compartment syndrom
DESCRIPTION
Compartment syndrom. Robert Dokke ort.avd . SØF. Compartment syndrom. Kronisk c ompartment syndrom Abdominalt c ompartment syndrom Akutt c ompartment syndrom. Richard von Volkmann 1830 - 1889. Beskrev for første gang compartment syndrom. - PowerPoint PPT PresentationTRANSCRIPT
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COMPARTMENT SYNDROM
Robert Dokke ort.avd. SØF
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COMPARTMENT SYNDROM
Kronisk compartment syndrom
Abdominalt compartment syndrom
Akutt compartment syndrom
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Richard von Volkmann 1830 - 1889
Beskrev for første gang compartment syndrom.
Patofysiologien først beskrevet av Seddon i 1966 !
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AKUTT COMPARTMENT SYNDROM
Økt trykk innen en muskellosje som fører til kritisk redusert blodsirkulasjon.Losje hviletrykk 6-8 mmHg
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Økt losjetrykk fører til redusert blodsirkulasjon i kapillære blodårer og dermed redusert oxygentilførsel til muskulatur og nerver.
Ved stort nok trykk fører oxygenmangelen til irreversible skader på muskulatur og nerver!
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Økt trykk Oxygenmangel i vev
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Oxygenmangel Muskel nekrose
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Patofysiologi
Ikke helt kjent!
Hevelse fører til økt venøst trykk og kollaps av vener og til slutt tap av kapilær sirkulasjon
.
Arterie spasmer?
Økt trykk også kollaps av arterioler.
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Tid !Ved øket losjetrykk
Tid før irreversibel skade oppstår avgjørende !
Ca. 6 timer !!
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Kapillærer
Bringer oxygen til vev!
1 celle tykk
Trykket i kapillærer av hengig av blodtrykk.
Ca 30 mm hg!
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Arterio - Venøs shunt
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Ubehandlet fører compartment syndrom til muskel / nerve skade med betydelig funksjonstap!!!!
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Vanligste årsaker til compartment syndrom
Tibia skaft fraktur 36%
Bløtdelskade 23%
Distal Radius fraktur 10%
Crush syndrome 8%
Underarm fraktur 8%
Femur skaft fraktur 3%
Tibia platå fraktur 3%
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Compartment syndrom legg
Forskjellig tye muskulatur i legg.
Fremre losje 45%
Dype bakre 40%
Laterale 10%
Overfladisk bakre 5%
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Mindre vanlige årsaker til compartment syndrom
Well leg syndrome
Revaskularisering
Osteotomi
Marevan blødninger
Slange bitt
Brann skader
Rumpert ganglion
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Husk!!Fjerne stramme bandager!
Klippe opp gipser
Når klippe opp gipser SKAL
HELE gippsen klippes opp!!
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IKKE SLIK!!
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HYPPIGHET7,3 menn per 100 000 / år
0,7 kvinner per 100 000 / år
10 ganger hyppigere hos menn.
Snitt alder menn 30 år
Snitt alder kvinner 44 år
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Risiko pasienten!!
Mann < 35 år
Tibia fraktur
Bløtdels kontusjon
Radius fraktur
Underarm fraktur
Hypotensiv
Blødnings forstyrrelser
Anticoagulantia
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Compartment syndrom alder / kjønn
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Diagnostikk compartment syndromKlinikk
Tenk muligheten!!!Smerter mer enn skaden tilsier!Høyt analgetica behov!!Hevelse / spent losjeNedsatt aktiv muskelaktivitet Smerter ved strekk av muskulaturNedsatt sensibilitet
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Myter
Puls ok alt ok ?
Måle omkrets ?
Åpen fraktur er spaltet?
Høyleie «the more the merrier»?
De 5 P`s.
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TRYKKMÅLING
Subjektivt Objektiv
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Diagnostikk Trykkmåling
Måling / monitorering av losjetrykk!!
Forenklet grensetrykk:Våken kooperabel pas. 30mmHgIkke kooperabel pas. 40 mm Hg
Diskutabelt!
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Delta P trykk
Delta P = Distolisk RR – losjetrykk!
Kritisk grense for Delta P > 30 mm Hg
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Mean pressure
MAP= DP + 1/3 ( SP – DP )
MAP = > 60 mmHg opprettholde oxygenering av organer
Pas. i «schock» med skader mer utsatt for compartmentsyndrom!!
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SØFort. Avd.
Alle legg frakturer trykk -monitoreres i minimum 48 timer
Trykk loggføres hver 30 min.
Sekundær vakt tilkalles ved trykk over 30 mmHg
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CAMINO TRYKKMÅLER
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HVOR ER TRYKKMÅLEREN?
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BEHANDLING
Compartment syndrom Faciotomi
6 timer fra etablert compartmentsyndrom til kirugi !!!
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BEHANDLING
Fasciotomi umiddelbart!!!
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Fasciotomi
Spalting av hud og muskel fascie av alle potentialt berørte losjer!
Spalte nok!!!!Spalt i tide!Spalt alle losjerFasciotomer heller en gang for mye!
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ETTER BEHANDLING
VAC /sekundær sutur Hudtransplantasjon
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SLIK SER DET DESSVERRE UT!!! NÅR DET ER FOR SENT!
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Sequele compartmentsyndrom
Muskel sene kontakturer.
Drop foot
Shortfoot
Nedsatt følelse
Senere korreksjons operasjoner.
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15 ÅR ETTER OVERSETT COMPARTMENTSYNDROM!
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Take home message!
Tenk tanken!
Gi beskjed!
Ikke gi dere!!!