Clinical practice guidelines for the management of acute limb compartment syndrome following trauma

Wall, Christopher J.; Lynch, Joan; Harris, Ian A.; Richardson, Martin; Brand, Caroline; Lowe, Adrian J.; Sugrue, Michael

doi:10.1111/j.1445-2197.2010.05213.x

Cited by 51 publications

(53 citation statements)

References 39 publications

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“…44 Patients should be monitored for the "six Ps" of compartment syndrome-pain, pallor, paresthesias, pulselessness, pressure, and paralysis-or a raised compartment pressure (higher than 30 mm Hg) after extravasation of hyperosmolar substances. 45 Surgical evaluation for vascular compromise or compartment syndrome should be instituted in higher risk extravasations including the use of higher osmolality agents (higher than 1000 mOsm/L), patients with early symptoms, skin discoloration, or highvolume infiltrations. 6 If compartment syndrome is diagnosed, emergent surgical decompression may be necessary to avoid compromise of tissue and nerve structures.…”

Section: Osmotically Active Agentsmentioning

confidence: 99%

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

et al. 2014

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Extravasations are common manifestations of iatrogenic injury that occur in patients requiring intravenous delivery of known vesicants. These injuries can contribute substantially to patient morbidity, cost of therapy, and length of stay. Many different mechanisms are behind the tissue damage during extravasation injuries. In general, extravasations consist of four different subtypes of tissue injury: vasoconstriction, osmotic, pH related, and cytotoxic. Recognition of high-risk patients, appropriate cannulation technique, and monitoring of higher risk materials remain the standard of care for the prevention of extravasation injury. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. The best therapeutic agent for treatment of vasopressor extravasation is intradermal phentolamine. Topical vasodilators and intradermal terbutaline may provide relief. Intradermal hyaluronidase has been effective for hyperosmotic extravasations, although its use largely depends on the risk of tissue injury and the severity of extravasation. Among the hyperosmotic agents, calcium extravasation is distinctive because it may present as an acute tissue injury or may possess delayed clinical manifestations. Extravasation of acidic or basic materials can produce significant tissue damage. Phenytoin is the prototypical basic drug that causes a clinical manifestation known as purple glove syndrome (PGS). This syndrome is largely managed through preventive and conservative treatment measures. Promethazine is acidic and can cause a devastating extravasation, particularly if administered inadvertently through the arteriolar route. Systemic heparin therapy remains the accepted treatment option for intraarteriolar administration of promethazine. Overall, the evidence for managing extravasations due to noncytotoxic medications is nonexistent or limited to case reports. More research is needed to improve knowledge of patient risk, prompt recognition of the extravasation, and time course for tissue injury, and to develop prevention and treatment strategies for extravasation injuries.

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Section: Osmotically Active Agentsmentioning

confidence: 99%

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

et al. 2014

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“…This rhabdomyolysis results in renal injury. 21,22,24 The pathophysiology of ECS following vascular occlusion may differ slightly. Ischemia-reperfusion injury plays a dominant role.…”

Section: Pathophysiologymentioning

confidence: 99%

Pressure, perfusion, and compartments

Ivatury¹

2014

Journal of Trauma and Acute Care Surgery

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“…Actions to take if compartment syndrome is suspected[20] Split circumferential casts or bandages Position affected limb(s) at heart level Ensure elevation level is \10 cm to maintain good tissue perfusionKeep patient normotensiveWhere the leg is affected, maintain the ankle in the neutral position Clinical review: Volkmann's ischaemic contracture 131…”

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confidence: 99%

Clinical review: Volkmann’s ischaemic contracture

Pettitt

McArthur

2011

Eur J Trauma Emerg Surg

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Prevention is essential regarding Volkmann's ischaemic contracture. This can be achieved through careful observation of patients sustaining high-risk extremity injuries, notably, children with supracondylar fractures of the humerus, and immediate decompression if signs and symptoms of a compartment syndrome are present. Increased awareness amongst doctors of compartment syndrome is fundamental and will allow early recognition, clinical diagnosis and subsequent fasciotomy.

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Clinical practice guidelines for the management of acute limb compartment syndrome following trauma

Abstract: Clinical practice guidelines for the management of acute limb compartment syndrome following trauma have been developed that will support consistency in management and optimize patient health outcomes.

Cited by 51 publications

References 39 publications

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

Pressure, perfusion, and compartments

Clinical review: Volkmann’s ischaemic contracture

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