Transcript 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.

Compartment Syndrome
IN EMS
Who Cares?
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Bandaging
Splinting
Trauma
IV’s
 Tourniquets
Edema
Exercise
What is it?
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Compartment syndrome is increased
tissue pressure within a closed space,
resulting in tissue ischemia.
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Any pressure that causes ischemia.
Can cause muscle damage, nerve damage,
and tissue necrosis.
What Happens
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Increased Pressure causes blood vessels
to collapse, which causes ischemia, which
causes tissue damage and eventually
death.
History
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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.
Signs and Symptoms
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Decreased Pulses distal to
affected area.
Pain in affected area
Tingling
Numbness
Swelling and tenderness
of skin below injury.
Hypotension
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In trauma
Signs and Symptoms
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Look for the five P’s of Ischemia
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Pain
Paresthesias (tingling)
Paralysis
Pallor
Pulselessness
Causes
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Trauma
Intensive muscle use
Burns
Blood clots
Casts
Tourniquets
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Sitting for long
periods
Snakebite
Inflammation
Edema/swelling
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CHF
Seizures
Causes
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Trauma
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Main cause of compartment syndrome
 64% of confirmed cases
Anything that causes swelling
 Crush injuries
 Long bone fractures
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Traction splints
Causes
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Tamponade
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Pressure from the outside can cause
increased internal pressure
Tourniquets
 Bandages to tight
 Mass Pants
 Casts and Splints/edema
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Causes
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Increased Fluid Content/Inflamation
Burns
 Infiltrated IV Sites
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Hemorrhage
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Especially in patients taking blood-thinners.
trauma
Snakebites
Complications
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Nerve Damage
Infection
Loss of Extremity
Necrosis
Blood Clots
Death
Volkmann’s Contracture
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Lack of blood flow
damages nerves and
muscle causing them
to shorten and
become permanently
contracted.
Complications Continued
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Be careful with entrapments and positional
causes of Compartment syndrome
Use caution when relieving pressure
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Acidosis
Thrombosis
Sepsis
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Toxins
Precautions in EMS
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Tourniquet
Bandaging
 CHF/edema
Internal Bleeding
 Broken femur
 Abdominal
trauma/bleeding
 Any bleeding into body
cavities
Entrapment
Treatment in the Field
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Apply Oxygen
Keep extremities level
with body
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Establish IV access
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Do not elevate
Watch for hypovolemia
Treat
inflammation/edema
Diesel
Hospital Treatments
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Fasciotomy
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Opening wound to
relieve pressure
Thrombolitics
Hyperbaric Oxygen
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New studies show that
Hyperbaric oxygen
increases tissue
perfusion. Decreasing
amount of tissue
damage.
Fasciotomy
References
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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
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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