compartment-syndrome ppt fix presentasi
TRANSCRIPT
![Page 1: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/1.jpg)
Compartment SyndromesPembimbing:
dr. A. Fauzi Sp.OT
Penyaji:Asih Suliistiyani
Dea Lita BarozhaRizky Bayu Ajie
![Page 2: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/2.jpg)
![Page 3: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/3.jpg)
• peningkatan tekanan interstitial dalam sebuah ruangan terbatas yakni kompartemen osteofasial yang tertutup. Hal ini dapat mengawali terjadinya kekurangan oksigen akibat penekanan pembuluh darah, sehingga mengakibatkan berkurangnya perfusi jaringan dan diikuti dengan kematian jaringan.
![Page 4: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/4.jpg)
• RAISED PRESSURE RAISED PRESSURE WITHIN A CLOSED SPACEWITHIN A CLOSED SPACE with a potential to cause irreversible damageirreversible damage to the contents of the closed space
![Page 5: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/5.jpg)
![Page 6: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/6.jpg)
![Page 7: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/7.jpg)
![Page 8: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/8.jpg)
![Page 9: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/9.jpg)
![Page 10: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/10.jpg)
Etiologi
![Page 11: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/11.jpg)
Pathophysiology• Local Blood Flow is reduced as a
consequence:LBF=Pa-Pv / R (A-V Gradient)
P= pressure (mmHg)R= ressistance to flow (mmHg x
time/volume)
![Page 12: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/12.jpg)
Kompartemen sindrom menyebabkan:1. peningkatan tekanan jaringan2. penurunan aliran darah kapiler3. hipoksia dan menyebabkan nekrosis
![Page 13: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/13.jpg)
Pathophysiology
Penigkatan tekanan jaringan menyebabkan obstruksi vena. Peningkatan tekanan yang terus menerus di dalam kompartemen terjadi sampai tekanan arteriol intramuskular terlampaui dan darah tidak bisa masuk ke kapiler Kebocoran dalam kompartemen P meningkat
![Page 14: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/14.jpg)
Pathophysiology
• Increased compartment pressure
Increased venous pressure
Decreased blood flow
Decreases perfusion
![Page 15: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/15.jpg)
Pathophysiology
Mekanisme autoregulasi dapat mengkompensasi:•Penurunan resistensi pembuluh darah perifer•Peningkatan ekstraksi oksigen
Jika sistem autoregulasi menurun:•“Critical closing pressure” tercapai•Perfusi oksigen otot dan saraf menurun
![Page 16: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/16.jpg)
Muscle Ischemia
• 4 hours - reversible damage• 8 hours - irreversible changes
Hargens JBJS 1981
![Page 17: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/17.jpg)
Muscle Ischemia
Mioglobinuria setelah 4 jam•gagal ginjal•output urin tinggi•Urin bersifat basa (alkalinize)
Kematian sel memulai "lingkaran setan"•meningkatkan permeabilitas kapiler•meningkat pembengkakan otot
![Page 18: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/18.jpg)
Increased muscle swelling
Increased permeability
Increased compartment pressure
![Page 19: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/19.jpg)
• Increased pressure
Increased venous pressure
Decreased blood flow
Decreases perfusion
![Page 20: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/20.jpg)
Increased muscle swelling
Increased permeability
Increased compartment pressure
Repetitive Cycle
![Page 21: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/21.jpg)
Nerve Ischemia
• 1 jam - konduksi yang normal• 1- 4 jam - kerusakan neuropraxic
reversibel• 8 jam – kerusakan saraf ireversibel
Hargens et al. JBJS 1979
![Page 22: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/22.jpg)
Diagnosis
– History– Physical Exam– Suporting exam
![Page 23: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/23.jpg)
Difficult Diagnosis• Classic signs of the 5 P’s - ARE NOT RELIABLE:
– pain– pallor – paralysis– pulselessness – paresthesias
• These signs may be present in the absence of compartment syndrome.
![Page 24: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/24.jpg)
Diagnosis
• Pulsasi biasanya masih teraba pada kompartemen sindrom akut kecuali pada cidera arteri
• Perubahan sensorik dan kelumpuhan tidak terjadi sampai iskemia telah berlangsung selama sekitar 1 jam atau lebih
![Page 25: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/25.jpg)
Diagnosis
• The most important most important symptomsymptom of an impending compartment syndrome is PAIN DISPROPORTIONATE PAIN DISPROPORTIONATE TO THAT EXPECTED FOR TO THAT EXPECTED FOR THE INJURYTHE INJURY
![Page 26: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/26.jpg)
Tanda dan gejala
• Nyeri–sakit–Otot peregangan pasif–Keluar dari proporsi–progresif–Tidak hilang dengan imobilisasi
![Page 27: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/27.jpg)
Tanda dan gejala
• Parasthesia–rasa kesemutan–Harus dapat membedakan dengan
cidera saraf
![Page 28: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/28.jpg)
Tanda dan gejala• Paralysis (Weakness)
– Tanda telah terjadinya iskemia otot– Merupakan tanda lambat akibat menurunnya sensasi
saraf yang berlanjut dengan hilangnya fungsi bagian yang terkena kompartemen sindrom.
![Page 29: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/29.jpg)
Pemeriksaan penunjang
![Page 30: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/30.jpg)
Pemeriksaan penunjang
Imaging :•Rontgen : pada ekstremitas yang terkena.•USG: USG membantu untuk mengevaluasi aliran arteri dalam memvisualisasi Deep Vein Thrombosis (DVT)
![Page 31: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/31.jpg)
Pengukuran Tekanan Kompartemen
1. Teknik pengukuran langsung dengan teknik injeksi• Alat : spuitt 20 cc, three way tap, tabung intra vena, normal saline sterile, manometer air raksa untuk
mengukur tekanan darah.
1. Atur spuit dengan plunger pada posisi 15 cc. Tandai saline sampai mengisi setengah tabung , tutup three way tap tahan normal saline dalam tabung. 2. Anestesi local pada kulit, tapi tidak sampai menginfiltrasi otot. Masukkan jarum 18 kedalam otot yang diperiksa, hubungkan tabung dengan manometer air raksa dan buka three way tap. 3. Dorong plunger dan tekanan akan meningkat secara lambat. Baca manometer air raksa. Saat tekanan kompartemen tinggi, tekanan air raksa akan naik.
![Page 32: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/32.jpg)
2. Wick kateter
Masukkan kateter dengan jarum ke dalam otot. Selanjutnya, tarik jarum dan masukkan kateter wick melalui sarung plastik. Setelah itu, balut wick kateter ke kulit, dan dorong sarung plastik kembali, isi system dengan normal saline yang mengandung heparine dan ukur tekanan kompartemen dengan transducer recorder. Periksa ulang patensi kateter dengan tangan menekan pada otot. Hilangkan semua tekanan external pada otot yang diperiksa dan ukur tekanan kompartemen, jika tekanan mencapai 30 mmHg, maka indikasi dilakukan fasciotomi.
Tekanan arteri rata-rata yang normal pada kompartemen otot adalah 8,5+6 mmHg.
Selama tekanan pada salah satu kompartemen kurang dari 30 mmHg (tekanan pengisian
kapiler diastolik), tidak perlu khawatir tentang sindroma kompartemen. sindroma
kompartemen dapat timbul jika tekanan dalam kompartemen lebih dari 10 mmHg.
![Page 33: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/33.jpg)
Tissue Pressure
![Page 34: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/34.jpg)
Pressure Measurement• Infusion
– manometer– saline– 3-way stopcock (Whitesides, CORR 1975)
• Catheter– wick– slit catheter
• Arterial line– 16 - 18 ga. Needle (5-19 mm Hg higher)– transducer– monitor
• Stryker device– Side port needle
![Page 35: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/35.jpg)
• Needle– 18 gauge– Side ported
• Catheter– wick– slit
• Performed within 5 cm of the injury if possible-Whitesides, Heckman
Side port
Pressure Measurement
![Page 36: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/36.jpg)
Penatalaksanaan suportif1. Menempatkan kaki setinggi jantung, untuk mempertahankan
ketinggian kompartemen yang minimal, elevasi dihindari karena dapat menurunkan aliran darah dan akan lebih memperberat iskemi.
2. Pada kasus penurunan ukuran kompartemen, gips harus di buka dan pembalut kontriksi dilepas.
3. Pada kasus gigitan ular berbisa, pemberian anti racun dapat menghambat perkembangan sindroma kompartemen
4. Mengoreksi hipoperfusi dengan cairan kristaloid dan produk darah5. Pada peningkatan isi kompartemen, diuretik dan pemakainan
manitol dapat mengurangi tekanan kompartemen. Manitol mereduksi edema seluler, dengan memproduksi kembali energi seluler yang normal dan mereduksi sel otot yang nekrosis melalui kemampuan dari radikal bebas.
![Page 37: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/37.jpg)
Penanganan awal
• Remove restricting bandages• Serial exams• When diagnosis made
– Immediate surgery• 4 compartment fasciotomy
![Page 38: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/38.jpg)
Treatment
THE ONLY EFFECTIVE WAY TO DECOMPRESS AN ACUTE COMPARTMENT SYNDROME IS BY SURGICAL FASCIOTOMY!!! (unless missed compartment syndrome)
![Page 39: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/39.jpg)
Treatment
• Fasciotomy–Insisi tunggal
• Dengan atau Fibulectomy
–Insisi ganda
![Page 40: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/40.jpg)
One Incision
• Direct lateral incision
![Page 41: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/41.jpg)
Perifibular Fasciotomy• Insisi tunggal• Dari kepala fibula sampai ke ujung proksimal dari lateral
malleolus• Memotong fasia antara soleus dan FHL secara distal dan
diperpanjang ke arah proksimal ke asal soleus dari fibula
![Page 42: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/42.jpg)
• Lateral compartment
![Page 43: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/43.jpg)
• Anterior compartment
![Page 44: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/44.jpg)
Two incisions
• Lateral • Medial
![Page 45: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/45.jpg)
![Page 46: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/46.jpg)
Double Incision
• 2 insisi vertikal dipisahkan oleh jarak antar insis kulit minimal 8 cm
• Insisi anterolateral: dari lutut sampai mata kaki, berpusat di interval antara anterior dan lateral kompartemen
![Page 47: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/47.jpg)
Double Incision• Posteromedial Insisi: berpusat 1-2cm di
belakangperbatasan posteromedial tibia• Soleus harus terlepas dari tibia untuk memadai
dekompresi bagian proksimal dari kompartemen posterior
![Page 48: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/48.jpg)
Compartments of the Forearm
• Lengan bawah dibagi menjadi 3 kompartemen: Dorsal, Volar and “Mobile Wad”
![Page 49: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/49.jpg)
Henry Approach
• Sayatan dimulai dari proksimal sampai fossa antecubital dan meluas di carpal tunnel
• Mulai lateral tendon biseps, melintasi lipatan siku dan memanjang secara radial, lalu diperpanjang kedistal sepanjang medial brakioradialis dan meluas di telapak sepanjang lipatan tenar
• Atau, sayatan langsung dari bisep lateral sampai radial styloid.
![Page 50: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/50.jpg)
Henry Approach
• Fascia yang ada di otot permukaan di potong
![Page 51: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/51.jpg)
Henry Approach
• Brakioradialis dan n. Radialis superfisial ditarik ke radial dan arteri radial ditarik ulnaris untuk mengekspos otot volar
• Fasia dari masing-masing otot kemudian dipotong
![Page 52: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/52.jpg)
Post Fasciotomy…
– Rawat luka secara basah (dengan PZ)– Ekstensi anggota gerak– Ganjal bantal/elevasi anggota gerak setinggi level
jantung– Observasi ketat: nyeri, parestesia, paresis– Delayed closure atau skin graft setelah oedema
berkurang (rata-rata pada hari ke 5-7)
![Page 53: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/53.jpg)
Conclusion• Sangat penting untuk membuat diagnosis• Salah diagnosis kompartemen sindrom adalah
bencana• pemeriksaan fisik• Ulangi memeriksa pasien!
![Page 54: Compartment-Syndrome Ppt FIX Presentasi](https://reader035.vdokumen.com/reader035/viewer/2022081417/5695d55c1a28ab9b02a51306/html5/thumbnails/54.jpg)
TERIMAKASIH