Pain is your key symptom: you cannot have compartment syndrome without pain. Your suspicion should be raised if the patient has one of the injuries listed above, has a known disorder that predisposes them to bleeding, or has a fracture in the high-risk areas listed above. Pathology of "crush syndrome": crushed muscle releases intracellular calcium → mitochondrial dysfunction → ATP production dysfunction → lactic acid buildup and sodium/potassium and calcium pump dysfunction (necessary for myocyte integrity) → myocyte death → release of intracellular muscle creatine kinase (CK), muscle enzymes, myoglobin, and various electrolytes, which cause acute tubular necrosis of the kidney.Ĭompartment syndrome and crush syndrome cause rhabdomyolysis (muscle cell death) which releases myoglobin into the circulation which is toxic to the tubules of the kidney → acute kidney injury → acute kidney failure.įollowing an initial survey of the scene and the ABCs, compartment syndrome is recognized by a thorough inspection or any and all areas of injury. Isotonic bicarbonate can be used to prevent (and treat) acidosis due to biochemical alterations from the toxins and counteract hyperkalemia.The sicker and more dehydrated the patient, the more deadly rhabdo is to the kidneys.The longer and more severe the ischemia, the more rhabdo occurs.
It often goes hand-in-hand with crush injuries and compartment syndrome.
MUSCLE BREAKDOWN (Rhabdomyolysis): a state where the membranes surrounding the muscle fibers become unstable and spill a nephrotoxic (kidney-killing) protein into the blood. This can occur at any time after a cast has been placed! However, it is most common in the first 12 hours of cast wear. Casts (and splints!) act to lower the amount of swelling, raising the compartment pressure above the ischemic threshold. These are often placed shortly after fracture, which can cause compartment syndrome. CASTS, just like snakebites, are most commonly placed on the forearm and lower leg-hotspots for compartment syndrome. NOTE: Sucking on the wound, applying tourniquets, and pouring substances onto the wound is not effective. If possible a picture or the body of the animal should be brought for identification and administration of appropriate antivenin. Venom from some species of snakes has a high likelihood of causing dramatic and rapid tissue swelling. Snakebites commonly occur on the forearm and lower leg, and these areas are already predisposed to compartment syndrome when injured. SPECIAL SITUATIONS: Snakebites, casts, and muscle breakdown complicate compartment syndrome. Irreversible injury begins 4 hours after the onset of ischemia, resulting in muscle breakdown and neuron degeneration. This gradient, once breached, will stop blood flow. The capillaries push blood forward at a pressure of 20 mmHg, with the normal compartment pressure usually being < 10 mmHg. PRESSURE: The root problem in compartment syndrome is a lack of perfusion to the tissues and resultant ischemia leading to the death of muscle/nerves. Finally, significant burns are another common cause of compartment syndrome.Īny soft tissue injury mediated by toxins, overexertion, medication, and even immobilization can result in compartment syndrome. The more proximal limbs are commonly involved in the setting of significant crush injuries, which can cause muscle damage and enough swelling to overcome the larger sizes of these compartments. Tibial, humeral, and radial/ulnar fractures account for the majority of compartment syndromes due to the small space and complex vascularity of these areas. INJURIES: Fractures and their casting are the most common cause of compartment syndrome. 
In order to understand how this syndrome occurs, we will explore For example, the posterior compartment of the lower leg contains the muscles that flex the knee and extend the foot, along with the major blood/nerve supply of the foot. Generally, a compartment consists of the muscles that perform a specific action and their associated nerves/vessels. Compartment syndrome is a condition that results from increased pressure within the fascial layers that the muscles are grouped into-the " compartments" after which the syndrome is named.
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