Acute compartment syndrome, Lost TV series and Viagra

You are probably wondering what relationship exists between the elements mentioned in the title, since a priori they do not seem to have much relationship. Don't worry, all your doubts will be resolved, but to do so you will have to read until the end.

Compartment syndrome is a serious and life-threatening condition, especially when it results from an accident or severe trauma. There are mild cases, such as those that affect some athletes due to very specific movements of their discipline, such as in the case of motorcycle riders, since it is common for them to develop this ailment in the forearms. In these cases it is called chronic compartment syndrome and is usually treated with elective surgery. However, there are critical situations caused by fractures or crushes in which it is imperative to go to the hospital immediately. In these extreme scenarios, it is sometimes necessary to amputate the affected limb to save the patient's life.

But what does compartment syndrome mean?

The human body is divided into compartments of muscles, nerves and blood vessels. These compartments are surrounded by fascia, a collagen envelope that is part of the connective tissue, very flexible, resistant, but not elastic, its function is to protect what is underneath and it does it very well, if it were not for the fascia any blow strong would mean a muscle tear, but that lack of elasticity is the key to compartment syndrome.

Due to accidents or sports problems, sometimes the pressure inside these compartments can increase drastically, since the fascia is highly resistant and not elastic, which causes the increase in internal volume to collapse the blood circulation of the area, triggering a series of chain reactions that lead to the death of the patient if not treated in time.

In the case of open fractures (the bone protrudes through the skin to the outside), although the fractures are more serious and have other serious complications, compartment syndrome is less likely to occur, since precisely by breaking the tissues, make it difficult for there to be excess internal pressure.

Curiosity: Acute compartment syndrome can also be caused by a third-degree burn, as internal pressure increases, or by a very tight bandage.

What are the complications of compartment syndrome if it is not treated?

Phase 0. Accident. For example, the patient suffers a crushed leg because a very heavy, blunt object has fallen on it. Common case in construction. The impact causes internal damage to the tissues and as a result of the blow they begin to swell. As the volume grows and the fascia does not stretch, the internal pressure increases until it reaches the point where blood circulation is interrupted.

Phase 1. Tissue damage. If normal blood flow is not restored to the affected areas, the tissues without irrigation begin necrosis (cell death) and release toxins that reach the bloodstream.

Phase 2: Rhabdomyolysis. After necrosis, muscle tissue begins to break down and release myoglobin into the blood. Myoglobin itself is not bad, since it is a protein that is part of muscle tissue, and is responsible for transporting oxygen within the muscle and giving it that characteristic reddish color. The problem is that the myoglobin should not reach the blood, because when it reaches the blood it ends up reaching the kidneys, and they are incapable of filtering the myoglobin. As the kidneys are not able to process it, myoglobin accumulates and the kidneys collapse, ceasing to fulfill their main function.

At this point, nothing can save the patient, who will end up dying from one of these two causes.

Cause of death 1 due to compartment syndrome. Kidney failure caused by rhabdomyolysis. Mortal in a few hours if normality is not restored beforehand, even if the patient's life is saved, it can lead to the death of the kidneys and a transplant may be necessary, with the patient having to undergo dialysis until a suitable solution is found. compatible organ.

Cause of death 2 due to compartment syndrome. Septicemia. It is a serious blood infection caused by bacteria released by the necrosis of injured tissues, which quickly spreads throughout the body, causing multiple organ failure.

 

What is the treatment of compartment syndrome?

The treatment of compartment syndrome must always be carried out by a surgeon, since it is a very complex and delicate process.

Treatment consists of emergency surgery called fasciotomy.

• Fasciotomy consists of cutting the skin and subcutaneous tissue of the affected area until reaching the fascia, which is what maintains pressure inside it.

• Once the surgeon reaches the fascia, he must make long longitudinal cuts throughout the affected area to be able to release the internal pressure first and to be able to evaluate the state of the tissues secondly.

• Once all the fascia has been cut, the tissues beneath it are evaluated, and if they are already necrotic, they must be debrided (cut and removed from the body) to prevent them from continuing to contaminate the blood. In case of bone fractures, the affected bone must also be repaired.

• Postoperative. Depending on the patient's progress and the internal damage, it is likely that instead of sewing the fascia and all the tissues back together, the cuts will be left open in the open air for a few days, until the patient's hemodynamic and cardiovascular situation improves. normalize. In this case, a soft sterile bandage is placed over the wounds and antibiotics may be administered to reduce the risk of infection.

As you can see, fasciotomy is a complex, very invasive surgery that also has a complicated recovery, since it requires a long postoperative monitoring and immobilization time and for the injuries from the accident and those caused by the surgery to heal in order to return. to normal.

In very serious cases, when the damage to the internal tissues is already complete or there is not enough time to perform the operation without losing the patient first, the doctor amputates the affected limb to save the patient's life.

 

What are the symptoms of compartment syndrome?

Since this problem disrupts blood circulation, following trauma or crushing, symptoms that may arise include:

• Severe, disproportionate pain: This is often more intense than would be expected given the initial injury and is not relieved by pain medications. The pain may worsen with stretching of the affected muscle.

• Paresthesia: Abnormal sensations, such as tingling or numbness, in the affected area.

• Loss of function: The affected limb or area may not function properly.

• Weak or absent pulse: Due to increased pressure in the compartment, circulation may be compromised, leading to a weak or absent pulse beyond the affected site.

• Pale and tight skin: The skin over the affected compartment may appear shiny and tight, due to a lack of blood circulation.

And what does all this have to do with the Lost series?

Attention: It is not a spoiler after almost 20 years, if you have not seen it already, you will never see it.

As a curiosity, in the series Lost, when good old Boone Carlyle dies, he does so due to compartment syndrome after falling into a yellow plane down a ravine.

This fall causes a very serious fracture and crushing when the cargo of the plane falls on him. When John Locke takes him badly injured and unconscious to Dr. Jack Shephard, he lies to the doctor and tells him that he has had a fall, omitting the crushing part and therefore causing the injury to not be treated correctly. (fasciotomy or amputation).

When Jack discovers the truth about the accident, it is too late and he decides to amputate his leg, although in the end it does not happen because Boone is already very serious and ends up dying. At the time of his death, Boone is sweating a lot, so in his case death occurred from septicemia and not from rhabdomyolysis, since such a high fever is not a characteristic of rhabdomyolysis.

Here you can see the complete sequence:

And what does all this have to do with Viagra?

After reading the entire article, you will have realized that compartment syndrome can occur in any part of the body where internal pressure can increase enough to cause tissue necrosis. These tissues also include the penis.

Although it may seem complicated to have such serious trauma in the intimate areas (although not impossible), there is a much more common situation that can cause acute compartment syndrome down there. The erection.

The erection itself is not a big problem since it does not last for a long time, but basically each erection is the beginning of compartment syndrome, since the cavernous bodies fill with blood, swell, causing rigidity of the organ and a strong internal pressure, with less blood circulation, that is, a textbook compartment syndrome.

When erections last for hours, as when the famous blue pills to combat sexual impotence are improperly abused, it can reach the point of causing acute compartment syndrome, which leads to hospitalization of the patient or even death. In this case, since the penis does not have muscle tissue, it does not release myoglobin, so rhabdomyolysis does not occur, but the tissues can necrotize, therefore the problem in this case of compartment syndrome is septicemia caused by the necrosis of the cavernous bodies.

In this situation, the treatment usually consists of the injection of an antagonistic solution that empties the corpora cavernosa or directly draining the limb to remove the blood from inside.

Although these types of situations are rare, they can and do happen, so if you are one of those who have sexual marathons, make them shorter :)

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