By Larry Greenemeier
Journalist Miles O’Brien (click here) earlier this week related a harrowing experience that began when a piece of TV equipment fell on his left forearm, leaving it sore and swollen but not enough for him to seek medical treatment. Two days later, after the pain and swelling had increased, a doctor delivered some terrible news to O’Brien. A sharp increase in pressure inside the journalist’s injured forearm was killing the nerve cells and damaging the arteries and veins. Hours later doctors amputated the dying limb....
...How common is acute compartment syndrome?
Compartment syndrome is a well-described, well-documented entity that orthopedic and vascular surgeons run into on a regular basis. One of the statistics that I’m aware of is that there’s about a 5 percent incidence of acute compartment syndrome as a result of tibia fractures. You’re going to see this condition more often in trauma centers, during wartime or in major disasters. You’ll also see it happen in drug overdose victims if they fall with their head on their arm and stay that way for hours. In those cases it’s not a lot of pressure at once, but over time a lower amount of pressure can cause a compartment syndrome....
...There are no technologies that can tell a physician this is happening. This is a clinical diagnosis based on the five “P”s of compartment syndrome: 1) Is the pain out of proportion? That means the patient doesn’t have a bad injury but is screaming and clawing at the ceiling because they’re in so much pain. 2) Is there pain on a passive stretch? In the case of a leg, if you take the patient’s toe and bend it up or down it will make the pain that much worse. The patient will yell or writhe in pain; more pain than you would expect. 3) Is there pallor? Does the injured limb’s coloring look different from the healthy one? Are the capillaries under the skin under pressure and not getting as much blood flow? 4) Is the patient experiencing "pulselessness" in their limb, or a change in pulse in that limb? 5) And is the patient experiencing paresthesia [a burning or prickling sensation]? When that nerve starts to die the patient will experience numbness and tingling. Once the limb is completely numb and weak, it’s often too late to save the limb....
The blood flow has to re-established through relief of pressure pinching the blood vessels. Blood flow = oxygen.
...do the fasciotomy [which involves making incisions in the fascia to relieve pressure].
If the patient is experiencing compartment syndrome already—they’re having numbness and weakness and pain out of proportion with the severity of their injury and the compartment is swollen and tense—I don’t even really measure pressures a lot in that case, I just move to release the pressure right away....
