Arterial flow compromised → ischemia → cell death → loss of function Clinical manifestation of CS Early recognition and treatment essential May occur initially or may be delayed several days Ischemia can occur within 4 to 8 hours after onset six Ps are characteristic of compartment syndrome: pain out of proportion to the injury and that is not managed by opioid analgesics, and pain on passive stretch of muscle traveling through the compartment; Increasing pressure in the compartment; paresthesia (numbness and tingling); also an early sign pallor, coolness, and loss of normal color of the extremity; paralysis or loss of function; late sign pulselessness (diminished or absent peripheral pulses) – late sign • Assess urine output and kidney function - Myoglobin (blood that carries and stores O2 in muscle cells) released from damaged muscle cells precipitates and causes obstruction in renal tubules. • This results in acute tubular necrosis and acute kidney injury. • Common signs are dark reddish brown urine * NO elevation above heart-may lower venous pressure and slow arterial perfusion. With suspected compartment syndrome NO ice -application of cold compresses may cause vasoconstriction and exacerbate compartment syndrome Surgical decompression (fasciotomy) - The fasciotomy site is left open for several days to ensure adequate soft tissue decompression. Infection resulting from delayed wound closure is a potential problem after fasciotomy. In severe cases of compartment syndrome, an amputation may be required.
Cx Venous Thromboembolism Thrombus formation after fx (esp hip fx) Interventions: Anticoagulant therapy • Coumadin • Heparin Aspirin Compression devices Doriflex, plantar – affected extremity ROM –unaffected extremity
Cx Fat Embolism Syndrome Presence of systemic fat globules from fracture that are distributed into tissues and organs after a traumatic skeletal injury Contributory factor in many deaths associated with fracture Most common with fracture of long bones, ribs, tibia, and pelvis Mechanical theory • Fat released from marrow and enters circulation where it can obstruct Biochemical theory • Hormonal changes caused by trauma stimulate release of fatty acids to form fat emboli Signs & Symptoms • Early recognition of FES is crucial • Symptoms 24 to 48 hours after injury • Fat emboli in the lungs (like pulmonary embolism) cause a hemorrhagic interstitial pneumonitis (respiratory distress syndro me (ARDS), such as chest pain, tachypnea, cyanosis, dyspnea, apprehension, tachycardia, and decreased partial pressure of arterial O2 (PaO2). • Respiratory and neurologic symptoms (restlessness, confusion, elevated temperature, and headache). • Petechiae – neck, chest wall, axilla, buccal membrane, conjunctiva (due to intravascular thromboses caused by decreased oxygenation).
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- Fall '19
- Bone fracture