Arterial flow compromised ischemia cell death loss of function Clinical

Arterial flow compromised ischemia cell death loss of

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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.
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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
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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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