1. TRANSITION SERIES Topics for the Advanced EMT CHAPTER Soft Tissue Injuries: Crush Injury and Compartment Syndrome 39

2. Objectives Review the occurrences of soft tissue trauma. Discuss pathophysiological changes of crush and compartment syndrome injuries.

3. Objectives (cont’d) Differentiate between assessment findings. Review current treatment interventions for these types of injuries.

4. Introduction Crush injury is a mechanism of blunt trauma, whereas compartment syndrome is an injury pattern. Crush injuries are caused by excessive compressive forces on the body. Can occur to small localized areas (thumb), or to large regions (thorax).

5. Epidemiology A broad definition of soft tissue injury accounts for the vast majority of traumatic injuries. Crush injuries are a small portion of this category.

6. Mechanism Direct force –Tissue destruction from compressive forces Entrapment/Weight-based compression –Compression caused by patient's position Internal compression –Internal swelling causing compartment syndrome

7. Direct force can cause crush injuries, some resulting in open wounds.

8. A stroke patient who has fallen and trapped her right leg beneath her body weight.

9. Pathophysiology Direct compression destroys tissue cells. Pressure can also inhibit normal blood flow to tissues, worsening tissue damage. Compression >4 hours may result in muscle breakdown with toxin release.

10. Pathophysiology (cont’d) Compartment syndrome –Compression from the opposite direction. –Swelling or bleeding in muscle occurs. –Fascia enveloping muscle is nondistensible. –Pressure builds, causing changes to blood flow.

11. Assessment Findings Common findings –Pain to traumatized area –Possible entrapment of extremity –Bruising, tenderness, ecchymosis –Deformity, loss of function –Diminished or absent distal PMS

12. Assessment Findings (cont’d) Specific compartment syndrome findings –Pain, discomfort, burning sensation –Pain that continues after immobilization –Tenderness, unusual firmness at injury site –Altered PMS distal to the injury –Weakness or paralysis of muscle

13. Assess circulation in an extremity following a crush injury.