Rhabdomyolysis, compartment syndrome and thermal injury
Rhabdomyolysis in a Weight Lifter Using. High-Dose Creatine As its use increases, especially among high- school athletes developed acute compartment syndrome raises sus- . Although a causal relation cannot be proved with. Exertional rhabdomyolysis is sequela that is occasionally seen after strenuous exercise. The progression to compartment syndrome or renal. Acute exertional compartment syndrome (AECS) is a rare cause of leg pain .. The relationship between tissue pressure, compartment, and the.
In the patient with a crush injury, IV fluids should be started even before the trapped limb is freed and decompressed, and certainly no later than six hours after decompression. The longer it takes for rehydration to be initiated, the more likely it is that oliguric renal failure less than mL of urine per day or anuric renal failure less than 50 mL of urine per day will be established. Initially, normal saline should be given at a rate of 1. Urine output should be maintained at mL per hour until myoglobinuria has ceased.
High rates of IV fluid administration should be used at least until the CK level decreases to or below 1, units per L. If these measures successfully thwart the development of oliguria, the patient can be switched to 0.Compartment Syndrome - Overview
Diuretics loop or other types should not be used because they do not improve, and may actually compromise, the final renal outcome. The objectives are to alkalinize urine to a pH of greater than 6.
However, these measures should not be employed if oliguria is established despite initial generous hydration with normal saline.
The use of mannitol remains controversial as it is mostly supported by experimental animal studies and retrospective clinical studies. There are also some concerns about the use of sodium bicarbonate, because it may worsen hypocalcemia or precipitate calcium phosphate deposition on various tissues.
Invasive hemodynamic monitoring is critical to fine-tune treatment in patients with comorbid cardiovascular disorders or preexisting chronic renal dysfunction.
- Exercise Induced Rhabdomyolysis with Compartment Syndrome and Renal Failure
- Etiology and Risk Factors
Diagnosis of atraumatic cases can be difficult, which is why awareness is equally as important as history and physical examination. While diagnosis is primarily clinical, it can be supported with direct intra-compartmental pressure measurements and maintaining a high index of suspicion in acute presentations of exertional limb pain. Anterior Compartment Syndrome, Athletic Injuries, Compartment Syndromes, Leg Injuries, Necrosis Background Acute exertional compartment syndrome AECS is characterized by a rise in pressure within a closed fascial space in the absence of a specific traumatic event [ 1 — 5 ].
This rise in pressure can override capillary perfusion pressure leading to a reduction in myocyte oxygenation and ultimately resulting in myonecrosis and neurologic damage [ 126 ]. In comparison to chronic exertional compartment syndrome, which is relatively benign and typically a self-limiting condition, AECS is a surgical emergency. Many clinicians are aware of the potential for acute compartment syndrome ACS in the setting of fractures, vascular injury, or significant non-fracture extremity trauma.
However, there is limited awareness to the risk of ACS in a non-fracture, non-traumatic presentation. Due to its rarity and atypical presentation, the diagnosis is often delayed [ 1 — 7 ]. Without prompt treatment with fasciotomy, AECS can lead to muscle necrosis and neurovascular injury [ 1 — 7 ].
Therefore, it is critical for clinicians to maintain a high index of suspicion for AECS in patients with acute presentations of non-fracture, atraumatic limb pain.
Acute Exertional Compartment Syndrome with Rhabdomyolysis: Case Report and Review of Literature
Case Report A year-old healthy African American male high school football player presented to the emergency department ED with the subacute onset of right leg pain and the inability to dorsiflex his foot. His past medical history was unremarkable. In the week preceding his presentation, he had attended an off-season football training camp. The day prior to his presentation, the patient developed relatively mild anterior leg pain after a strenuous workout but went to bed that evening thinking it was typical post-exercise muscle soreness.
He woke the next morning with worsening pain in the anterior leg and the inability to dorsiflex his right foot.
He denied any constitutional symptoms such as fevers, chills, sweats, or other musculoskeletal complaints. He maintained normal sensation to the remainder of the foot and ankle. The anterior compartment pressure measured 54 mm Hg with all others less than 25 mm Hg.
Radiographs of the leg and ankle were negative for any abnormalities. Subsequent tests during his admission for glucosephosphate dehydrogenase, sickle cell disease, and hemoglobin electrophoresis were all negative.
Case Reports in Emergency Medicine
Serum electrolytes and electrocardiogram were normal. The patient was diagnosed with acute exertional compartment syndrome of the anterior compartment of the right leg with rhabdomyolysis.
Treatment The Internal Medicine Service was consulted for management of his rhabdomyolysis. The patient received intravenous fluid resuscitation with a total of 4 L of isotonic crystalloid 0.
He was taken to the operating room for emergent anterior and lateral compartment fasciotomies six hours after his presentation to the ED and approximately 24 hours after the onset of his initial symptoms.
Surgical technique Once in the operating theater, general anesthesia was induced. The right leg was prepped and draped in standard fashion and a final timeout was performed.
To avoid any additional ischemia, no tourniquet was utilized during the procedure. Due to his clinical presentation and isolated elevated pressures within the anterior compartment, only the anterior and lateral compartments were released.
The deep and superficial posterior compartments were not entered. An extensive longitudinal incision was made midway between the anterior crest of the tibia and the fibula.