Compartment Syndrome

September 2012

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Compartment Syndrome

The most common complication encountered by TRAUMA patients at NorthBay Medical Center is Compartment Syndrome

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Compartment Syndrome
Click on the link below for a clear explanation of this condition and the surgical treatment .

http://youtu.be/hDHyrhbwq-M

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Compartment Syndrome
Be highly suspicious of compartment syndrome development in the following patients with fractures:

High energy blunt injury MVC Falls from height GSW Crush injury
Having operative management does not exclude compartment syndrome PLEASE REMAIN VIGILANT.

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Compartment Syndrome
If not caught early, the results can be disasterous.

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Compartment Syndrome

P P

Signs and symptoms of compartment syndrome are:

Progressive pain OUT OF PROPORTION Pain on passive motion OUT OF PROPORTION Paresthesia Pulselessness Progressive loss of motion Pallor

P P

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Compartment Syndrome
Document Neurovascular checks in I-View at the frequency ordered by the physician

If you suspect compartment syndrome, you can conduct more frequent neurovascular assessments without a physicians order.
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Compartment Syndrome
There are many more data points to assess and document than capillary refill

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Compartment Syndrome
Do you know how to assess the radial nerve, ulnar nerve, median nerve??

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Compartment Syndrome
Do you know how to assess the tibial nerve, peroneal nerve??

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Compartment Syndrome
Documentation
Neurovascular assessment and documentation includes: a. Extremity b. Pain OUT OF PORPORTION c. Sensation (sensory) See Next Slides d. Temperature (distal to pressure point) e. Movement (motor) See Next Slides f. Capillary refill (blanches) g. Pulses h. Color b. Any other pertinent observations (i.e. swelling) (document in comments section)

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Compartment Syndrome
Assessment:
Peroneal Nerve
SENSATION Prick the web space between great toe and 2nd toe

SENSATION

MOTION

MOTION Passively dorsiflex the ankle and extend toes at the metatarsal phalangeal joints (this should not cause PAIN OUT OF PROPORTION)

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Compartment Syndrome
Assessment:
Tibial Nerve
SENSATION Prick the medial and lateral surfaces of the sole of the foot

SENSATION

MOTION

MOTION Passively plantar flex patient ankle & toes (this should not cause PAIN OUT OF PROPORTION)

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Compartment Syndrome
Assessment:
Radial Nerve
SENSATION Prick the web space between the thumb and the index finger

SENSATION

MOTION

MOTION Passively hyperextend thumb, then wrist, and hyperextend 4 fingers @ MCP joints (this should not cause PAIN OUT OF PORPORTION)

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Compartment Syndrome
Assessment:
Ulnar Nerve
SENSATION Prick the distal fat pad of the small finger

SENSATION

MOTION

MOTION Passively abduct all fingers (this should not cause PAIN OUT OF PROPORTION)

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Compartment Syndrome
Assessment:
Median Nerve
SENSATION Prick the distal surface of the index finger

SENSATION

MOTION

MOTION Passively oppose thumb & small finger; note whether patient can flex wrist. (this should not cause PAIN OUT OF PROPORTION)

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Injury to extremity
Yes
PREVENTION Maintain alignment Elevate TO level of the heart not above Monitor splints/ casting

No

Monitor patients with Fluid resuscitation, any blunt trauma for any evidence of compartment pressure increase even without evidence of injury

Compartment Syndrome Practice Management Guideline

Yes

ASSESS extremities every 4 hours (x24hrs) PAIN- OUT OF PROPORTION then increase assessment PALPATION tense compartment PAIN ON PASSIVE STRETCH plantar flex toes, check anterior leg compartment PARASTHESIA decreased sensation, 1st webspace foot (deep peroneal nerve) LATE sign PARALYSIS foot drop, VERY LATE sign PULSELESSNESS VERY LATE sign

Immediate call to Trauma / Ortho

Emergent transport to OR for fasciotomies less than 6 hrs from onset

Measure compartment pressures Pdiastolic Pcompartment = (positive > 30 mmHg)

Compartment Syndrome
Nursing Interventions
Immediately contact the physician
Keep the limb at heart level elevating the limb decreases arterial perfusion and further compromises local blood flow Adequate hydration to maintain limb arterial blood pressure Neurovascular and pain assessment at least every 4 hours if compartment syndrome is suspected (1 -2 hours for pts. in immediate danger of developing compartment syndrome)

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Compartment Syndrome
Nursing Interventions
Immediately contact the physician
Observation of wound Pain management and comfort measures Reducing anxiety, teaching Avoid use of ice in pts. with suspected compartment syndrome due to further vascular constriction

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Compartment Syndrome
Bottom Line:

1. Assessing patients extremities post op or post trauma is essential 2. When pt. complains of unrelieved pain, pressure or numbness, take it seriously and investigate reason.not always just related to post op or post trauma pain.

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Your Turn

We welcome questions and comments.

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