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TRANSITION SERIESTRANSITION SERIES
Topics for the Advanced EMTTopics for the Advanced EMT
CHAPTERCHAPTER
Soft Tissue Injuries: Soft Tissue Injuries: Crush Injury and Crush Injury and Compartment SyndromeCompartment Syndrome
3939
ObjectivesObjectives
• Review the occurrences of soft tissue trauma.
• Discuss pathophysiological changes of crush and compartment syndrome injuries.
Objectives (cont’d)Objectives (cont’d)
• Differentiate between assessment findings.
• Review current treatment interventions for these types of injuries.
IntroductionIntroduction
• 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).
EpidemiologyEpidemiology
• A broad definition of soft tissue injury accounts for the vast majority of traumatic injuries.
• Crush injuries are a small portion of this category.
MechanismMechanism
• Direct force– Tissue destruction from compressive
forces
• Entrapment/Weight-based compression– Compression caused by patient's
position
• Internal compression– Internal swelling causing compartment
syndrome
PathophysiologyPathophysiology
• 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)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 FindingsAssessment 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)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