Compartment Syndrome Overview
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Questions and Answers

What is compartment syndrome?

A condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space.

What are the four compartments found in the lower leg?

  • Lateral, Posterior, Superficial Posterior, Deep Posterior
  • Internal, Anterior, Superficial Posterior, Deep Posterior
  • Lateral, Anterior, Superficial Posterior, Deep Lateral
  • Lateral, Anterior, Superficial Posterior, Deep Posterior (correct)

What are two factors that can increase compartment pressure?

  • Localized external pressure, Bleeding/Hematoma (correct)
  • Localized external pressure, Increased Capillary Permeability (correct)
  • Localized internal pressure, Bleeding/Hematoma
  • Localized internal pressure, Increased Capillary Permeability

What are some causes of compartment syndrome?

<p>Fractures, blunt trauma, tight cast or dressing, closure of fascial defects, burns/electrical, Hemophilia/coag. disorder, snake bite and arterial injury.</p> Signup and view all the answers

Muscle damage is reversible if it occurs within 6-8 hours.

<p>False (B)</p> Signup and view all the answers

What are the 5 Ps of compartment syndrome?

<p>Pain, Pallor, Paresthesia, Pulseless, and Paralysis</p> Signup and view all the answers

What is the normal tissue pressure? What is the absolute pressure to diagnose CS?

<p>0-4 mm Hg, 30 mm Hg</p> Signup and view all the answers

What is the treatment for compartment syndrome?

<p>Fasciotomy</p> Signup and view all the answers

The fascia should be cut on both sides of the leg during a fasciotomy.

<p>True (A)</p> Signup and view all the answers

What are two signs of compartment syndrome that should be investigated urgently?

<p>Pain out of proportion to the injury, Pain on passive stretching of the involved compartment.</p> Signup and view all the answers

What is the absolute pressure threshold for diagnosing compartment syndrome?

<p>30 mm Hg (A)</p> Signup and view all the answers

Which of the following is NOT a principle of fasciotomy?

<p>Perform a limited incision in the fascia (B)</p> Signup and view all the answers

What should be done as soon as compartment syndrome is clinically evident?

<p>Perform a fasciotomy immediately (B)</p> Signup and view all the answers

Which of the following is an indication for performing a fasciotomy?

<p>Pressure within 15-20 mm Hg (C)</p> Signup and view all the answers

What should NOT be done when diagnosing compartment syndrome?

<p>Delay treatment until pressure measurement (A)</p> Signup and view all the answers

What can lead to irreversible muscle changes in compartment syndrome?

<p>Irreversible changes occurring after 6-8 hours (D)</p> Signup and view all the answers

Which of the following symptoms indicate a late stage of compartment syndrome?

<p>Pallor (A)</p> Signup and view all the answers

Which condition is NOT typically associated with the etiology of compartment syndrome?

<p>Venous thrombosis (C)</p> Signup and view all the answers

What is the primary method for diagnosing compartment syndrome?

<p>Direct measurement of tissue pressure (A)</p> Signup and view all the answers

Which of the following is NOT one of the 5 Ps used for diagnosing compartment syndrome?

<p>Pulsation (B)</p> Signup and view all the answers

Which situation could potentially increase compartment pressure due to compartment content?

<p>Severe capillary permeability from trauma (B)</p> Signup and view all the answers

What is the role of a special catheter in the context of compartment syndrome?

<p>To measure the pressure inside the compartment (B)</p> Signup and view all the answers

Which of the following factors can compromise tissue function within a compartment?

<p>Localized external pressure (C)</p> Signup and view all the answers

What is formed when AMP is deaminated by AMP deaminase?

<p>IMP (A)</p> Signup and view all the answers

Which energy system is predominantly used during high intensity activities lasting no longer than 10 seconds?

<p>ATP/PC system (B)</p> Signup and view all the answers

What is the primary characteristic of the anaerobic glycolysis system?

<p>It lasts approximately 1 minute. (D)</p> Signup and view all the answers

Which process occurs when blood lactate is removed through gluconeogenesis?

<p>Conversion to glucose in the liver (B)</p> Signup and view all the answers

What is the predominant energy system utilized for activities exceeding 2-3 minutes?

<p>Aerobic energy system (C)</p> Signup and view all the answers

What is the primary function of creatine in muscles?

<p>Provides additional energy supply (D)</p> Signup and view all the answers

Where does the synthesis of creatine begin in the human body?

<p>Kidney (C)</p> Signup and view all the answers

Which enzyme is responsible for the conversion of creatine into phosphocreatine?

<p>Creatine kinases (B)</p> Signup and view all the answers

What happens to creatinine once it is formed in the body?

<p>It is excreted in urine (B)</p> Signup and view all the answers

How do levels of creatinine in urine correlate with body muscle mass?

<p>They increase with higher muscle mass (B)</p> Signup and view all the answers

Which of the following conditions is creatine kinase (CK) elevated in?

<p>Myocardial infarction (D)</p> Signup and view all the answers

Which isoenzyme of creatine kinase is primarily found in the heart muscle?

<p>CK-MB (D)</p> Signup and view all the answers

During exercise, what compounds does ATP degrade into?

<p>ADP and AMP (A)</p> Signup and view all the answers

What is the primary function of muscles in the human body?

<p>To convert chemical energy into mechanical energy (B)</p> Signup and view all the answers

Which type of muscle fibers are best suited for activities requiring endurance?

<p>Slow-twitch type I fibers (C)</p> Signup and view all the answers

What characterizes fast-twitch type IIb muscle fibers?

<p>Low levels of myoglobin and few mitochondria (C)</p> Signup and view all the answers

What role do mitochondria play in skeletal muscle fibers?

<p>They produce ATP for muscle contraction (C)</p> Signup and view all the answers

Which characteristic is associated with cardiac muscle?

<p>Involuntary control and striated structure (C)</p> Signup and view all the answers

Which components are commonly found in the sarcoplasm of muscle cells?

<p>Creatine phosphate and glycogen (A)</p> Signup and view all the answers

Which type of muscle is primarily responsible for controlling movements of the skeleton?

<p>Skeletal muscle (C)</p> Signup and view all the answers

Which function is NOT associated with muscle metabolism?

<p>Storage of excess fat (B)</p> Signup and view all the answers

Flashcards

Compartment Syndrome

Increased pressure within a confined space, compromising blood flow and tissue function.

Anterior Compartment Syndrome

High pressure in the front muscle compartment of the leg.

Compartment

A defined anatomical space with specific muscles and nerves.

Lower Leg Compartments

Four areas in the lower leg – lateral, anterior, superficial posterior, and deep posterior.

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Etiology (Compartment Syndrome)

The causes of compartment syndrome, including fractures, tight dressings, bleeding, and trauma.

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Tissue Damage (Compartment Syndrome)

Muscle tissue can experience reversible damage within 3-4 hours, leading to irreversible damage beyond 6-8 hours; nerves are affected in similar timelines.

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5 Ps (Compartment Syndrome)

A clinical evaluation tool for Compartment Syndrome: Pain, Pallor, Paresthesia, Pulselessness, and Paralysis.

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Pain (Compartment Syndrome)

Severe pain, disproportionate to the injury, is a key symptom of potential compartment syndrome.

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Pallor (Compartment Syndrome)

Pale or whitish appearance of the skin, indicating poor circulation.

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Paresthesia (Compartment Syndrome)

Abnormal sensations like numbness or tingling, indicating nerve compression.

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Pulselessness (Compartment Syndrome)

Inability to feel a pulse in the affected limb, indicating severely reduced blood flow.

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Paralysis (Compartment Syndrome)

Loss of muscle function, indicating severe nerve damage, is a late sign.

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Compartment Pressure Measurement

A catheter measures the pressure inside the affected limb.

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Normal Tissue Pressure

0-4 mm Hg (up to 10 with exertion).

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Compartment Syndrome Pressure Threshold

Above 30 mm Hg, compartment syndrome is considered present.

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Fasciotomy

Surgical procedure to release pressure by cutting the fascia.

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Fascia

The connective tissue surrounding and separating muscles in a compartment

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Indications For Fasciotomy

High compartment pressure (15-20 mm Hg), increasing pressure, significant tissue injury, or prolonged limb ischemia (>6 hours)

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Fasciotomy Principles

Immediate diagnosis, long incisions for full compartment release, preserving neurovascular structures, open wound for treatment, skin closure within days.

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Limb Ischemia

Reduced or absent blood flow to a limb.

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Urgent Treatment

Immediate action to prevent permanent muscle and nerve damage, such as removal of tight bandages and fasciotomy.

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Compartment syndrome pressure?

A compartment syndrome diagnosis is confirmed when pressure within a compartment is greater than 30 mm Hg.

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Why release the fascia?

Fasciotomy involves surgically incising the fascia to relieve pressure within a compartment, restoring blood flow and preventing tissue damage.

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Urgent management for CS?

Prompt actions include removal of tight bandages, limb elevation, and oxygen administration to enhance blood flow. Urgent fasciotomy may be necessary to prevent permanent tissue damage.

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High-risk CS injuries?

Fractures and severe blunt trauma carry a higher risk of compartment syndrome due to potential muscle damage and blood vessel compromise.

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Fasciotomy incision?

Extended incisions are made on both sides of the leg, releasing all compartments and preserving vital structures like nerves and blood vessels.

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Causes of Compartment Syndrome

Factors that cause pressure buildup in a compartment, including fractures, tight dressings, bleeding, and trauma.

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5 Ps of Compartment Syndrome

Five key symptoms that indicate the presence of compartment syndrome: Pain (out of proportion), Pallor (paleness), Paresthesia (numbness/tingling), Pulselessness, and Paralysis.

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Pain in Compartment Syndrome

Severe pain that is out of proportion to the injury, especially when stretching or pressing on the affected area.

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Measuring Compartment Pressure

A special catheter is inserted into the muscle compartment to measure the pressure inside.

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Normal Compartment Pressure

Healthy compartment pressure is normally between 0-4 mm Hg, increasing slightly with exertion.

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Urgent Treatment for Compartment Syndrome

Immediate action is needed to prevent permanent damage, such as removing tight dressings and performing a fasciotomy.

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What are muscles?

Muscles are the biochemical transducers that convert chemical energy into mechanical energy. They allow movement by contracting and relaxing.

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What is ATP's role in muscles?

ATP (adenosine triphosphate) is the primary energy source for muscle contraction and relaxation.

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What is creatine phosphate?

Creatine phosphate is a high-energy molecule that quickly provides energy to regenerate ATP during short, intense muscle activity.

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What are the three types of muscle cells?

The three types of muscle cells are: skeletal, smooth, and cardiac.

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What are skeletal muscles?

Skeletal muscles are attached to bones and are responsible for voluntary movement.

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What are slow-twitch fibers?

Slow-twitch fibers are good at sustained, low-intensity activities like jogging.

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What are fast-twitch fibers?

Fast-twitch fibers are good at short bursts of high-intensity activity like sprinting.

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What is the difference between Type IIa and Type IIb fibers?

Type IIa fibers have a high myoglobin content and are used for medium-intensity activities, while Type IIb fibers have low myoglobin and are used for short, explosive movements.

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Anaerobic glycolysis

A fast but unsustainable energy production pathway used for short bursts of activity. It produces ATP quickly but leads to muscle fatigue.

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Creatine

A compound found in muscles that provides additional energy by helping to quickly regenerate ATP from ADP.

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Creatine synthesis

The process of creating creatine, which begins in the kidneys and is completed in the liver. It utilizes amino acids glycine and arginine.

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Creatine kinase (CK)

An enzyme essential for converting creatine into phosphocreatine, a high-energy compound used in muscle function. It exists in different forms depending on tissue location.

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Creatinine

A waste product formed from the breakdown of creatine phosphate, excreted in the urine.

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ATP metabolites

Breakdown products of ATP, including ADP and AMP, which can be recycled back into ATP through various pathways.

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Adenylate kinase reaction

A process that converts two ADP molecules into one ATP and one AMP, contributing to ATP recycling.

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What is the main pathway for ATP production in short bursts of activity?

Anaerobic glycolysis is the primary energy pathway for short bursts of activity, like sprinting or weightlifting. It produces ATP rapidly but is not sustainable for long periods.

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ATP/PC system

Provides immediate energy for high-intensity activities lasting less than 10 seconds. It involves the breakdown of phosphocreatine (PC) to regenerate ATP.

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Aerobic system

Provides energy for sustained, moderate to low-intensity activities lasting longer than 2-3 minutes. Uses oxygen to break down glucose and fats for energy.

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Cori cycle

A metabolic pathway that removes lactic acid from the muscles and converts it to glucose in the liver.

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How are the energy systems used during exercise?

The body uses all three energy systems simultaneously, but one system will be dominant depending on the intensity and duration of the activity.

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Study Notes

Compartment Syndrome

  • A condition where increased pressure in a confined space reduces blood flow and tissue function.
  • Anterior compartment syndrome is a type, where high pressure in the front of the leg impairs circulation to muscles, nerves, and distal circulation.
  • The lower leg has 4 compartments: Lateral, Anterior, Superficial Posterior, and Deep Posterior.

Etiology/Pathophysiology

  • Compartment Size: Localized external pressure (tight dressings, casts), or fascial defects can cause this.
  • Compartment Content: Bleeding (hematoma from fractures or vascular injury), increased capillary permeability (trauma, burns, snake bites).

Etiology

  • Fractures
  • Blunt trauma
  • Tight casts or dressings
  • Fascial defects
  • Burns/electrical injuries
  • Hemophilia/coagulation disorders.
  • Snake bites
  • Arterial injuries

Tissue Survival

  • Muscle: Reversible changes under 3-4 hours, irreversible damage after 6-8 hours (muscle death).
  • Nerve: Reversible changes (neuropraxia) within 2-4 hours; irreversible changes after 8 hours.

Diagnosis (5 P's)

  • Pain: disproportionately intense compared to the injury, often in the calf muscles.
  • Pallor: pale skin colour.
  • Paresthesia/Hypoesthesia: decreased or absent sensation.
  • Pulselessness: absent pulse.
  • Paralysis: muscle weakness or inability to move.

Clinical Evaluation

  • Pain is the most crucial sign, especially if disproportionate to the injury.
  • Pain on passive stretching and palpation of the affected compartment are reliable indicators.
  • Other signs (pallor, pulselessness, paralysis, paresthesia) typically appear later and shouldn't delay treatment.

Measuring Compartment Pressure

  • A catheter measures pressure inside the compartment.
  • Normal tissue pressure: 0-4 mm Hg (up to 10 mm Hg during exertion).
  • Compartment syndrome diagnosis: pressure above 30 mm Hg.

General Management

  • Remove tight bandages/casts.
  • Maintain the limb at the level of the heart (to improve blood flow to the area).
  • Administer supplemental oxygen.
  • Perform fasciotomy promptly to prevent irreversible muscle and nerve damage.

Surgical Treatment

  • Fasciotomy: incision into the skin, subcutaneous tissue, and deep fascia to relieve pressure.

Indications for Fasciotomy

  • Pressure within 15–20 mm Hg.
  • Rising pressure inside the compartment.
  • Significant tissue injury.
  • 6 hours of complete limb ischemia.
  • Injuries with a high risk for compartment syndrome (fractures or severe blunt trauma).

Fasciotomy Principles

  • Prompt diagnosis is crucial (early detection).
  • Long incisions are made on both sides of the affected limb (skin, subcutaneous tissue, and deep fascia).
  • Release all fascial compartments.
  • Preserve neurovascular structures.
  • Maintain the wound and administer antibiotics.
  • Close the skin or cover with a skin graft within 7–10 days.

Summary

  • High suspicion for compartment syndrome.
  • Treat quickly upon suspicion.
  • If clinically apparent, do not measure compartment pressure.
  • Fasciotomy is the only treatment to prevent permanent damage and should be performed promptly.

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Related Documents

Compartment Syndrome PDF
Biochemistry of Creatine Metabolism 2024-2025 PDF

Description

This quiz explores the condition of compartment syndrome, focusing on its etiology, pathophysiology, and effects on muscle and nerve survival. Learn about different types, causes, and how increased pressure in confined spaces affects blood flow and tissue function. Test your knowledge on a critical medical topic.

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