Compartment syndrome symptoms and medical malpractice
Patients with a broken arms and legs have an increased risk for compartment syndrome
As a Houston, Texas medical malpractice attorney, I handle cases in Harris County, as well as throughout the State of Texas.
A new client recently contacted Painter Law Firm regarding her teenage son who broke his lower leg (fibula) while playing football.
He went to a Corpus Christi, Texas hospital, where he was admitted and an orthopedic surgery was scheduled. The young man remained in the hospital for around four days after surgery. His mother remembers him having bad pain and screaming throughout those days. At one point, both parents had to hold him down onto his bed.
Over the course of time, different nurses told the patient’s mother that they had asked the surgeons to check his legs for compartment syndrome. One of the surgeons commented that he was “past that” and dismissed that idea.
Two days after this young man was discharged from the hospital, his foot dropped and had no pulse. He went to another Corpus Christi Hospital, where his surgeon was working, and was immediately rushed to the operating room for a fasciotomy surgery.
The nurses had been right. The patient had compartment syndrome. Even after the fasciotomy, this young man has no feeling in his leg and unsightly scars from grafts and skin flaps. He is saddened that he cannot run, let alone play football.
Muscles are surrounded by connective tissue called fascia, which forms a compartment around the muscle tissue. Compartment syndrome is a medical condition caused by increased pressure within a muscle compartment of an arm, or leg. It is most common in the forearm and lower leg.
Patients with an injury or fracture (broken bones) account for most cases of compartment syndrome, but exercise has also been known to be a culprit. In these situations, blood fills the confined compartment spaces causes swelling and increased pressure.
If the pressure is unrelieved, it cuts off the blood and oxygen supply to the muscle tissue, which can cause extensive damage, including nerve damage, loss of muscle tissue, infection, and even amputation.
Symptoms of compartment syndrome
The classic symptoms of compartment syndrome are pain that is greater than would be expected for the type of injury, and a change in sensation, like numbness.
Someone came up with a short-cut to remember the “5 Ps” of compartment syndrome: pain, paresthesia (altered sensation), pallor (pale skin color), paralysis, and poikilothermia (inability to regulate temperature). Some experts add a sixth “P,” for pulselessness (a lack of a pulse in the extremity).
The standard of care requires physicians to initiate orders to prevent compartment syndrome in at-risk patients, including elevating and icing the affected extremity. Under Texas law, when a nurse has a suspicion for compartment syndrome, the Board of Nursing rules and regulations, as well as the standard of care, require them to advocate for a physician intervention. This sometimes means that the nurse should escalate an issue to a supervisor if a doctor will not act. Patient safety and well-being are the goals.
If a surgeon or physician suspects compartment syndrome, the standard test would be to insert a needle directly into the potentially-affected muscle compartment. The needle is attached to a pressure monitoring device.
If compartment syndrome is confirmed and was caused by a recent injury, the only treatment is a surgical procedure called fasciotomy. This is typically performed by either an orthopedic or general surgeon and involves opening the thick, fibrous connective tissue lining the muscles, to allow them to swell and relieve pressure within the compartment. Sometimes an additional surgery is necessary to close the skin after the swelling goes away.
Of course, a delay in diagnosing and treating acute compartment syndrome can have devastating impacts on a patient. Those are the situations where an experienced medical malpractice attorney can be of assistance.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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