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Hand and Upper Limb Emergencies
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
Compartment syndrome is a limb-threatening condition in which increased pressure within a closed (fascial) compartment compromises blood flow to muscles and nerves. If untreated it leads rapidly to tissue ischaemia and necrosis, which can ultimately result in loss of function, loss of limb, rhabdomyolysis and renal compromise. In the upper limb, compartment syndrome most commonly affects the deep compartment of the forearm but it can also affect other compartments of the forearm, hand and (less commonly) the upper arm. Acute compartment syndrome is a surgical emergency for which the only definitive management is decompression with fasciotomies. Time to theatres is crucial as irreversible tissue injury starts at approximately 3 hours of warm ischemia with 6 hours as the upper limit of muscle viability.
Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Important symptoms of compartment syndrome would include pain, which is an early sign and often disproportionate to the injury sustained. It can be elicited with passive stretching of the muscle in the compartment that is affected. Patients may also complain of a tightness or pressure in the affected limb, which is another early indication of developing pathology. Paraesthesia is another early sign and may be in the distribution of the nerve if it travels through the affected compartment. Objective signs, which are often late, include pallor suggesting vascular insufficiency, and pulselessness, although this would need to be confirmed on doppler ultrasound. Paralysis is one of the latest signs, suggesting loss of motor function in the limb. It can be difficult to interpret as the mechanism of injury may prevent movement, however in disease pathology, prolonged nerve or muscle injury can result in permanent damage.
Miscellaneous
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Compartment syndrome is a clinical diagnosis. It should be suspected in patients presenting with pain that is disproportionally high in the affected limb. As the intracompartment pressure increases, further neurovascular compromise occurs which is a late sign. Normal pressure is between 0–10 mmHg and ischaemia can occur at >30 mmHg. If compartment syndrome is suspected, stop using the IO device and measure the compartment pressure. This is a time-critical emergency as irreversible neurovascular injury can occur 4–8 hours after the onset of symptoms.
Comparison and convergence of compartment syndrome techniques: a narrative review
Published in Expert Review of Medical Devices, 2023
Naveen Sharma, Nitin Mohan Sharma, Apurva Sharma, Sarfaraj Mirza
Figure 1 [3] describes the structure of a calf, showing the compartments. Compartment syndrome is a disorder characterized by increased pressure on the tissues or muscles, which is caused by an injury that causes swelling or bleeding within the compartment. Because fascia tissue does not stretch or expand easily, it helps maintain the position of the muscles. Consequently, any swelling, bleeding, or fluid release inside the compartment will exert additional pressure on the muscles, nerves, and so forth, which reduces the oxygenated blood flow and nutrients inside the compartment, resulting in internal damage. This condition may cause irreversible tissue damage if left untreated. Figure 2 [3] represents the condition of compartment syndrome, in which the blood flow has been reduced due to the increased pressure inside the compartments.
Echis coloratus envenomation in children: a retrospective case series
Published in Clinical Toxicology, 2022
Miguel Glatstein, Liat Lerman, Dvir Gatt, Dennis Scolnik, Ayelet Rimon, Christopher Hoyte, Isaac Iazar
None of the patients had prior exposure to antivenom. One patient developed mild urticaria 30 min after initiation of the antivenom; the antivenom infusion was stopped and he was treated with intravenous hydrocortisone and diphenhydramine. Antivenom administration was then restarted at a slower rate, with no further adverse reactions. Patients with significant envenomation were followed up using universal health care system records to ensure that no cases of serum sickness developed. Four patients were treated with hydrocortisone: one for urticaria as described, two patients before a second dose of antivenom. Two patients underwent fasciotomy (Table 3): one developed compartment syndrome, diagnosed by pressure measurement, after antivenom treatment, and the second patient experienced a delay in antivenom therapy due to the fact that the antivenom was not available at the referring hospital. There, they decided to perform fasciotomy before transfer to our institution, as they expected a prolonged transfer time. This child suffered life-threatening bleeding, arriving at our institution with a hemoglobin of 2 g/dL, before the bleeding was controlled with antivenom treatment. Ten patients were admitted to the pediatric intensive care unit. Overall, patients’ clinical outcome was excellent, with complete resolution of all symptoms, signs and laboratory aberrations.
A rare cause of acute compartment syndrome after gluteal cyst rupture
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Moaaz Baghal, Viral Amrutiya, Husam Ali, Siddhant Mehta, Adam Atoot, Abraham Lo
Acute compartment syndrome (ACS) is a limb threatening surgical emergency, and delay in diagnosis and intervention can result in significant morbidities from limb loss and systemic morbidities and even death in some cases [1]. The most common etiology of ACS in extremities is trauma-related fracture or massive soft tissue injury, yet when it is present in non-trauma setting, ACS could be missed or delayed to recognize and intervene upon. Especially in the atypical presentation when classic six Ps: pain out of proportion, palor, paresthesia, poikilothermia, pulsation, paralysis are absent or partially present [2]. Common causes of ACS of the thigh include extreme exercise, DVT, anticoagulation therapy, surgical complications and trauma, with and without fractures [3–5]. The literature review showed a high incidence of ACS in young male patients who have experienced significant trauma. We present an unusual case in which we believe the ACS was secondary to gluteal cyst rupture formed from long-term self-injections of testosterone.