00:01
Compartment Syndrome,
definition.
00:04
There are few things they
will ask you in the exam.
00:08
The wordings they've
been looking for is
micro circulation is affected
not the micro circulation.
00:16
Then myoneural necrosis,
osseo-fascial compartment.
00:20
So these are the things
they will be asking you.
00:25
In compartment syndrome, what is an
increase in the interstitial fluid,
within the fascial compartment,
between the bone and the fascia?
Needs to compromise of
the micro circulation.
00:35
So what they are trying to get is you
can have a normal peripheral pulse
and the patient can have
a compartment syndrome.
00:41
Okay,
so just because somebody
has got peripheral pulse
doesn't mean they haven't got.
00:46
Yeah.
00:49
Absolutely, you're right,
this is only for the limbs, absolutely,
limbs,
also a fascial compartment.
00:53
Yeah.
00:54
Have you been asked to abdominal
compartment syndrome part A?
I don't think, no, Part B has been
asked, but not in Part A.
01:01
Part A is,
certain things don't happen.
01:06
Part A, you get the compartment
syndrome in the limbs,
and usually there
are still lower limb.
01:11
Very rarely the upper
limb bone in the hand.
01:15
It's exactly the same principle
except that there is no bone.
01:24
Pain,
patient has been
shocked as well.
01:27
Yeah, because...
01:33
Have you seen many?
Have you seen any?
No, it hasn't been asked in
the exam but having said that
they can... the principle is the
same for compartment syndrome.
01:53
Causes...
01:56
this other ones.
01:57
Of which the first two are the
most important one, fracture.
02:02
Trauma, bleeding.
02:04
Although others are...
02:07
or some of there recognized
causes of compartment syndrome.
02:15
Escharotomy,
escharotomy,
will do that when you do burns.
02:20
No, that's okay.
02:22
What's the first symptom?
Pain.
02:24
Next?
Okay, pain on passage to the affected
compartment, that's your first one.
02:33
And then you can paraesthesia,
this is an order.
02:35
This is a same 6 pieces
you get in critically schemically
but this is the order.
02:40
Sensory loss occurs before motor
loss, that's a MCQ question.
02:44
And microvasculature is affected
before the microvasculature.
02:47
So, you can paraesthesia
first, before paralysis.
02:50
And you could pallor first
before pulselessness.
03:03
Okay.
03:05
What's normal compartment
pressure in the lower leg?
Wow, that's too high
normal pressure in you.
03:12
No, it's 0 to 5.
03:14
Yeah.
03:15
You know the...
03:17
32 second off.
03:19
Normal more pressure is 0 to 5,
Compartment pressure
in your exam,
this is what I am going to clarify.
03:27
It is agreed that anything about 30 to 40,
you consider releasing the compartment.
03:32
You think it's
compartment syndrome.
03:34
How are the current guideline
is a differential pressure.
03:37
So what that means is,
if you have a patient
who's in shock,
who's got a diastolic
blood pressure of...
03:48
40, so the blood
pressure 70 over 40.
03:53
Instead of the normal 120/80,
you can't let the compartment
pressure rise to...
04:00
set 12 here,
because the differential
pressure between that is 28.
04:06
So in other words,
the differential blood pressure
between the diastolic pressure
and your compartment pressure
should not exceed 30.
04:16
So differential pressure.
04:17
So if we have a patient with
a normal blood pressure,
you can allow their compartment
pressure to go up to 35.
04:23
Because your differential
pressure is still 45.
04:26
The the rationale is that
much pressure is sufficient
to push the fluid through
into the...
push the food into the circulation.
04:37
Okay, so the differential
pressure is what is important.
04:39
The differential pressure
between the diastolic pressure
and the compartment pressure
shouldn't go less than 30.
04:49
So if this keeps on increasing
or if this keeps on falling
then that serious trouble.
04:55
Okay.
05:07
The compartment syndrome?
No, even if you're associated...
here, you mean?
Well, tricky because let's
say we put it to 90 or 50,
but if this keeps on going
up, what do you do?
If this goes to
14, 15, 16, 17, 18,
so this will maybe
buy you some time
but nothing more than that.
05:31
If the patient has got
compartment syndrome,
nowadays you don't even
measure compartment pressure.
05:35
You just go in by on
clinical suspicion.
05:39
But if you go by absolute value,
then you have to go by those numbers.
05:44
Again the guidelines say you have
to measure the compartment pressure
before you release a
compartment because
the patient ends up with
severe complication
post fasciotomy,
which will end up with
an amputation later.
05:58
Then, the always a question is how do you
know the patient had compartment syndrome?
How did you decide?
What was your objective finding?
You can't say just I
did a bit of (inaudible) and had
I thought the patient
compartment syndrome
so that's why they
suggest to measure it,
just for our records.