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| The “P’s” of Compartment Syndrome: How Nurse Practitioners and Physician Assistants can Identify and Treat this Injury |
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by Bob Blumm, MA, PA-C, DFAAPA - July 20, 2010
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Many complications of injuries seen in a practice setting are preventable; chief among them is an entity called compartment syndrome. Failure to prevent, recognize and treat can result in loss of limb or loss of function and large settlements against the PA, their SP and institution. This omission almost always has legal implications for the provider and therefore is worthy of our focused attention.
If you are the unfortunate provider to misdiagnose an injury or was negligent in the workup and treatment, you may discover that your practice or institutional malpractice insurance will address this by first protecting the hospital, secondly, the physician and lastly, you, the PA. As unfair as this may seem, it too is a preventable situation if you have purchased your personal professional liability insurance. Prevention is key in protecting yourself just as it is in preventing this unfortunate situation. What are the “P’s” of compartment syndrome?
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Pain- out of proportion for the injury.
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Pressure-a swollen palpably tense compartment.
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Paresis-muscle weakness due to injury to the nerves, muscle ischemia, vascular damage.
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Pressure stretching passive movement creating pain.
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Paresthesias-requires sensory exams to rule out.
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Pulselessness-serial exams of every fifteen minutes required. Sometimes the patient will initially have a pulse but as the compartment compress, the pulse becomes absent.
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Pressures-When suggestive. Call orthopedist for intracompartment pressures.
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Prevention is better than treatment. The adage is,”an ounce of prevention is worth a pound of cure.”
Interventions:
A. Identify high risk patients (pt taking Coumadin.)
B. Re-examine frequently.
C. Document frequently.
D. Relax tight dressings, or splint and bi-valve cast if casted.
E. Protect soft tissue.
Hopefully you will never be involved in a patient treatment failure such as this and hopefully you will have made the decision to protect yourself with a personal professional liability insurance policy.
Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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