Medical students lecture

1. Compartment
Compartment
Syndrome
Syndrome
Kyle Miller
Kyle Miller

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

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

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

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

6. SYMPTOMS
SYMPTOMS
 The main symptom of compartment
The main symptom of compartment
syndrome is severe pain that does not
syndrome is severe pain that does not
respond to elevation or medication. In
respond to elevation or medication. In
a more advanced case, there may be
a more advanced case, there may be
decreased sensation, weakness and
decreased sensation, weakness and
paleness of the skin.
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
Diagnosis
 Pressure testing of the muscle.
Pressure testing of the muscle.
 Insertion of small plastic catheter into the skin
Insertion of small plastic catheter into the skin
of the affected muscle to measure pressure.
of the affected muscle to measure pressure.
 Patient engages in the pain inducing activity
Patient engages in the pain inducing activity
while recording of compartment pressure is
while recording of compartment pressure is
recorded.
recorded.
 Reproduction of symptoms associated with
Reproduction of symptoms associated with
pressures above the certain value confirms the
pressures above the certain value confirms the
diagnosis.
diagnosis.

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

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

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

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

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

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

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

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