The Six P’s of Compartment Syndrome
1) Pain is the universal symptom in compartment syndrome. While significant pain is almost always present as the pressure within the limb compartment rises, we may mistakenly attribute it solely to the injury itself. When pain seems dramatically out of proportion for the severity of the mechanism, consider the possibility of a compartment syndrome and look a little closer. The pain typically felt with compartment syndrome is a dull, deep aching that is difficult to localize. Pain that increases upon manipulation of the muscle is also suspect for compartment syndrome. 2) Paresthesia this is that hallmark “pins-and-needles” sensation that we feel when one of our limbs has been without adequate circulation for a period of time. If you’ve ever had a crossed leg become temporarily numb while you were sitting down and then felt a rush of pin-prick sensations as circulation returned, you’ve felt two different types of paresthesia (numbness and tingling). Numbness isn’t typically associated with our run-of-the-mill limb injuries. It can indicate nerve damage or it might suggest a progressing compartment syndrome. 3) Pallor Pale, shiny skin distal to the injury should raise our suspicion of compartment syndrome. Bruising May also is present. 4) Paralysis More common in crush injuries, the total inability to move the limb distal to the injury might suggest compartment syndrome. If the limb is still intact, some movement should be possible in the distal extremity. If the limb is lifeless we should suspect significant muscle and nerve disruption and, possibly compartment syndrome. 5) Pulselessness we normally associate pulelessness with the severely angulated limb or massive soft tissue damage. But the absence of a pulse distal to the extremity can be caused by any mechanism that produces a tourniquet type effect. A strong pulse certainly doesn’t rule out compartment syndrome. If the artery you are palpating doesn’t pass through the affected compartment, the pulse may be just fine. But finding a diminished or absent pulse in an otherwise intact limb should lead the caregiver to consider compartment syndrome. Also consider that delayed capillary refill may be a more subtle but earlier sign of decreased circulation in this patient. 6) Poikilothermia Always a great buzz-word to drop at cocktail parties, the specific definition of poikilothermia is an organism or body part that normalizes its temperature with its surrounding temperature. If something attempts to achieve room temperature, it is poikilothermic. In the context of compartment syndrome it refers to the finding of differing temperatures between the affected limb and the uninjured limb. Place a hand on the painful limb just distal to the injury or the site of pain. Then place your other hand on the opposite limb in the same location. If the affected limb feels cooler than the unaffected limb, this suggests that the injured limb is unable to thermoregulate. Anticipate that you would only find differences in temperature with significant and advanced compartment syndrome. When treating limb injuries, compartment syndrome is definitely a possibility that you should add to your differential diagnosis bag. Acute compartment syndrome is a limb threatening issue that requires surgical intervention. As prehospital providers, we should be aware of its hallmark clinical presentation. If we suspect compartment syndrome we should transport the patient to a facility with surgical capabilities and relay our findings to the hospital staff. APPLICATION OF TRACTION:
1. SKIN TRACTION
- In skin traction, the pull is applied to the client's skin which transmitted the pull to the musculoskeletal structures. A belt, head halter, foam rubber wrapped with an elastic bandage, or a foam boot is applied to the client’s skin before the appendage is attached to traction. TYPES OF SKIN TRACTION
a. Pelvic Traction
Used in pelvic fractures to support...
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