Nursing Care and Pathophysiology for Compartment Syndrome
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Outline
Overview
Pathophysiology: An increased pressure within a space that can only hold so much pressure causes a compromise in the circulation. The tissue in the space will become ischemic and nerve damage will occur.
- Compartment syndrome
- Fluid build up compartments
- Limbs
- Abdomen
- Needs emergent treatment
- Fluid build up compartments
Nursing Points
General
- Injury occurs
- Physical
- Anabolic steroid use
- Fluid or blood fill compartment –> may occur quickly or take a few days
- Pressure on vessels, nerves, muscles
- Oxygen and nutrients aren’t supplied
- Damage –> tissue necrosis
- Abdominal compartment syndrome
- Occurs from injury
- Ruptured aorta
- Ruptured Ileus
- Trauma
- Increased pressure
- Translocation of bacteria
- Inflammation process
- Risk for MODS
- Occurs from injury
Assessment
- Presentation
- Pain
- Tight swollen limb
- Numbness
- Paralysis
- Palpate limb for swelling
- Palpate pulses
- Assess for sensation
- Abdominal pressure –> measured bladder pressure using catheter
- Systemic effects –>rhabdomyolysis
- Myoglobin released, block kidneys
- Decreased urine output
Therapeutic Management
- Surgery = only treatment!
- Fasciotomy –> cut open compartment
- Amputation –> remove limb
Nursing Concepts
- Tissue/Skin Integrity –> leads to necrosis from lack of nutrients and oxygen
- Mobility –> damage to limb, faciotomy and possibly amputation
- Clinical Judgement –> emergent situation
Patient Education
- Avoid anabolic steroid usage
- If injury occurs, see doctor
- Wound care after fasciotomy or amputation
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Transcript
Hey guys! Welcome to the lesson on compartment syndrome where we will explore what causes it and what to do if a patient has it.
Compartment syndrome is the buildup of fluid in compartments in the body that aren’t made to stretch. This can happen in the limbs or the abdomen, and requires emergent treatment.
How does this happen? Well, first injury of some kind occurs to the patient. This could be physical, or caused by anabolic steroid use. The patient might have fractured their arm, or maybe it was crushed by a piano or something. So let’s imagine that this is the inside view of an arm that was injured, and these are the compartments. Fluid or blood begins to fill the compartment because of the damage, putting pressure on the vessels, nerves, and muscles. The increased pressure results in the lack of oxygen and nutrients to the tissues, causing further damage and eventually tissue necrosis.
Compartment syndrome can also happen in the abdomen after an injury such as a ruptured aorta, ruptured ileus, or trauma like a burn in this picture. Burns can cause compartment syndrome by making the skin hard and unable to expand. The injury causes fluid or blood build up and increased pressure. The increased pressure not only makes it more difficult for oxygen and nutrients to reach the tissues, but also causes the translocation of bacteria in the gut. This starts the inflammation process and puts the patient at high risk for MODS which can lead to complete organ failure.
The patient with compartment syndrome will present with pain and a tight swollen limb or abdomen. So here is our patient holding his arm out and a visualization of the compartments in his arm. His arm is super swollen and painful, and he is experiencing some numbness as well because of all the pressure in those compartments pushing on his nerves and vessels.
When you have a patient that presents with these symptoms, you will carefully palpate the limb for swelling and check the pulses. See if the patient has sensation by gently touching the affected limb. If there is question about the patient having abdominal compartment syndrome, the doctor may choose to check the pressure in the abdomen. This is done by using a catheter and a manometer to measure the pressure in the bladder after pushing fluid into the bladder. Next let’s explore what you will do if a patient is diagnosed with compartment syndrome.
Guys, I want you to also think about what this is going to do to the rest of the body. These patients are at risk for rhabdomyolysis because of the muscle breakdown. Breakdown releases myoglobin into circulation, which then obstructs the kidneys causing less urine output. Check out the lesson on rhabdomyolysis to get more details on what rhabdo is and how it affects the body.
The only treatment for compartment syndrome is surgery. The surgeon will either choose to perform a fasciotomy or amputation. A fasciotomy is where the surgeon cuts the compartment lengthwise to open to release pressure. The wound will remain opened until the swelling goes away. After cut open, the limb will try to re-perfuse with blood. This initially is going to make more swelling. While open, the wound will be wrapped in a dressing and monitored. The open wound will have to be cleaned and new dressings applied. The physician may choose to stitch the wound closed before the swelling goes away, and tighten them day by day as the swelling goes down. It could take a couple of weeks to close, and skin grafts could be needed to cover areas that the skin aren’t covering.
So, sometimes after the fasciotomy is performed, the limb does not re-perfuse the tissues. With no perfusion, the tissue will die. If the leg or arm is too far gone where the tissues are dead, an amputation may be performed where the limb or part of the limb is removed.
We should educate our patients to avoid anabolic steroid use to prevent compartment syndrome. They should be educated to see a doctor if severe injury or trauma occurs. The patient will need instructions on wound care after the fasciotomy or amputation. The dressing should be kept dry, and they should only use the dressings that the doctor tells them to use. The limb should be kept elevated as much as possible to help the swelling go down. If they suddenly aren’t able to move the affected limb, the stitches come undone, or redness and new swelling occurs, they need to contact the doctor right away.
The priority nursing concepts for the patient with compartment syndrome are tissue/skin integrity, mobility, and clinical judgement.
Alright, so let’s review the key points. Compartment syndrome occurs after injury of a limb or the abdomen such as trauma or rupture. Oxygen and nutrients are lacking after the fluid builds up, pressure increases, and tissues are damaged that may lead to necrosis of the tissues. The patient will present with pain, numbness, and severe swelling. We assess this patient by checking pulses, carefully palpating the edema, and checking for sensations. If abdominal compartment syndrome is suspected, the bladder pressure will be measured. Remember, surgery is the only treatment for compartment syndrome. The surgeon might perform a fasciotomy or an amputation.
That’s it for our lesson on compartment syndrome. Thanks for listening. Now go out and be your best self today, and as always, happy nursing!
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