1/6. Compartmental syndrome and its relation to the crush syndrome: A spectrum of disease. A review of 11 cases of prolonged limb compression.A review of 11 cases of prolonged limb compression usually following drug overdose, revealed a spectrum of disease from isolated compartmental syndromes to full crush syndromes with renal failure. Residual limb contractures were moderate or severe in 80 per cent of the extremities involved. Five of the 11 patients demonstrated significant, systematic manifestations, Stage II or Stage III crush syndrome by our definition. The severity of the systemic manifestations is related to the amount of muscle tissue being subjected to elevated pressure and the length of time this pressure is maintained. Delay in hospitalization, delay in diagnosis, and delay in treatment prolong this period. The diagnosis should be made on the basis of the histroy of prolonged immobilization and the finding of a swollen extremity. Fasciotomy should be performed immediately, both to minimize residual limb contracture and to prevent the crush syndrome from developing secondary to myonecrosis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/6. lower extremity compartment syndrome in an adolescent with spinal cord injury.OBJECTIVE: Describe the unusual complication of lower extremity compartment syndrome occurring in an adolescent with spinal cord injury (SCI). methods: Case presentation. RESULTS: A 17-year-old male with C5 asia A complete SCI developed a compartment syndrome of his lower leg on the ninth day postinjury. Presenting signs included an equinus deformity of the foot, blackened induration over the anterior tibia, circumferential erythematous markings over the calf, large urticarial lesions over the knee, and calf swelling. The presumed etiology of the compartment syndrome was excessive pressure from elastic wraps, which were placed over gradient elastic stockings. Pressures were 51 mmHg in the superficial posterior, 50 mmHg in the deep posterior, 33 mmHg in the anterior, and 34 mmHg in the peroneal compartments. The patient also developed rhabdomyolysis with myoglobinuria. In addition to supportive care, the patient underwent a dual incision fasciotomy for compartment release. CONCLUSIONS: The development of lower extremity compartment syndrome was probably a result of excessive pressure applied by elastic wraps. Elastic wraps should be used with caution in individuals with SCI.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/6. Gluteal compartment and crush syndromes. Report of three cases and review of the literature.Gluteal compartment syndromes are rare. The pathophysiology and the principles of diagnosis and treatment, however, are the same as those for leg and forearm compartment syndromes. Trauma may not be a salient feature of gluteal compartment syndromes where substance abuse and a prolonged period of unconsciousness, recumbency, or both are more typical. Because of this and the large muscle mass involved, systemic manifestations of a crush syndrome are usually present. Altered mental status and metabolic abnormalities may distract from the primary problem, resulting in delayed diagnosis and treatment. The proximity of the sciatic nerve can result in compression induced neuropathy. Measurement of an elevated compartment pressure confirms the diagnosis. In three patients, aged 37, 31, and 37 years, prompt fasciotomy relieved muscle ischemia, preserved neurologic function, and produced a satisfactory functional result.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/6. Acute compartment syndrome of the upper arm: a report of 2 cases.compartment syndromes of the upper arm are rare clinical entities but can be a serious problem, especially in unconscious patients or those presenting with altered mental status. A high index of suspicion is needed to make an accurate diagnosis. Measuring compartment pressures is helpful, but the role of pressure measurement in the diagnosis and treatment may be secondary to the clinical examination. In patients presenting without histories of trauma, who have sustained long periods of immobilization, a suspicion of a crush syndrome should also be included during the workup of a compartment syndrome. Fasciotomy and debridement of necrotic and nonviable tissue are the treatments of choice for a patient with a compartment syndrome, but initiating medical management and providing medical stability for systemic complications resulting from a crush syndrome may be necessary prior to surgical intervention to prevent organ failure and death. overall, prognosis is improved by early diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/6. Crush injury in pregnancy: an unusual experience in obstetrics.BACKGROUND: Crush injury is the result of prolonged pressure to the limbs when individuals are trapped under the debris of earthquakes, bombings, and other disasters. Muscle integrity is compromised, and the local and systemic manifestations, including rhabdomyolysis, hyperkalemia, renal failure, and disseminated intravascular coagulation may be fatal. CASE: A 32-year-old woman, gravida 2, para 1, was trapped under fallen masonry at 6 weeks' gestation for approximately 6 hours. On initial examination, she showed early signs of hypovolemic shock and crush injury, including hyperkalemia. Prompt management with fluid therapy and careful monitoring led to a rapid recovery. Antenatal follow-up was routine and concluded in spontaneous delivery of a healthy infant. CONCLUSION: The unique physiology of the pregnant woman may affect the outcome of crush injury, and it presents a particular challenge to the trauma team. The obstetrician should be aware of its dangers and should be an active participant in the prompt management of pregnant victims of crush injury to ensure a satisfactory outcome for both mother and fetus.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
6/6. crush syndrome--delayed diagnosis due to a lack of apparent injury mechanism--a case report.A 38-year-old male presented to the emergent department complaining of bilateral leg numbness and weakness after waking from a sleep. Finding himself on the floor, he attributed this problem to falling out of bed. His subsequent course was complicated by progressive leg swelling, shock, profound hemoconcentration and renal failure. He received large volume of crystalloid and fasciotomy in the emergent department and then admitted. He ultimately recovered well. crush syndrome without obvious compressive trauma or substance induced sleep is highly unusual. Early recognition is important because a delay of more than 6 hours in giving adequate volume support will lead to renal failure. Ischemic muscle times of greater than eight hours inevitably lead to residual disability. It remains imperative therefore, to recognize the presence of a compartment syndrome secondary to fluid sequestration early, either clinically or using compartment pressures. A fasciotomy within this eight hour window may still lead to complete recovery.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |