Compartment syndrome, meaning , types, causes , nursing management , murugesh (1).pptx

This ppt with few visuals will explains meaning of compartment syndrome , main causes , types, nursing management, Intra abdominal pressure monitoring, procedure ,main role of nurses...intra abdominal hypertension & Intra abdominal pressure vitality in maintaining homeostasis.....

1. Compartment syndrome, meaning , types,causes,IAP monitoring,procedure , nursing management PREPARED BY MURUGESH H J RN ICU 02 KFCH JAZAN SAUDI ARABIA

2. Meaning : Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow , which prevents nourishment and oxygen from reaching nerve and muscle cells. Compartment syndrome can be either acute (having severe symptoms for a short period of time) or chronic (long-lasting). Acute compartment syndrome is a medical emergency. It is usually caused by a severe injury and is extremely painful. Without treatment, it can lead to permanent muscle damage. Chronic compartment syndrome, also known as exertional compartment syndrome , is usually not a medical emergency. It is most often caused by athletic exertion and is reversible with rest .

3. A “compartment” is the medical term for a group of muscles, nerves and  blood vessels . Compartments are covered by a fascia — a thin, firm membrane . Compartment syndrome happens when extra pressure builds up inside a compartment and muscles they press against the fascia more than they should. Compartment syndrome can happen to any muscle group, but it’s most common in : ** .Legs , especially in lower legs .** ** .Arms , including   hands and wrists .** ** .Feet.** ** .Abdomen (belly ).** ** .Buttocks (butt ).** MOST COMMON SITES ARE B/L LOWER LIMBS & ABDOMEN ( IN PROLONGED ICU PATIENTS) How it is occurring ? Common sites:

4. LOWER LIMBS COMPARTMENT SYNDROME : What is the main cause of compartment syndrome? Compartment syndrome happens when an injury or repeated stress causes swelling and bleeding inside a muscle compartment. If the pressure builds too much, muscles press against the fascia that holds them in place.

5. CAUSES :- Car accidents. Falling from a high place (like off a roof or ladder). Bone fractures  (broken bones). Crushing injuries (when something heavy falls ). Severe  muscle contusions . Sports injuries . Complications after surgery. Complications from wearing a  cast  or  splint  that’s too tight. Prolonged pressure on an arm or leg after not moving for several hours at a time . Prolonged restraints application , BURNS

6. SIGNS & SYMPTOMS : --- the most common signs and symptoms of lower limbs compartment syndrome include: Visible bulging or swelling around a muscle. Muscle pain  (more severe than the usual soreness feel after intense activity). Tightness. Severe pain when stretching. Numbness . Tingling or a burning feeling under skin ( paresthesia ). Feeling like muscle is fuller, firmer or bigger than usual . The "5 P's" are oftentimes associated with compartment syndrome :   pain, pallor (pale skin tone), paresthesia (numbness feeling), pulselessness (faint pulse) and paralysis (weakness with movements)

7. Nursing management Proper History collection, Thorough physical examination if any abnormality , watch for discoloration , pulse , warm or coldness Elevate the limbs ; if doctors advised Immediate  surgical consult Provide supplemental oxygen. Remove any restrictive casts, dressings, or bandages to relieve pressure. Keep the extremity at the level of the heart to prevent hypo-perfusion. Prevent hypotension and provide blood pressure support in patients with hypotension . Watch for PE Documentation

8. Abdominal compartment syndrome: Abdominal Compartment Syndrome (ACS ) :   is defined as sustained pressures  >  20 mmHg with evidence of organ dysfunction.  General surgery notification should be considered and lactate monitored closely.

9. IMPORTANT TERMS : What is Intra-abdominal Hypertension and Abdominal Compartment Syndrome?? It is the measurement of the pressure inside the abdominal compartment.  Normal Intra-abdominal Pressure (IAP)   is 0 - 5 mmHg; 5-7 mmHg during critical illness. Intra-abdominal Hypertension (IAH)  is defined by pressures > 12 mmHg (may be sufficient to restrict perfusion to the organs of the gut) Abdominal compliance  refers to the ability of the abdominal compartment to accommodate volume and is influenced by the elasticity of the abdominal wall and diaphragm.  It should is expressed as the change in intra-abdominal volume per change in IAP

10. IMPORTANT TERMS : Abdominal Perfusion Pressure (APP)  should be > 60 mmHg and is defined as: APP = MAP – IAP APP is dependent upon an adequate MAP and low IAP Primary IAH or ACS  is the result of abdominopelvic injury or disease and often requires surgical or interventional radiology treatment Secondary IAH or ACS  is the result of conditions that originate outside the abdominopelvic region (e.g., systemic inflammation) Pressure may rise rapidly with active bleeding. Edema ( which occurs with any ischemic insult) will generally result in a later rise in the pressure (27 hours or more post insult) Polycompartment syndrome  is a condition where two or more anatomical compartments have elevated pressures

11. IAP MONITORING : How is Intra-abdominal Compartment Pressure measured? It can be measured directly by inserting a catheter into the abdominal compartment, or indirectly, by monitoring the pressure in the bladder, stomach or other cavities. The simplest and most frequently used method is to measure bladder pressure from an indwelling Foley catheter. Why is it done? All patients who are edematous, critically ill or who have abdominal distension for any reason are at risk. ARDS, intra abdominal disorders and inflammatory states are important risk factors.

12. IAP MONITORING : Procedure for Intra-abdominal Compartment Pressure? Abdominal compartment syndrome pressure can be measured very quickly, by hooking a pressure monitoring system up to the Luer -lock connection of the drainage collecting tubing.  Measurement via the drainage tubing sampling port (versus catheter) allows measurements from any catheter that is connected to continuous drainage.

13. Cont …. Prior to measuring pressure, the bladder should be empty . A volume of 25 ml of saline should be instilled into the empty bladder to allow pressure to facilitate pressure wave transmission while maintaining a constant bladder volume with each measurement . All pressures should be taken with the patient lying supine, head flat and transducer level confirmed. Each measurement should be taken at end expiration.

14. PROCEDURE : ABDOMINAL COMPARTMENT PRESSURE MONITORING VIA BLADDER CATHETER Ensure that  patient and health care provider safety standards are met  during this procedure including: Risk assessment and appropriate PPE 4 Moments of Hand Hygiene Procedural Safety Pause is performed Two patient identification Safe patient handling practices Biomedical waste disposal policies

15. SUPPLIES NEEDED non-sterile gloves   1 litre bag of normal saline one set of pressure tubing with transducer and arterial line extension  1 Kelly clamp  1 30-60 ml Luer -lock syringe  1 urinary drainage bag with a sampling port close to the catheter connection Sterile end cap and alcohol-impregnated Luer -lock cap to maintain sterility after disconnection

16. PROCEDURE: Patients do not require deep sedation, analgesia or neuromuscular blockade for initial screening.    If pressure is elevated , sedation and or neuromuscular blockade may be considered to rule-out false positive due to abdominal wall resistance. Position the head of bed flat with patient supine to relax abdominal wall . Place hand over abdomen to assess for muscle relaxation. Level and zero transducer to mid-axillary line with patient supine and bed flat . Be aware that intra-abdominal pressure may increase after head of bed is elevated due to increased abdominal wall resistance, particularly in patients with elevated pressures ( ie . abdominal pressure measured flat may underestimate the pressure after HOB elevation),

17. PROCEDURE: Scrub the hub of the sampling port on the catheter drainage tubing and allow to dry one minute.  Connect the pressure tubing to the sampling port. Ensure bladder is empty, then clamp the drainage tubing with a Kelly clamp. Connect the syringe to the Luer -lock connection on the extension connection of the pressure tubing

18. PROCEDURE : Turn the stopcock open to the saline and fill the syringe with 25 ml of 0.9% normal saline. Turn the stopcock open to the patient catheter and instill the 25 ml of saline.  Turn the stopcock off to the syringe (open to patient and transducer). Volumes higher than 25 ml can overestimate the pressure, while lower volumes can prevent waveform transmission, and use of a consistent volume reduces variance due to bladder volume. The abdominal blood flow should produce fluctuations in the waveform with the heart beat and show pressure variations with breathing. Flush the pressure system if waveform variation cannot be detected. Wait 60 seconds after instilling saline to give bladder muscle time to relax

19. PROCEDURE : If intra-abdominal pressure is greater than 12 mmHg, review the "Management of Intra-Abdominal Hypertension " with provider and initiate the interventions that are appropriate for this patient. Implement interventions that do not require an order immediately. Monitor for signs of organ dysfunction due to increased intra-abdominal pressure (e.g., rising lactate, decreased urine output, impaired ventilation, mental status changes, hypotension, decreased venous oxygen saturation ). Documentation

20. Referances American Academy of Orthopaedic Surgeons. Compartment Syndrome  (https://orthoinfo.aaos.org/en/diseases--conditions/compartment-syndrome/) . Last reviewed 5/2022. Accessed 12/18/2023. Flautt W, Miller J. Post-surgical rehabilitation following fasciotomies for bilateral chronic exertional compartment syndrome in a special forces soldier: a case report  (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811735/) .  Int J Sports Phys Ther . 2013;8(5):701-715. Accessed 12/18/2023. Garner MR, Taylor SA, Gausden E, Lyden JP. Compartment syndrome: diagnosis, management, and unique concerns in the twenty-first century  (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071472/) .  HSS J . 2014;10(2):143-152. Accessed 12/18/2023. Torlincasi AM, Lopez RA, Waseem M. Acute Compartment Syndrome  (https://pubmed.ncbi.nlm.nih.gov/28846257/) . In:  StatPearls . Treasure Island (FL): StatPearls Publishing; 16 January 2023. Accessed 12/18/2023. Via AG, Oliva F, Spoliti M, Maffulli N. Acute compartment syndrome  (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396671/) .  Muscles Ligaments Tendons J . 2015;5(1):18-22. Accessed 12/18/2023 . London health care centres , critical care trauma centre ; Information and Procedure: Intra-Abdominal Pressure Monitoring

21. Thank you all