Transcript AEMT Transition - Unit 39

TRANSITION SERIES
Topics for the Advanced EMT
CHAPTER
39
Soft Tissue Injuries:
Crush Injury and
Compartment Syndrome
Objectives
• Review the occurrences of soft tissue
trauma.
• Discuss pathophysiological changes of
crush and compartment syndrome
injuries.
Objectives (cont’d)
• Differentiate between assessment
findings.
• Review current treatment interventions
for these types of injuries.
Introduction
• Crush injury is a mechanism of blunt
trauma, whereas compartment
syndrome is an injury pattern.
• Crush injuries are caused by excessive
compressive forces on the body.
• Can occur to small localized areas
(thumb), or to large regions (thorax).
Epidemiology
• A broad definition of soft tissue injury
accounts for the vast majority of
traumatic injuries.
• Crush injuries are a small portion of
this category.
Mechanism
• Direct force
– Tissue destruction from compressive
forces
• Entrapment/Weight-based compression
– Compression caused by patient's
position
• Internal compression
– Internal swelling causing compartment
syndrome
Direct force can cause crush injuries, some resulting in open wounds.
A stroke patient who has fallen and trapped her right leg beneath her body
weight.
Pathophysiology
• Direct compression destroys tissue
cells.
• Pressure can also inhibit normal blood
flow to tissues, worsening tissue
damage.
• Compression >4 hours may result in
muscle breakdown with toxin release.
Pathophysiology (cont’d)
• Compartment syndrome
– Compression from the opposite
direction.
– Swelling or bleeding in muscle occurs.
– Fascia enveloping muscle is
nondistensible.
– Pressure builds, causing changes to
blood flow.
Assessment Findings
• Common findings
– Pain to traumatized area
– Possible entrapment of extremity
– Bruising, tenderness, ecchymosis
– Deformity, loss of function
– Diminished or absent distal PMS
Assessment Findings (cont’d)
• Specific compartment syndrome
findings
– Pain, discomfort, burning sensation
– Pain that continues after immobilization
– Tenderness, unusual firmness at injury
site
– Altered PMS distal to the injury
– Weakness or paralysis of muscle
Assess circulation in an extremity following a crush injury.