1. Compartment Syndrome Kyle Miller

2. Compartment Syndrome Definition Definition Compartment Syndrome involves the compression of nerves and blood vessels within an enclosed space. This leads to impaired blood flow and muscle and nerve damage. Compartment Syndrome involves the compression of nerves and blood vessels within an enclosed space. This leads to impaired blood flow and muscle and nerve damage.

3. Causes: Causes: Thick layers of tissue called fascia separate groups if muscles in the arms and legs from each other. Inside each layer of fascia is a confined space, called a compartment. This includes muscle tissue, nerves and blood vessels. This is much like wires surrounded by insulation. Thick layers of tissue called fascia separate groups if muscles in the arms and legs from each other. Inside each layer of fascia is a confined space, called a compartment. This includes muscle tissue, nerves and blood vessels. This is much like wires surrounded by insulation.

4. Unlike a balloon, fascia do not expand, so any swelling in a compartment will lead to increasing pressure in that compartment. This will compress the muscles, blood vessels and nerves. If this pressure is high enough, blood flow to the compartment will be blocked. This can lead to permanent injury to the muscle and nerves. If it lasts long enough, the limb may die and need amputation. Unlike a balloon, fascia do not expand, so any swelling in a compartment will lead to increasing pressure in that compartment. This will compress the muscles, blood vessels and nerves. If this pressure is high enough, blood flow to the compartment will be blocked. This can lead to permanent injury to the muscle and nerves. If it lasts long enough, the limb may die and need amputation.

5. Swelling leading to compartment syndrome is associated with high-energy trauma, such as a car accident or even surgery. It may also occur from tight bandages or from a cast. Pressure will build up and cause compartment syndrome. Chronic compartment syndrome can be caused by repetitive activities like running or cycling that increase pressure only during those activities. Swelling leading to compartment syndrome is associated with high-energy trauma, such as a car accident or even surgery. It may also occur from tight bandages or from a cast. Pressure will build up and cause compartment syndrome. Chronic compartment syndrome can be caused by repetitive activities like running or cycling that increase pressure only during those activities. Compartment syndrome is most common in the lower leg and forearm, but can also occur in the foot, thigh and upper arm. Compartment syndrome is most common in the lower leg and forearm, but can also occur in the foot, thigh and upper arm.

6. SYMPTOMS The main symptom of compartment syndrome is severe pain that does not respond to elevation or medication. In a more advanced case, there may be decreased sensation, weakness and paleness of the skin. The main symptom of compartment syndrome is severe pain that does not respond to elevation or medication. In a more advanced case, there may be decreased sensation, weakness and paleness of the skin.

7. Overuse Overuse Local Tissue Swelling Local Tissue Swelling Tight Compartment Tight Compartment Decreased Blood Supply Decreased Blood Supply More Tissue Swelling More Tissue Swelling Cycle repeats itself Cycle repeats itself

8. Diagnosis Pressure testing of the muscle. Pressure testing of the muscle. Insertion of small plastic catheter into the skin of the affected muscle to measure pressure. Insertion of small plastic catheter into the skin of the affected muscle to measure pressure. Patient engages in the pain inducing activity while recording of compartment pressure is recorded. Patient engages in the pain inducing activity while recording of compartment pressure is recorded. Reproduction of symptoms associated with pressures above the certain value confirms the diagnosis. Reproduction of symptoms associated with pressures above the certain value confirms the diagnosis.

9. TREATMENT Correction of biomechanical abnormalities. Correction of biomechanical abnormalities. Soft tissue therapy. Soft tissue therapy. Usually surgery. Long incisions are made in the fascia to release the pressure. Usually surgery. Long incisions are made in the fascia to release the pressure. Incisions generally left open to prevent pressure rebuilding. Incisions generally left open to prevent pressure rebuilding. Skin grafts may be required to close the wound. Skin grafts may be required to close the wound.

10. Prognosis If pressure release is accomplished promptly, the outlook is very good for muscle and nerve recovery. If pressure release is accomplished promptly, the outlook is very good for muscle and nerve recovery. The overall outlook is determined by the injury that lead to the syndrome. The overall outlook is determined by the injury that lead to the syndrome. If diagnosis is delayed, there may be permanent nerve and muscle damage and loss of muscle function. This is more common when a person has been heavily sedated and incapable of complaining. Permanent nerve injury can occur after only 12-24 hours of compression. If diagnosis is delayed, there may be permanent nerve and muscle damage and loss of muscle function. This is more common when a person has been heavily sedated and incapable of complaining. Permanent nerve injury can occur after only 12-24 hours of compression.

11. Complications Dramatic function impairment. Dramatic function impairment. In more severe cases, limbs may have to be removed because the muscles in the compartment have died from lack of oxygen. In more severe cases, limbs may have to be removed because the muscles in the compartment have died from lack of oxygen.

12. PREVENTION Always be aware of this condition so early diagnosis can prevent complications. Always be aware of this condition so early diagnosis can prevent complications. If placed in a cast, be aware of the risk of increased swelling so they contact a health care provider immediately if they have increased pain under the cast, despite elevation and pain medication. If placed in a cast, be aware of the risk of increased swelling so they contact a health care provider immediately if they have increased pain under the cast, despite elevation and pain medication.

13. Abdominal Compartment Syndrome Pressure inside the abdominal compartment can increase as a result of the build up of blood, fluid or edema in the critically ill, trauma, and post operative patients. Pressure inside the abdominal compartment can increase as a result of the build up of blood, fluid or edema in the critically ill, trauma, and post operative patients. Accumulation of fluid can be the result of traumatic injury, bowel ischemia or infarction or gastrointestinal hemorrhage. Accumulation of fluid can be the result of traumatic injury, bowel ischemia or infarction or gastrointestinal hemorrhage. The build up can result in abdominal bleeding, cirrhosis, profound hypothermia, pancreatitis and fluid resuscitation in severe sepsis are other possible causes. The build up can result in abdominal bleeding, cirrhosis, profound hypothermia, pancreatitis and fluid resuscitation in severe sepsis are other possible causes. When pressure inside the abdominal compartment overcomes the pressure inside the capillaries perfusing the organs of the abdomen, ischemia and infarction of these organs can occur. When pressure inside the abdominal compartment overcomes the pressure inside the capillaries perfusing the organs of the abdomen, ischemia and infarction of these organs can occur.

14. Adverse Effects of Increased Abdominal Pressure Oliguria (urine output) due to renal ischemia. Oliguria (urine output) due to renal ischemia. Increased peak airway pressures due to restriction and elevation of the diaphragm. Increased peak airway pressures due to restriction and elevation of the diaphragm. Hypotension and decreases CO as a result of decreased venous return, increased ventricular wall tension and intra- abdominal volume loss. Hypotension and decreases CO as a result of decreased venous return, increased ventricular wall tension and intra- abdominal volume loss.

15. GI bleeding due to ischemia of the bowel. GI bleeding due to ischemia of the bowel. Impaired distal extremity circulation secondary to pressure on the aorta. Impaired distal extremity circulation secondary to pressure on the aorta. With concurrent head injury, the ICP can be elevated, along with decreased cerebral perfusion pressure. With concurrent head injury, the ICP can be elevated, along with decreased cerebral perfusion pressure. When a patient develops a distended and taunt abdomen, the measurement of abdominal compartment pressure can help with early recognition of organ dysfunction. When a patient develops a distended and taunt abdomen, the measurement of abdominal compartment pressure can help with early recognition of organ dysfunction.

16. Sources http://ccforum.com/content/4/1/23 http://ccforum.com/content/4/1/23 http://ccforum.com/content/4/1/23 Merck Manual eighteenth edition,2006 Merck Manual eighteenth edition,2006 Paramedic Care, Bledsoe Porter and Cherry, 2006 Paramedic Care, Bledsoe Porter and Cherry, 2006 www.med.umich.edu/ccmu/acs.htm www.med.umich.edu/ccmu/acs.htm www.med.umich.edu/ccmu/acs.htm www.rice.edu www.rice.edu www.rice.edu www.nlm.nih.gov www.nlm.nih.gov www.nlm.nih.gov