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Posted
compartment syndrome is the build up of lactic acid. and when released acidosis happens we had a case the other day. a car was on top of a man for at least 13 hrs when he was found the next morning. and form my understand sodium bicarb help by leveling out the PH form a lactic acidosis

What you're describing is more consistant with CRUSH syndrome, not COMPARTMENT...

Posted
so do i --- I will never stop learning

Then you should learn to use the correct syndrome when trying to explain something to someone...

Posted

Now..now guys....I appreciate everyone's help......and compartment syndrome has 5 P's

pain

parestheias

passive stretch

pressure

pulselessness

Thank you both. :lol:

Posted

vs-eh? you most be one of the rudest person I have seen on here--- Pt was invalid in a one car MVC in the over night

pt found next morning 13 hrs after the MVC car was on top of his ABD pt leg was pined not crushed against a root and the car

stopping blood flow and compartment syndrome started. pt his being treated for a compartment syndrome to his leg at hospital--- vs-eh sorry for not giveing all the info. and yes i still have alot to learn never stop learning

Posted

I see we need a little reeducation on compartment syndrome vs. rhabdomyolysis. I'll provide a few links at the end, but to give a brief synopsis:

A muscle compartment (most commonly the compartments in the shin or the forearm) suffers some for of injury. This injury can be a fracture of the bone (tibia, radius/ulna), crush injury, hypoperfusion, etc. The comparment fills with fluid (could be edema or blood) and the pressure in the compartment begins to rise. The compartment has no place to release the additional volume (this is Compartment Syndrome). The pressure inside the compartment gets to the point that it is higher than the perfusion pressure in the muscle and so the blood supply is cut off leading to necrosis and muscle breakdown (this is rhabdomyolysis). So, compartment syndrome can lead to rhabdomyolysis, but hopefully it will be caught before it gets to this point. Compartment syndrome causes the 5 Ps (pain, pallor, parasthesia, pulselessness and poikliothermia). There is no lab test that can be used to diagnose Compartment syndrome. The diagnosis is made by putting a needle into the compartment and measuring the pressure. Treatment is an open fasciotomy (the fascia covering the muscle compartment is cut to reduce the pressure and improve perfusion). There is also an abdominal compartment syndrome, but I won't go into the details (see the link below).

Rhabdomyolysis is the breakdown of muscle tissue. There are many causes (trauma and nontraumatic). To diagnose rhabdo you need a blood test (CPK). The treatment is fluid, fluid, fluid, diuresis, correction of electrolyte abnormalities, monitoring of renal function (dialysis if needed, possibly permanently) and alkalinization of the urine.

Hope this helps clear up some confusion.

http://www.emedicine.com/orthoped/topic55.htm

http://www.emedicine.com/orthoped/topic596.htm

http://www.emedicine.com/emerg/topic508.htm

http://www.emedicine.com/emerg/topic935.htm

Posted

Ok guys, there are 3 mechanisms of crush syndrome--

1. Immediate cell disruption.

2. Direct pressure on muscle cells.

3. Vascular Compromise.

I think tha it would be a good ideal to administer soduim Bicarb, but before extrication of a crush syndrome pt. This keeps myoglobin floating in curculation postponing remal casting and heads off hyperkalemia.

What do you think?????

Thank goodness the pt didn't go into V-fib on me.

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