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