Pediatric emergency medicine trisk 3427 3427
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (69.94 KB, 1 trang )
older) had an increased risk of compartment syndrome compared with younger
children.
Clinical Considerations
Clinical Recognition
Open fractures typically occur due to a high-energy mechanism; therefore, a
complete examination to identify other potentially life-threatening injuries is
imperative. A fractured extremity should be carefully examined for the presence
of an open wound, potentially signifying an open fracture. However, it is not
always obvious if the injury is an open fracture or if it is a laceration that does not
communicate with the fracture. Operative exploration by the orthopedist may be
necessary to determine this.
Compartment syndrome develops when there is an accumulation of
intracompartmental pressure resulting in obstruction of venous outflow and then
increased pressure in the nonelastic compartment. If untreated, small arterioles
and capillaries are eventually occluded, resulting in ischemia with irreversible
muscle and neurovascular tissue damage. Compartment syndrome must be
suspected with any fracture or blunt tissue injury when there is pain out of
proportion to the injury or if the pain is increasing, despite analgesic
administration. The patient may also complain of paresthesias and pain with
passive extension. On physical examination the patient may have pallor and
pulselessness of the injured extremity, although these may be late findings.
Triage Considerations
Children presenting with a concern for an open fracture or compartment
syndrome should be evaluated immediately in the ED with urgent orthopedic
consultation.
Clinical Assessment
For open fractures, the wound should be carefully examined and considered in the
context of the fracture location. With compartment syndrome, the extremity may
be pale and the muscular compartments may be swollen and feel hard and tense.
The pulses may be diminished or absent and the limb may have paralysis or
muscle weakness. Children may present with only a single sign or symptom of
compartment syndrome.
Management
