J Emerg Med
-
Vital signs upon arrival to the emergency department were studied retrospectively in 59 consecutive patients with isolated penetrating abdominal injuries to determine their chronotropic response to hypotension. Forty-three patients with documented intraperitoneal injury were included in the study and separated into hypotensive and normotensive groups using a systolic blood pressure of 90 or 100 mm Hg. The difference in mean pulse rates between normotensive and hypotensive groups was not statistically significant (P greater than 0.05) although a wide range of pulse rates was noted in both groups. ⋯ Similar findings were observed when the 117 sets of vital signs recorded both in the field and in the emergency department were analyzed as independent pieces of data. Several mechanisms are proposed for the lack of tachycardia in the presence of hypotension. This data suggest that tachycardia may not be a reliable sign of hypovolemic shock when defined by blood pressure criteria in these patients.
-
An athletic young male presented with right calf pain following a twisting injury during a soccer game. Other than apparently severe calf pain, no symptoms or signs of compartment syndrome were noted. The patient later returned with lateral and anterior compartment syndrome, and suffered partial loss of peroneal nerve and muscle function despite fasciotomy. ⋯ Pain out of proportion to the apparent injury and a history of chronic leg pain with exertion may be helpful in identifying these patients prior to development of more obvious signs and symptoms. The diagnosis of acute compartment syndrome may be confirmed by compartmental pressure measurement. Prompt intervention is indicated once the diagnosis is established.