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What is the primary consequence of increased pressure in compartment syndrome?
Which compartment of the lower leg is primarily associated with anterior compartment syndrome?
Which of the following conditions can directly lead to compartment syndrome?
How long can muscle tissue survive in a compromised compartment before irreversible damage occurs?
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What is one of the key indicators (often referred to as the '5Ps') used in the diagnosis of compartment syndrome?
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Which condition related to increased compartment content can occur due to a fracture?
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What changes occur to nerve function within 2-4 hours of compromised circulation?
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Which of the following is NOT one of the classic '5Ps' of compartment syndrome diagnosis?
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What is the primary indicator for diagnosing Compartment Syndrome?
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When should fasciotomy be performed for Compartment Syndrome?
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What is the normal tissue pressure in a healthy compartment?
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What is a primary reason for elevating the limb in the management of Compartment Syndrome?
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Which of the following is a critical sign that indicates the need for a fasciotomy?
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What should be done immediately upon suspecting Compartment Syndrome?
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Which of the following is NOT a part of the fasciotomy principles?
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Which of the following conditions is an indication for performing a fasciotomy?
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Study Notes
Compartment Syndrome
- Compartment syndrome is a condition where increased pressure within a confined space impairs circulation and function of tissues
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Types:
- Anterior: High pressure in the anterior compartment of the lower leg affects circulation to muscles and nerves.
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Lower Leg Compartments:
- Lateral
- Anterior
- Superficial Posterior
- Deep Posterior
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Etiology: Causes of compartment syndrome include:
- External Pressure: Tight dressings, casts, bandages, or closure of fascial defects.
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Compartment Content Increase: Due to:
- Bleeding/Hematoma: From fractures or vascular injuries.
- Increased Capillary Permeability: From trauma, burns, or snake bites.
Causes of Compartment Syndrome
- Fractures
- Blunt Trauma
- Tight Casts or Dressings
- Closure of Fascial Defects
- Burns or Electrical Injuries
- Snake Bites
- Arterial Injury
- Hemophilia or Coagulation Disorders
Tissue Survival
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Muscle:
- Reversible changes occur within 3-4 hours.
- Irreversible changes (muscle death) happen after 6-8 hours.
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Nerve:
- Reversible changes (neuropraxia) occur within 2-4 hours.
- Irreversible changes happen after 8 hours.
Diagnosis: 5Ps
- Pain: Disproportionate to the injury.
- Pallor: Paleness of the skin.
- Paresthesia: Numbness or tingling.
- Pulselessness: Lack of a pulse in the affected area.
- Paralysis: Loss of muscle function.
Clinical Evaluation
- Pain: Most important sign, especially pain out of proportion to the injury.
- Passive Stretching and Palpation: Pain on these actions is a reliable indicator.
- Late Signs: Pallor, pulselessness, paralysis, and paresthesia manifest later and should not be waited for diagnosis.
Pressure Measurement
- Procedure: A catheter is inserted into the muscle compartment and connected to a machine that digitally records the pressure.
- Normal Pressure: 0-4 mmHg (up to 10 mmHg with exertion).
- Compartment Syndrome Pressure: 30mmHg or higher.
General Management
- Remove Circumferential Bandages and Full Casts
- Maintain Limb at Heart Level: Elevation reduces tissue perfusion.
- Supplemental Oxygen Administration
Urgent/Bedside Fasciotomy
- Purpose: Relieve pressure to prevent permanent damage to muscles and nerves.
Surgical Treatment: Fasciotomy
- Incisions: Made in the skin, subcutaneous tissue, and deep fascia to release pressure.
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Indications for Fasciotomy:
- Compartment pressure of 15-20 mmHg or higher.
- Rising pressure inside the compartment.
- Significant tissue injury.
- More than 6 hours of total limb ischemia.
- Injuries at high risk of compartment syndrome (fractures or severe blunt trauma).
Fasciotomy Principles
- Early Diagnosis: Crucial for successful treatment.
- Long Extended Incisions: Made on both sides of the leg.
- Release All Fascial Compartments: To relieve pressure.
- Preserve Neurovascular Structures: During the procedure.
- Keep the Wound Open and Administer Antibiotics: To prevent infection.
- Skin Closure or Coverage within 7-10 Days: With a skin graft.
Summary
- Maintain a high index of suspicion for compartment syndrome.
- Treat promptly when suspected.
- If clinically evident, do not delay fasciotomy to measure pressure.
- Fasciotomy is the only treatment for compartment syndrome. When performed on time, it can prevent permanent damage.
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Description
This quiz covers the essential aspects of compartment syndrome, including its definition, types, and causes. Gain insights into how increased pressure impacts circulation and function within muscle compartments of the lower leg. Test your knowledge on this crucial medical condition and its implications.
