Compartment Syndrome...Part 1

Fractures — account for about 75% of compartment syndrome
especially tibia, humeral shaft, combined radius and ulna fractures, and supracondylar fractures in children

The forearm (volar compartment) and leg (the anterior compartment — the anatomical leg being the bit below the knee…) are most commonly affected.

compartment syndrome can occur in other regions, including the back, buttocks, thigh, abdomen and foot.
compartment syndrome of the deep posterior compartment of the leg is easily missed

Pathophysiology :

Muscles are contained within inelastic fascial sheaths. When injured muscles swell, a hematoma forms, or external compression is applied, the pressure within the fascial compartment increases. If the pressure rises high enough, capillary pressure is exceeded and circulation is compromised. This results in ischemic injury to the muscles and nerves within the fascial compartment.

Consquenses:

Ischemic injury to muscles and nerves occurs after 4 hours of complete ischemia. This becomes irreversible at some point over the next 4 hours (i.e. 4-8 hours after the onset of ischemia), resulting in local rhabdomyolysis and neuropraxis progresses to axonotmesis as nerve injury worsens.

Comments

The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by: the area of the curve the slope of the line from points C to D the distance of the line from points C to D the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by: the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.

Driving Pressure in ARDS: A new concept!

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body

sedationstation

Search This Blog