DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
5. A 44-year-old woman is brought to the emergency department 40 minutes after being stabbed in the left groin. Her blood pressure is 128/84 mm Hg, pulse is 100/min, and respirations are 16/min. Examination of the wound shows a small hematoma and no external bleeding. Popliteal and pedal pulses are palpable in the left lower extremity below the injury. Lacerations of the femoral artery and vein are found and repaired. Two days postoperatively, she has progressively severe pain of the left lower extremity and swelling of the leg from the knee down. Which of the following is the most likely cause of her new symptoms?
O A) Arterial embolism
O B) Compartment syndrome
O C) Lymphatic disruption from the injury
O D) Thrombosis of the femoral vein
0 E) Wound hemorrhage
Leg swollen below the knee, pulses palpable…
Compartment Syndrome (B)
OR
Femoral Artery Thrombosis (D)
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| Aashi
Forum Moderator
Topics: 114
Posts: 1,062
|
Compartment Syndrome (B)
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
|
| Eagle_303
Forum Guru
Topics: 77
Posts: 655
|
After two vessels insults
-injury
Embolism
Compartment syndrome is likely to appear..It can appear even after musle injury.
|
| Tuscani
Forum Guru
Topics: 48
Posts: 492
|
why not D) ?
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
Yes, those who think Compartment syndrome, please also explain how you can rule out fem. a. thrombosis!
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| Eagle_303
Forum Guru
Topics: 77
Posts: 655
|
In case of thrombosis of femorla vein whole lower should show swelling.Swelling only below the knee goes in favor of compartment syndrome.
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
Eagle_303 wrote:
In case of thrombosis of femorla vein whole lower should show swelling.Swelling only below the knee goes in favor of compartment syndrome.
Ah, Good explanation... I'm convinced! 
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| risho2008
Forum Newbie
Topics: 0
Posts: 5
|
what about c. lymph obstruction ??
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
risho2008 wrote:
what about c. lymph obstruction ??
I think that would only cause local inflammation in the groin area, not extend below that... correct me if I'm wrong.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| wcfhg
Forum Newbie
Topics: 2
Posts: 7
|
My guess is femoral vein thrombosis. Anyone who answer compartment syn please tell can it be compartment syn in the lower leg when the stabbed wound is in the groin?
|
| Eagle_303
Forum Guru
Topics: 77
Posts: 655
|
Dear
compartment syndrome occurs most probably in the area where there is ischemia.In femoral artery lesion ,thigh has pretty good blood supply in addition to femoral artery through
Gluteal vessels (superior and inferior cruciate anastomosis) + profunda femoris artery .
But leg has only supply i.e through femoral ooing on as popliteal and tibial arteries
Best of luck
|
| Addicudo
Forum Guru
Topics: 124
Posts: 615
|
Nice discussion ..
I'd like to add a bit too...
The answer is Definitely Compartment Syndrome .. As the Question asks .. What is the cause of the patients new symptom..
Now .. As Eagle_303 said ... Blood supply to the thigh is multiple .. This would Rule out Femoral ARTERY thrombosis .... And not INCLUDE Compartment syndrome .. as it is not Solely due to Ischemia .. But it is due to AN INCREASE in the interstitial Pressure...
Therefore .. the options ... Femoral Vein Thrombosis ... and Lymphatic Obstruction may Contribute to the increased Interstitial pressure ... and they then might cause Compartment syndrome ...
Thus ... the answers Femoral Vein and Lymph Obstruction .. might be the cause .. BUT the Answer to the Question is .. COMPARTMENT SYNDROME .
___________________
... Idle hands are the DeVilS play ground ...
|
| The-surgeon
Forum Newbie
Topics: 4
Posts: 22
|
(Popliteal and pedal pulses are palpable in the left lower extremity below the injury.)
but at time of injury the story suggests a good blood supply to the lower leg aand foot?!
as to say no signs of ischemia...
please anyone can explain?
|
| Eagle_303
Forum Guru
Topics: 77
Posts: 655
|
Dear this ischemia does not develop at the time of compartment syndrome presentation.
Events go like this
Femoral artery lesion -------------> ishemia of the leg -------------> accumulation of vasodilator metabolites -----------> restoration of blood supply --------------> edema of the leg -----------> compression of the veins -------------> more edema -------------> more compression and so on (Compartment syndrome) .
Best of luck
|
| Addicudo
Forum Guru
Topics: 124
Posts: 615
|
 (Y) !!!
___________________
... Idle hands are the DeVilS play ground ...
|
| janan
Forum Newbie
Topics: 0
Posts: 44
|
But what about those classical 5ps of compartment syndrome....
pain, PULSNESSNES,paresthesia,pallor,paresis...there are pulses...two days after, it's more of venous thrombosis..which is commonest after 2 days and then after 7 days..
|
| hero
Forum Guru
Topics: 42
Posts: 557
|
janan wrote:
But what about those classical 5ps of compartment syndrome....
pain, PULSNESSNES,paresthesia,pallor,paresis...there are pulses...two days after, it's more of venous thrombosis..which is commonest after 2 days and then after 7 days..
exactly, this is the classic. but presence of pulses does not exclude compartment syndrome. UW stressed on it.
|
| The-surgeon
Forum Newbie
Topics: 4
Posts: 22
|
but presence of pulses does not exclude compartment syndrome. UW stressed on it.
what goes with ompartment syndrome is severe pain , a swelling below knee level and if the above sentence is certian then the answer would be compartment sundrome.
regarding thrombosis of femoral vein what goes against is the swelling which is only below knee if it was a real thrombosis of femoral vein then the swelling level should be higher ...
i will choose B.
eagle & hero thanks for the explanation
|
| paheli
It'sAllAboutGoodKarma
Topics: 197
Posts: 2,720
|
It's B. Good one, guys. Thanks.
___________________
Prepare as if you're the worst, Perform as if you're the best! As you dream, so you manifest. So, DREAM BIG!! When you face hardship, remember, God never gives you more than you can handle. Keep your face to the sunshine and you cannot see the shadows. Internship, Here I come!!
|
| nightflight1945
banned
Topics: 32
Posts: 920
|
B is the correct answer
|
|
| |
| | | | | | | | | | | | | | | | | | | | |
Similar forum topics