(no subject)
John Wood
bonecrusher@orthotrauma.freeserve.co.uk
Thu, 30 Mar 2000 19:37:24 +0100
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The only time a faschiotomy may be indicated under the circumstances you =
describe would be a) if the compartment pressure was 30 mm Hg within the =
patients Diastolic BP b) clinical examination is not possible eg patient =
comatose, intubated and paralysed or a regional block has been given
c) you have a high index of suspicion. I agree that a two incision, four =
compartment decompression is not without morbidity but is not as =
devastating as a Volkman's ischaemic contracture of the lower limb, =
remember you only have six hours. Better to see red, bleeding, =
contractile muscle than dead muscle (unless you're a lawyer!).
Woody
----- Original Message -----=20
From: Caesar M. Ursic=20
To: trauma-list@trauma.org=20
Sent: Thursday, March 30, 2000 2:58 AM
Subject: (no subject)
"But--compartment syndrome is a clear possibility, and this is a =
classic=20
setting for this--measure compartment pressures! Or--just do a =
4-compartment=20
fasciotomy ."
Perform a fasciotomy if the compartment pressures are normal (<30 mm =
Hg) and the clinical exam doesn't suggest a comp. syndrome??
For what purpose? You wouldn't be decompressing anything, since the =
pressures are already low. If a compartment syndrome had previously =
existed with resultant death of nerves and muscles, opening up the =
compartment at this late stage won't bring them back - but it will =
increase the risk of infection (of non-viable tissues). =20
"Physical findings are notoriously unreliable, and are late=20
manifestations of already damaged tissue when they present--and of =
course,=20
the presence of pulses NEVER excludes it, as the entire musculature of =
the=20
leg can be dead before the pulses go"
Physical findings such as paresthesias and dysesthesias are some of =
the earliest signs and symptoms of extremity compartment syndrome - in =
the patient who is reliable and willing to cooperate with the exam. And =
these early neurologic changes by no means indicate irreversible tissue =
damage. The presence of a pulse, however (as you state) is never of any =
use in ruling out a comp. syndrome.
C.M. Ursic, MD
Dept. of Surgery
UC Davis-East Bay
Oakland, California
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<DIV><FONT face=3DArial size=3D2>The only time a faschiotomy may be =
indicated under=20
the circumstances you describe would be a) if the compartment pressure =
was 30 mm=20
Hg within the patients Diastolic BP b) clinical examination is not =
possible eg=20
patient comatose, intubated and paralysed or a regional block has been=20
given</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>c) you have a high index of suspicion. =
I agree that=20
a two incision, four compartment decompression is not without morbidity =
but is=20
not as devastating as a Volkman's ischaemic contracture of the lower =
limb,=20
remember you only have six hours. Better to see red, bleeding, =
contractile=20
muscle than dead muscle (unless you're a lawyer!).</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Woody</FONT></DIV>
<BLOCKQUOTE=20
style=3D"BORDER-LEFT: #000000 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: =
0px; PADDING-LEFT: 5px; PADDING-RIGHT: 0px">
<DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
<DIV=20
style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
<A href=3D"mailto:cursic@email.msn.com" =
title=3Dcursic@email.msn.com>Caesar M.=20
Ursic</A> </DIV>
<DIV style=3D"FONT: 10pt arial"><B>To:</B> <A=20
href=3D"mailto:trauma-list@trauma.org"=20
title=3Dtrauma-list@trauma.org>trauma-list@trauma.org</A> </DIV>
<DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Thursday, March 30, 2000 =
2:58=20
AM</DIV>
<DIV style=3D"FONT: 10pt arial"><B>Subject:</B> (no subject)</DIV>
<DIV><BR></DIV>
<DIV><FONT size=3D2>
<DIV><EM>"But--compartment syndrome is a clear possibility, and this =
is a=20
classic <BR>setting for this--measure compartment pressures! =
Or--just do=20
a 4-compartment <BR>fasciotomy ."</EM></DIV>
<DIV> </DIV>
<DIV>Perform a fasciotomy if the compartment pressures are normal =
(<30 mm=20
Hg) and the clinical exam doesn't suggest a comp. syndrome??</DIV>
<DIV>For what purpose? You wouldn't be decompressing anything, =
since the=20
pressures are already low. If a compartment syndrome had =
previously=20
existed with resultant death of nerves and muscles, opening up the =
compartment=20
at this late stage won't bring them back - but it will increase the =
risk of=20
infection (of non-viable tissues). </DIV>
<DIV> </DIV>
<DIV><EM>"Physical findings are notoriously unreliable, and are late=20
<BR>manifestations of already damaged tissue when they present--and of =
course,=20
<BR>the presence of pulses NEVER excludes it, as the entire =
musculature of the=20
<BR>leg can be dead before the pulses go"</EM></DIV>
<DIV><BR>Physical findings such as paresthesias and dysesthesias are =
some of=20
the <STRONG>earliest </STRONG>signs and symptoms of extremity =
compartment=20
syndrome - in the patient who is reliable and willing to cooperate =
with the=20
exam. And these early neurologic changes by <STRONG>no means=20
</STRONG>indicate irreversible tissue damage. The presence of a =
pulse,=20
however (as you state) is never of any use in ruling out a comp.=20
syndrome.</DIV>
<DIV> </DIV>
<DIV>C.M. Ursic, MD</DIV>
<DIV>Dept. of Surgery</DIV>
<DIV>UC Davis-East Bay</DIV>
<DIV>Oakland, California</DIV>
<DIV> </DIV></FONT></DIV></BLOCKQUOTE></BODY></HTML>
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