Frequent neurovascular assessments are necessary in patients with compartment syndrome. Late signs of compartment syndrome include pulselessness and paralysis. Early assessment is imperative for early intervention to prevent permanent damage to muscles and nerves.
Determine the location, quality, and intensity of the patient's pain and evaluate the level of pain on a scale of 0 to 10. Pain that is not relieved with medications or is inconsistent with the level of injury may indicate impending compartment syndrome. Increased or excessive pain should be reported immediately to the healthcare provider.
Do not elevate the extremity with compartment syndrome. The extremity should be kept below the level of the heart to promote arterial flow and circulation in the affected extremity.
Items such as casts or bandages should be loosened or removed to prevent vasoconstriction and further complications of compartment syndrome. Increased pressure caused by vasoconstriction may result in tissue ischemia. The cast may be split into half (bivalving the cast) to decrease the possibility of impaired circulation in the extremity. If the patient is in traction, reducing the amount of traction weight will help decrease external pressure surrounding the extremity.
A fasciotomy is a surgical decompression of the extremity used in compartment syndrome; often performed with burn patients. For several days after the procedure, the operative site is left open to ensure adequate soft tissue decompression. Delayed wound closure following a fasciotomy may lead to infection.
Severe cases of compartment syndrome may require amputation because of the great extent of permanent nerve and muscle damage. Providing emotional support is critical for a patient undergoing an amputation.
After a fasciotomy, the surgical site is left open to ensure adequate tissue decompression and increases the patient's risk for developing an infection. The patient may also develop an infection if there is delayed wound closure of the surgical site.
Damaged muscle cells release myoglobin and cause renal tubular obstruction that may progress to acute tubular necrosis and kidney injury. This condition known as rhabdomyolysis is characterized by dark reddish brown urine. Assessing the patient's urine output is critical in determining renal function.
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