Case report: A rare case of acute lumbar paraspinal compartment syndrome in a military trainee

Image by: Airman st Class Janelle Patio

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Author: Conner Murphy, MSIV, Ivan Yue, MSIV, and Vivek Abraham, MSIV
Uniformed Services University School of Medicine
AAEM/RSA Publications and Social Media
Committee

INTRODUCTION
Acute lumbar paraspinal compartment syndrome is a rare injury, occurring primarily in male patients and often related to overhead weight lifting activities.[1] It has also been reported following skiing, surfing, blunt trauma, and as the result of reperfusion injury following abdominal aortic procedures.[2] The syndrome occurs when the enclosed fibro-osseous space of the lumbar paraspinal compartment increases in pressure beyond perfusion pressure, leading to ischemia, intractable pain and eventually tissue necrosis if left untreated.[1] Patients generally present with intense acute pain after exercise, physical exam revealing swollen and tense lumbar paraspinal muscles, and laboratory abnormalities including high creatine kinase levels and myoglobinuria, often appearing like or in conjunction with rhabdomyolysis.[2] Muscle tissue may remain viable for up to four hours without irreversible damage, while eight hours of ischemia has been known to cause irreversible necrosis.[3] Early recognition and orthopedic consultation for surgical management decreases prolonged suffering and neurovascular compromise, allowing resolution of rhabdomyolysis and pain, as well as return to baseline athletic activity.[4] In this case report, we present a case of acute lumbar compartment syndrome in a young athletic male in the context of intense military training.

CPR Induced Consciousness – An Important Phenomenon to be Aware Of

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Author: Jake Toy, DO
Harbor UCLA Medical Center
Originally published: Common Sense July/August 2019

In a recent resuscitation of an unconscious elderly woman in ventricular fibrillation, my team observed that upon initiation of cardiopulmonary resuscitation (CPR), she began to make purposeful movements with her arms and legs. During compressions, she batted at the mechanical CPR device and reached for her endotracheal tube. When attempting to place a femoral line, she withdrew to pain from the needle on that side. Through these periods of seemingly purposeful movements, her eyes remained closed and she was not responsive to voice commands. Upon pulse checks, these movements abruptly ceased. Many questions arose during this resuscitation for my team: Should we physically restrain the patient? Should we chemically sedate? What was the level of the patient’s awareness?

The Power of Mentorship

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Author: Alexandria Gregory, MD

AAEM/RSA Social Media & Publications Committee Chair

Originally published: Common Sense

July/August 2019 

I fell in love with emergency medicine before medical school. Truth be told, I had been hooked on EM since the first time I watched “ER” when I was ten years old. But as I entered college and became pre-med in earnest, I started to wonder if perhaps another specialty might be right for me. That was until I started working as a scribe in the ED. It was there that I fell in love with emergency medicine all over again, and this time for better reasons than I had seen on television. Above all, though, were the people.

SVI: The Next Step 2 CS

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Author: Haig Aintablian, MD
AAEM/RSA President
Originally published: Common Sense July/August 2019

I did great on my SVI. The day of, I had just gotten a haircut and shaved my beard. My top half was covered by a nicely pressed navy blue suit jacket my mom bought me 4 years ago but that I hadn’t touched since my undergrad graduation. Under the blazer, a white shirt I’d worn twice that week already, and a baby blue tie I’m pretty sure I’ve had since high school. Best of all though, my bottom half was covered with a pair of stereotypical grey Hanes boxers – the type you buy in a 6+1 pack because you get one for free. I sat behind a desk in the middle of my half disastrous room (the side not covered by the camera), prayed an Our Father, and I said what had become my motivational slogan at this point, “**** it, we’re almost done.” I looked great on camera. My upper body displaying a professional, well-groomed student against a clean room backdrop with undergraduate degrees newly hung on the wall. There were no tight pants to hold me back (away rotations made me gain weight like a CHFer off Lasix). Regardless of how I looked on camera, I felt a deep helplessness. During the hardest half year of medical school trying to prove myself on away rotation after away rotation, devoid of family, friends, and proper sleep or nutrition, I was expected to be a robot in front of a video camera for reasons no medical student understood, no administrator could directly answer, and almost no PD would actually care about (let alone watch).

FIX Scholarship Winner - Valerie Pierre

Name: Valerie Pierre, MD
Residency Program: Brookdale University Hospital and Medical Center
Graduation Date: June 2021

This photo highlights the importance of mentorship - an integral aspect of my journey in emergency medicine. As I reflect on my matriculation into emergency medicine residency, and the successes, triumphs and failures during my training, I can truly say that my mentors’ support has been a source of encouragement for me. More specifically, I have been fortunate to have strong female mentors who came before me. They continually share their wisdom and experience gained in overcoming the many barriers throughout their journeys in emergency medicine and encourage me to persevere in a primarily male-dominated field. This knowledge that my story is not unique serves as daily inspiration for me.