mikbone Posted April 27, 2023 Author Report Share Posted April 27, 2023 1 hour ago, Carborendum said: hematohydrosis There is one other option, that I can think of, that is quite terrifying. There are two conditions that orthopaedic surgeons commonly treat that are both caused by extreme trauma. One is called fracture blisters, and the other is compartment syndrome. We see these injuries when people are involved with severe trauma. High speed MVA, fall from height, extreme torture. Compartment syndrome “Symptoms of acute compartment syndrome can include severe pain, poor pulses, decreased ability to move, numbness, or a pale color of the affected limb. It is most commonly due to physical trauma such as a bone fracture (up to 75% of cases) or crush injury, but it can also be caused by acute exertion during sport. It can also occur after blood flow returns following a period of poor blood flow. Diagnosis is generally based upon a person's symptoms and may be supported by measurement of intracompartmental pressure before, during, and after activity. Normal compartment pressure should be within 12-18 mmHg; anything greater than that is considered abnormal and would need treatment. Treatment is by surgery to open the compartment, completed in a timely manner. If not treated within six hours, permanent muscle or nerve damage can result.” Fracture Blisters “At the location of the fracture, there is an increase in compartment pressure that is found around the area in limbs where blisters do not form and a fasciotomy is not performed, versus in those where the blisters are found. It is presumed that the formation of the blisters relieves some of the myofascial pressure.. It can be noted that there is a decreased number of tight junctions and activation of the paracellular pathway in the blistered skin, allowing for fluid passage into the blister. These blisters are thought to be caused by shearing forces applied at the time of injury. When the bones are broken and deform from their normal shape, the attached skin is then strained to a predictable degree which can be calculated using a formula that takes into account the angle of deformation and the start and end lengths of the area of skin being measured. The shearing and subsequent strain is a result of the difference in elasticity between the dermis and epidermis. There are two types, clear fluid and hemorrhagic, and the difference is found in the level of the shear. Clear fluid blisters separate layers within the epidermis, and hemorrhagic blisters separate at the dermal-epidermal junction. It was found that a strain of 152% generated enough force to shear the skin layers and cause the formation of a hemorrhagic blister. Hemorrhagic blisters are more serious as they represent a complete stripping of epidermal cells. Clinically, the type of blister determines the healing time; clear blisters take about 12 days and hemorrhagic blisters heal in about 16 days.” When the blisters burst, it looks like that person has been sweating blood, the epithelial layer has been disrupted and the exposed dermis is visible. Compartment syndrome is a medical emergency and requires that we surgically release the compartments if not, the muscle and nerve tissues die. The above is an upper extremity status post fasciotomies of all compartments in the forearm and brachium. The patients are extremely thankful after we release the tissues as the pain is tremendous. I hope this did not happen in the Garden. Quote Link to comment Share on other sites More sharing options...
Carborendum Posted April 27, 2023 Report Share Posted April 27, 2023 10 minutes ago, mikbone said: There is one other option, that I can think of, that is quite terrifying. There are two conditions that orthopaedic surgeons commonly treat that are both caused by extreme trauma. OK. 10 minutes ago, mikbone said: Compartment syndrome Sounds pretty painful. But it doesn't seem to fit. 10 minutes ago, mikbone said: Fracture Blisters This could fit. Pretty Painful. But again, why didn't anyone notice the blood afterward? Quote Link to comment Share on other sites More sharing options...
mikbone Posted April 27, 2023 Author Report Share Posted April 27, 2023 (edited) 15 minutes ago, Carborendum said: OK. Sounds pretty painful. But it doesn't seem to fit. This could fit. Pretty Painful. But again, why didn't anyone notice the blood afterward? Unfortunately, it fits. If a compartment syndrome is missed, blisters develop. Once you pop the blisters the fluids drain. The exposed dermis continues to glisten until it dries out or heals. He would have required miraculous intervention to heal the traumatized tissue. Fracture blisters usually heal after a couple of weeks. As long as the dermis is not injured and the pressures are released the patient can recover with minimal scarring. Minimally invasive fasciotomies bilaterally. Edited April 27, 2023 by mikbone Quote Link to comment Share on other sites More sharing options...
Carborendum Posted April 27, 2023 Report Share Posted April 27, 2023 32 minutes ago, mikbone said: Unfortunately, it fits. If a compartment syndrome is missed, blisters develop. Maybe I'm not quite getting it. But what you've shown me so far, I'm not seeing it fitting the narrative. Quote Link to comment Share on other sites More sharing options...
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