Compartment Syndrome IN EMS

Who Cares? Bandaging Bandaging Splinting Splinting Trauma Trauma IV’s IV’s Tourniquets Tourniquets Edema Edema Exercise Exercise

What is it? Compartment syndrome is increased tissue pressure within a closed space, resulting in tissue ischemia. Compartment syndrome is increased tissue pressure within a closed space, resulting in tissue ischemia. Any pressure that causes ischemia. Any pressure that causes ischemia. Can cause muscle damage, nerve damage, and tissue necrosis. 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. 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 Richard VonVolkman first described Compartment syndrome in In 1941 two doctors, Bywaters, and Beall studied the effects of crush injuries on victims of the London Blitz. 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. Decreased Pulses distal to affected area. Pain in affected area Pain in affected area Tingling Tingling Numbness Numbness Swelling and tenderness of skin below injury. Swelling and tenderness of skin below injury. Hypotension Hypotension In trauma In trauma

Signs and Symptoms Look for the five P’s of Ischemia Look for the five P’s of Ischemia Pain Pain Paresthesias (tingling) Paresthesias (tingling) Paralysis Paralysis Pallor Pallor Pulselessness Pulselessness

Causes Trauma Trauma Intensive muscle use Intensive muscle use Burns Burns Blood clots Blood clots Casts Casts Tourniquets Tourniquets Sitting for long periods Sitting for long periods Snakebite Snakebite Inflammation Inflammation Edema/swelling Edema/swelling CHF Seizures Seizures

Causes Trauma Trauma Main cause of compartment syndrome Main cause of compartment syndrome 64% of confirmed cases 64% of confirmed cases Anything that causes swelling Anything that causes swelling Crush injuries Crush injuries Long bone fractures Long bone fractures Traction splints Traction splints

Causes Tamponade Tamponade Pressure from the outside can cause increased internal pressure Pressure from the outside can cause increased internal pressure Tourniquets Tourniquets Bandages to tight Bandages to tight Mass Pants Mass Pants Casts and Splints/edema Casts and Splints/edema

Causes Increased Fluid Content/Inflamation Increased Fluid Content/Inflamation Burns Burns Infiltrated IV Sites Infiltrated IV Sites Especially in patients taking blood-thinners. Especially in patients taking blood-thinners. Hemorrhage Hemorrhage trauma trauma Snakebites Snakebites

Complications Nerve Damage Nerve Damage Infection Infection Loss of Extremity Loss of Extremity Necrosis Necrosis Blood Clots Blood Clots Death Death

Volkmann’s Contracture Lack of blood flow damages nerves and muscle causing them to shorten and become permanently contracted. 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 Be careful with entrapments and positional causes of Compartment syndrome Use caution when relieving pressure Use caution when relieving pressure Acidosis Acidosis Thrombosis Thrombosis Sepsis Sepsis Toxins Toxins

Precautions in EMS Tourniquet Tourniquet Bandaging Bandaging CHF/edema CHF/edema Internal Bleeding Internal Bleeding Broken femur Broken femur Abdominal trauma/bleeding Abdominal trauma/bleeding Any bleeding into body cavities Any bleeding into body cavities Entrapment Entrapment

Treatment in the Field Apply Oxygen Apply Oxygen Keep extremities level with body Keep extremities level with body Do not elevate Do not elevate Establish IV access Establish IV access Watch for hypovolemia Watch for hypovolemia Treat inflammation/edema Treat inflammation/edema Diesel Diesel

Hospital Treatments Fasciotomy Fasciotomy Opening wound to relieve pressure Opening wound to relieve pressure Thrombolitics Thrombolitics Hyperbaric Oxygen Hyperbaric Oxygen New studies show that Hyperbaric oxygen increases tissue perfusion. Decreasing amount of tissue damage. New studies show that Hyperbaric oxygen increases tissue perfusion. Decreasing amount of tissue damage.

Fasciotomy

References Critical Care Medicine. 28(6): , June Ertel, Wolfgang MD; Oberholzer, Andreas MD; Platz, Andreas MD; Stocker, Reto MD; Trentz, Otmar MD Critical Care Medicine. 28(6): , June 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. 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 Merck Research Laboratories, Merck Manual of Diagnosis and Therapy Eighteenth Edition, Whitehouse Station, NJ, 2008