RESUMO
Acute compartment syndrome is a critical condition, most commonly arising as the result of high-energy trauma, fracture, and crush injury. Early diagnosis and treatment are imperative to avoid permanent functional damage to the affected extremity. Although isolated pedal compartment syndrome is well studied in adults, in the pediatric population, it has been seldom reported. Pediatric patients pose a unique challenge when diagnosing compartment syndrome. Their inability to appropriately verbalize symptoms and participate in physical examinations often causes a delay in diagnosis. We present the case of a 5-year-old female who developed compartment syndrome of her left foot 26 hours after sustaining an isolated crush injury to the distal forefoot. Her treatment included emergent fasciotomy in combination with 20 hyperbaric oxygen therapy treatments. The progression of her acute digital ischemia was monitored by using serial fluorescence microangiography studies performed at 17 hours, 7 days, and 3 weeks postinjury. Throughout these serial studies, improvement in hypofluorescence was noted involving the dorsolateral midfoot, as well as digits 3, 4, and 5, which correlated with physical examination. The patient went on to uneventfully autoamputate the distal aspects of digits 4 and 5 within 4 months of injury. At the 12-month follow-up visit, she denied any pain, sensory deficits, or functional disability and had returned to all preinjury activities. Our case study demonstrates the use of serial microangiography to monitor progression of acute ischemia associated with acute pediatric compartment syndrome and discusses prognostic capabilities.
Assuntos
Angiografia/métodos , Síndromes Compartimentais/diagnóstico por imagem , Lesões por Esmagamento/diagnóstico por imagem , Antepé Humano/diagnóstico por imagem , Isquemia/diagnóstico por imagem , Doença Aguda , Pré-Escolar , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/terapia , Lesões por Esmagamento/complicações , Lesões por Esmagamento/terapia , Progressão da Doença , Fasciotomia , Feminino , Fluorescência , Antepé Humano/irrigação sanguínea , Antepé Humano/lesões , Antepé Humano/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Humanos , Oxigenoterapia Hiperbárica , Isquemia/etiologia , Isquemia/terapia , Falanges dos Dedos do Pé/diagnóstico por imagem , Falanges dos Dedos do Pé/lesõesRESUMO
The realm of addiction and addiction medicine is one in which physicians receive little formal training, particularly in surgical subspecialties. This article presents an overview of addiction medicine and treatment, concentrating on the neurophysiology, psychological aspects, and terminology. Assessment tools and objective findings for recognizing addiction in patients in pain are discussed, as is the management of acute pain and perioperative considerations for patients who are undergoing opioid treatment programs.
