Compartment Syndrome

Compartment Syndrome
By
Patti Hamilton
DEFINITION
• Compartment syndrome involves the
compression of nerves and blood vessels
within an enclosed space.
• This leads to impaired blood flow, muscle
and nerve damage.
CAUSES
• Swelling in a
• This can lead to
compartment will lead
permanent injury to
to increasing pressure
the muscles and
in that compartment,
nerves ( within 6 hrs).
which will compress
• If the pressure last
the muscles, blood
long enough, the limb
vessel and nerves.
may die and need to
• If the pressure is high
be amputated( within
enough blood flow to
24-48 hrs).
the compartment will
be blocked.
INCIDENCE AND RISK FACTORS
• Swelling associated
with high energy
trauma- car accident,
crush injury, or
surgery.
• Tight bandages or
casts.
• Repetitive activities running
• Most common in the
lower leg and
forearm, but can
occur in the hand,
foot, thigh and upper
arm.
SUBJECTIVE ASSESSMENT
• The hallmark symptom of compartment
syndrome is severe pain that does not respond
to elevation or pain medicine.
• The patient will complain of sharp pain that
increases with passive movement of the hand or
foot.
• Numbness or tingling in the affected extremity is
common.
• In advanced cases, there may be decreased
sensation, weakness, and paleness of the skin.
OBJECTIVE ASSESSMENT
• Severe pain will occur when a muscle running
through a compartment is passively moved.
• The skin overlying the compartment will be
tensely swollen, shiny, and cool to the touch.
• Assessment of skin color may reveal pallor or
cyanosis.
• Cap. Refill time will be increased with gentle
palpation of the extremity.
• Monitor vital signs.
MEDICAL MANAGEMENT
• Surgery is usually required. A fasciotomy –
incision into the fascia – to relieve the pressure
and allow return of normal blood flow to the
area.
• This needs to be done immediately, within 30
minutes.
• Incision is left open to heal by granulation,
covered by a sterile dressing.
• If a cast or bandage is the problem, the dressing
or cast should be loosened or cut down to
relieve the pressure.
NURSING INTERVENTIONS
•
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Administration of analgesics.
Elevate the limb – no higher than heart level.
Application of cold packs.
Removal of any restricting material.
Observe for signs of infections.
Encourage patients to verbalize fears and
emotional needs.
• Proper postioning and alignment to prevent
permanent contracture known as Volkmann’s
Contracture ( claw hand, flexion of wrist and
finger, atrophy of forearm).
PREVENTION
• Not preventable – but being aware of this
condition and early diagnosis will help
prevent many of the complications.
• People placed in casts need to be made
aware of the risk of swelling. To seek
immediate medical attention if they have
increasing pain under the cast despite
elevation and pain medicine.
PROGNOSIS
• If the diagnosis is made
promptly and surgical
release performed the
outlook is excellent for
recovery of the muscles
and nerves inside the
compartment.
• If there is a delay in
diagnosis, there can be
permanent damage. This
is most common when
the injured person is
unconscious or heavily
sedated and incapable of
complaining. Permanent
injury can occur after 1224 hours of compression.