Compartment Syndrome for Certified Emergency Nursing (CEN)
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Study Tools For Compartment Syndrome for Certified Emergency Nursing (CEN)
Outline
Compartment Syndrome:
Definition/Etiology:
Compartment syndrome is the buildup of pressure within a closed body space, usually one of the extremities, but can also occur in the abdomen.
This is usually the result of bleeding or edema secondary to a traumatic event, most commonly seen in crush injuries.
Pathophysiology:
The compartments that house the muscle, bone and serve of the extremities are surrounded by a nonelastic fascia. I’ll say it again…non-elastic. As pressure from bleeding or edema increases, microcirculation is compromised, causing more edema. Eventually, the pressure within the compartment starts to cause collapse of the small vessels which leads to ischemia and necrosis.
The process can be triggered by a fracture, soft tissue injury (envenomation, crush), vascular injury, burns, or external compression like when a cast has been applied too tightly or when someone falls asleep on their arm or leg, or some who has “FDGB” (fallen down and gone boom, like an elderly person for example, or someone under the influence of ETOH or drugs)
Clinical Presentation:
The most reliable indicator of progressing compartment syndrome is pain out of proportion to the injury. This is important… Disproportionate pain is a key finding in compartment syndrome.
- No relief from pain medications.
Can follow a “5 Ps” progression:
- Pain
- Pallor
- Paresthesias
- Paralysis
- Pulse
This is how this may progress. Starts with that disproportionate pain, then the discoloration or pallor to the area. As the nerves become compressed, they develop paresthesias which progress to paralysis and finally the compression of the vasculature will cause a loss of pulses! Keep that in mind, loss of pulse is a very late sign in compartment syndrome and would require immediate action.
Collaborative Management:
- We need to remove any restrictive items, like tape or ace wraps or anything that could be constricting to the limb.
- Maintain the limb AT THE LEVEL OF THE HEART. Not above. Not below. Hang it low and you increase the pressure. Raise it up and you inhibit arterial perfusion.
- We would want to measure intracompartmental pressure. Check with your facility as to what device you have for this. A very common one, like this one, is the stryker needle. You basically insert the needle into the compartment and get a reading. 10mmhg or less is good. 30-40 and were talking possible fasciotomy.
- Labs…UA, myoglobin, MB, CPK, CBC, Coags
Evaluation | Patient Monitoring | Education:
- Continued monitoring of compartment pressures. If pressures recede and pain is reduced, then we can surmise that the compartment pressures are reducing.
- Cardiac monitoring is a must.
- As with any trauma, don’t lose focus of the whole patient. While the limb is concerning, make sure any other injuries are also being addressed.
Linchpins: (Key Points)
- 5 Ps
- Stryker Needle
- Disproportionate pain
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Emergency Nurses Association. (2022). Emergency Nursing Orientation 3.0. Cambridge, MA: Elsevier, Inc.
- Sheehy, S. B., Hammond, B. B., & Zimmerman, P. G. (2013). Sheehy’s manual of emergency care (Vol. 7th Edition). St. Louis, MO: Elsevier/Mosby.
22 Jan – 28 Feb
Concepts Covered:
- Cardiovascular
- Circulatory System
- Nervous System
- Skeletal System
- Emergency Care of the Cardiac Patient
- Neurological
- Respiratory
- Urinary System
- Respiratory System
- Endocrine System
- Studying
- Tissues and Glands
- Medication Administration
- Hematologic System
- Digestive System
- Reproductive System
- Endocrine and Metabolic Disorders
- Muscular System
- Sensory System
- Basics of Human Biology
- Prefixes
- Suffixes
- Fetal Development
- Terminology
- Proteins
- Statistics
- Med Term Basic
- Med Term Whole
- Preoperative Nursing
- Integumentary Disorders
- Urinary Disorders
- Noninfectious Respiratory Disorder
- Cardiac Disorders
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Central Nervous System Disorders – Brain
- Hematologic Disorders
- Delegation
- Perioperative Nursing Roles
- Acute & Chronic Renal Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Documentation and Communication
- Legal and Ethical Issues
- Factors Influencing Community Health
- Immunological Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Vascular Disorders
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Gastrointestinal Disorders
- Newborn Complications
- Peripheral Nervous System Disorders
- Communication
- Microbiology
- Emergency Care of the Trauma Patient
- Integumentary Disorders
- Musculoskeletal Disorders
- EENT Disorders
- Postoperative Nursing
- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Fundamentals of Emergency Nursing
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Emergency Care of the Neurological Patient
- Neurologic and Cognitive Disorders
- Central Nervous System Disorders – Spinal Cord
- Renal and Urinary Disorders
- Respiratory Disorders
- Infectious Disease Disorders
- EENT Disorders
- Emergency Care of the Respiratory Patient
- Adult
- Anxiety Disorders
- Depressive Disorders
- Dosage Calculations
- Understanding Society
- Concepts of Pharmacology
- Newborn Care
- Adulthood Growth and Development
- Pregnancy Risks
- Postpartum Complications
- Substance Abuse Disorders
- Bipolar Disorders
- Learning Pharmacology
- Psychotic Disorders
- Prenatal Concepts