Compartment syndrome (of the extremities) (mechanism of disease) скачать в хорошем качестве

Compartment syndrome (of the extremities) (mechanism of disease)

This is a flowchart on acute compartment syndrome of the limbs, covering the etiology, pathophysiology, and manifestations. ADDITIONAL TAGS: X-rays: identify associated fractures Penetrating injuries: Risk factors / SDOH Cell / tissue damage Structural factors Acute compartment syndrome of the extremities Medicine / iatrogenic Infectious / microbial Biochem / metabolic Immunology / inflammation Signs / symptoms Tests / imaging / labs Neurological pathology Genetic / hereditary Flow physiology Pathophysiology Etiology Manifestations ↑ pressure within a fascial compartment Obstruction of venous outflow Collapse of arterioles ↓ tissue perfusion ↓ oxygen supply to muscles Irreversible damage (necrosis) to muscles, nerves after 4-6 hours External compression Internal compression Burn eschars Constrictive bandage/cast applied before limb has stopped swelling Immobility → poor positioning Hematoma Long bone fractures Gunshot Stab wounds Iatrogenic radial artery perforation Hemorrhage into muscle compartment Crush → deep tissue injury Coagulopathy Spontaneous bleeding Severe edema Burns Venomous animal bites (esp snakes) IV infusion → extravasation Seizures Repetitive muscle use Excessive running Ischemia → reperfusion synd Shock → ↑ capillary permeability External compression Early features (within 1-2 hours) Late features Pain out of proportion to injury: “deep”; “burning”; poorly localized Worse with passive stretch or extension of muscles Extreme tenderness to touch Soft tissue swelling Tight, wood-like muscles Neuro deficits Impaired perfusion Paresthesia (pins and needles sensation) Muscle weakness or paralysis Sensory deficits Cold extremity with pallor Absent or weak distal pulses +/- 6 Ps of acute limb ischemia: Pain, Pallor, Paresthesias, Poikilothermia, Pulselessness, and Paralysis Internal compression Invasive compartment pressure measurement: Delta pressure = diastolic b.p. - intracompartmental pressure ΔP = 30 mm Hg ; rising or sustained ΔP Blood / urine tests for crush injury / rhabdomyolysis: ↑ CK, ↑ LDH, ↑ myoglobin; myoglobinuria