 
the farmer |
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| Author | 10 Posts |
avir
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A 55-year-old male who is a farmer gets injured by a cow that pins him against a fence. His leg was trapped against the fence for several minutes. Being a typical
midwestern farmer  , he ignores the injury until later that afternoon, when he presents to your office complaining of severe pain in the calf area. A radiograph is
normal, and the patient has normal distal pulses. The calf (his leg, not the cow) is tender with increased pain on passive stretch. His pain seems to be out of proportion to his injury.
1. Which of the following is true?
A) Since the patient has excellent pulses, a compartment syndrome is not likely.
B) Compartment syndrome is defined as compartment pressures of 30 mm Hg.
C) Compartment syndrome is only associated with significant crush injuries or fractures.
D) Pain out of proportion to the injury is a red flag for compartment syndrome.
E) His calf (the leg, not the cow) likely has mad cow disease.
2. You decide that it is likely that this patient has a compartment syndrome.
Which of the following labs will be the most helpful in treating this patient?
A) CBC.
B) UA.
C) Glucose.
D) Sodium.
E) PT/PTT.
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| drlilac
Forum Fanatic
Topics: 84
Posts: 3,425
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D & C
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| avir
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why do u need his glucose value?
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| drlilac
Forum Fanatic
Topics: 84
Posts: 3,425
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Oh I'm sorry. Was that lab values you were asking? I thought treatment. Was thinking hyper K...Let's see...UA then
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| avir
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yeah, 'they' were asking......funny Q
yes, D and B
Pain out of proportion to the injury is a red flag for compartment syndrome. Answer A is incorrect because pulses can be maintained until there is significant increase in compartment pressures and significant injury to muscle and nerves. Answer B is incorrect because it is difficult to define a specific cutoff for compartment syndrome. Some patients tolerate higher pressures and others cannot tolerate 30mm Hg (normal compartment pressure is zero).
However, when the pressure gets above 20–30 mg Hg,strong consideration should be given to the presence of compartment syndrome. Answer C is incorrect. Compartment syndrome can be due to a number of
factors including electrical injury, excessive muscle use, tetany, reperfusion after ischemia, etc.
One of the major complications of compartment syndrome is rhabdomyolysis. This will manifest itself as urine that is dipstick-positive for blood but with a negative microscopic exam for red blood cells. The positive dipstick is picking up myoglobin in the urine.
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| drlilac
Forum Fanatic
Topics: 84
Posts: 3,425
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 Salamat!
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| belle
Forum Senior
Topics: 17
Posts: 157
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wow..i got that one rt! I hate it when they twist it all around 
are your qns getting easier avir?!
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| avir
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........yes belle, i have bad days when i can't find tough mcq's...
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| vinegar
Forum Senior
Topics: 13
Posts: 180
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I don't remember what the exact apparatus is called, but if I recall correctly, it's got a needle on one end (which you insert into the leg/arm/wherever) and a pressure measuring device connected to it by rubber tubing.
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| avir
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with Stryker device
http://www.youtube.com/watch?v=hNa2yXCnixw
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