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7 results

  • 3.13.5 - Traumatic Abdominal and Pelvic Injuries

  • from Section 3.13 - Severe Trauma and Multiple Injuries
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 408-410

  • Summary

    Key Learning Points

    1. 1. Abdominal and pelvic trauma may be concealed.

    2. 2. Exsanguination into the abdominal or pelvic cavity should be managed in the resuscitation phase.

    3. 3. Obvious abdominal distension is an indication for laparotomy.

    4. 4. Post-operative ileus should be anticipated and managed appropriately.

    5. 5. Abdominal compartment syndrome is a serious complication of abdominal/pelvic trauma.

  • Compartment syndrome and suicide attempt

  • E. Rodríguez Vázquez, C. Capella Meseguer, J. Gonçalves Cerejeira, I. Santos Carrasco, M. Queipo De Llano De La Viuda, A. Gonzaga Ramírez, G. Guerra Valera
  • Journal:
    European Psychiatry / Volume 64 / Issue S1 / April 2021
    Published online by Cambridge University Press:
    13 August 2021, p. S647
    • Article
      • You have access
      • Open access
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  • Introduction

    The compartment syndrome is a pathological condition characterized by a decrease, or even interruption, of the microcirculation within a soft tissue compartment. There have been a few cases reported about compartment syndrome due to a suicide attempt.

    Objectives

    To present an unusual complication of an autolytic attempt

    Methods

    A descriptive study of a clinical case and literature review

    Results

    A 49-year-old woman, divorced. With no psychiatric history and no somatic antecedents. Comes to the hospital after been found lying face down on the bathroom’s floor for 48 hours, next to her two empty blister packs of lorazepam and naproxen. Her partner says they argued two days ago. Brain CT: with no abnormalities. Blood analysis: metabolic acidosis with rhabdomyolysis and kidney failure. She presents ischemic injuries in both inferior extremities with right food ischemia and with no pedal pulses. Compartment syndrome is diagnosed, being necessary a bilateral fasciotomy and later a right lower extremity amputation. Initiates referral from Vascular Surgery for self-poisoning. She refers to low mood and mild anxiety due to work and relationship issues/problems. She accepts that she self-poisoning only to attract her partner’s attention after the argument. The examination shows logical thought, emotional lability, good judgement, future-oriented without suicidal ideation. Clinical judgement: acute stress reaction.

    Conclusions

    The compartment syndrome is a rare complication of the suicide attempt. Our patient suffered a compartment syndrome lying on the bathroom’s floor for 48 consecutive hours without apparent trauma and no somatic antecedents. This syndrome could be developed by high naproxen and lorazepam intake.

    Disclosure

    No significant relationships.

  • Section 11 - Environmental emergencies

  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 413-450

  • Summary

    This chapter discusses the diagnosis, evaluation and management of rhabdomyolysis. Physical examination of a patient with rhabdomyolysis may reveal muscle swelling and tenderness, with occasional skin changes including discoloration, induration, and blistering. It is possible for rhabdomyolysis to present without any of these signs or symptoms, making serum markers essential to the diagnosis. Severe cases may present with hypovolemic shock, acute kidney injury (AKI), metabolic acidosis, disseminated intravascular coagulation (DIC), compartment syndrome, hyperkalemia, and cardiac arrhythmias. Compartment syndrome occurs due to swelling and edema of the injured muscle: classic physical examination findings include pain, paresthesias, paralysis, pallor, and pulselessness. The cornerstone of management includes discontinuation of inciting factors and aggressive management of fluid and electrolyte abnormalities. Intravenous fluids enhance renal perfusion and increase urinary flow in order to prevent AKI and increase potassium excretion.

  • 24 - Acute decompensated heart failure

  • from Section 4 - Cardiovascular emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 164-170

  • Summary

    This chapter discusses the diagnosis, evaluation and management of compartment syndrome. In trauma, the anterior compartment of the leg is the most common location of compartment syndrome; however, it is possible for it to occur in any extremity compartment. Symptoms commonly arise within 2 hours of injury but can also present up to 6 days later. The additional findings of paresthesias, anesthesia, paralysis, poikilothermia, and pulselessness are very late findings and should not be relied upon in the initial evaluation of compartment syndrome. The treatment of compartment syndrome is immediate relief of the pressure and this starts with removing any constricting devices, bandages or casts. Surgical intervention is the definitive treatment in which complete fasciotomy is performed in the operating room (OR) by trauma, vascular, or orthopedic surgeons. Neutral elevation is the preferred position. Raising the limb above the heart decreases perfusion without decreasing compartment pressures.

  • Acute compartment syndrome of the dorsal forearm following noncontact injury

  • Brent Crawford, Sean Comstock
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 12 / Issue 5 / September 2010
    Published online by Cambridge University Press:
    21 May 2015, pp. 453-456
    Print publication:
    September 2010
    • Article
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  • Acute compartment syndrome is a limb-threatening condition in which early diagnosis and surgical consultation for fasciotomy are required to preserve functional outcome. The diagnosis is typically considered in patients with traumatic mechanisms of injury such as a direct blow and crush to the compartment, particularly when there is a fracture in the same compartment. We report the case of a patient with acute compartment syndrome of the dorsal forearm that occurred as a result of an atypical noncontact traumatic mechanism. Establishing the diagnosis of compartment syndrome was complicated in this patient, as some of the signs and symptoms of acute compartment syndrome could have been attributed to the presence of a coexisting rupture of the extensor digitorum muscle. This report serves to remind emergency physicians that, although rare, acute compartment syndrome can result from exertional and noncontact traumatic mechanisms.

  • 30 - Peripheral Nerve Injuries and Compression Neuropathies

  • from SECTION IV - NEUROLOGICAL TRAUMA
    • By Patricia B. Jozefczyk, Department of Neurology Allegheny General Hospital Pittsburgh, Pennsylvania, Mark Baratz, Department of Orthopedic Suegery Allegheny General Hospital Pittusburgh, Pennsylvania
  • Edited by Sid M. Shah, Michigan State University, Kevin M. Kelly, Drexel University, Philadelphia
  • Book:
    Principles and Practice of Emergency Neurology
    Published online:
    06 August 2009
    Print publication:
    18 February 2003, pp 304-312

  • Summary

    Peripheral nerve injuries are one of three types: neuropraxia, axonotmesis and neurotmesis. Blunt trauma and traction injuries may cause nerve transection when associated with open fractures, but the majority result in neuropraxia or axonotmesis. High-energy trauma to an extremity with or without a fracture may produce a compartment syndrome. Nerve injury does not usually result from a direct electrical source. Typically, the energy is dissipated throughout the soft tissues and the nerve injury resolves more commonly from surrounding soft tissue swelling. Peripheral nerve compression may occur where the nerve passes through a tunnel and slides back and forth with joint flexion and extension. The upper extremity compression neuropathies are: pronator syndrome, anterior interosseous syndrome, carpal tunnel syndrome, thoracic outlet syndrome, cubital tunnel syndrome, Guyon's canal syndrome, posterior interosseous nerve syndrome, radial tunnel syndrome, and radial sensory nerve entrapment.