What Is Lgb Syndrome

Leon S. Benson

History and Clinical Presentation

After giving birth, a 26-year-old woman became acutely hypotensive from postpartum bleeding. Despite initial efforts at fluid resuscitation, she developed hypovolemic shock and subsequently was the recipient of massive volumes of intravenous fluids and blood to save her life. At one point an infusion pump was used to aid in rapid administration of electrolyte solution. Efforts to resuscitate her were successful and she was then transferred from the maternity ward to the intensive care unit (ICU). It was noted shortly after transfer to the ICU that her left forearm was swollen and discolored, but no further assessment of the extremity was performed at that time. Nursing notes indicated that despite the forearm appearance, peripheral pulse remained "good." The patient was intubated and heavily sedated.

About 8 hours after transfer to the ICU, it was noted that the patient's left forearm and hand were massively swollen and blue. The hand surgery service was then consulted.

Physical Examination

Massive swelling was noted from the left elbow to left hand with severe ecchymosis throughout the dorsal forearm. The patient was obtunded, and no pain responses could be elicited. Radial and ulnar pulses were easily palpable at the wrist. The entire forearm reflected "rock-hard" soft tissue tension. A hospital identification bracelet that had been around the left wrist was extremely tight and at this time was removed. Furthermore, an automatic blood pressure cuff had been placed at the left upper arm and had been cycling on and off every 20 minutes to check the patient's blood pressure. This cuff was also removed and relocated elsewhere. It was also noted that an intravenous catheter (20-gauge) had been placed into the dorsal wrist to aid in rapid fluid replacement earlier in the day. This catheter was now removed and fluid could be seen leaking from the site. Later review of the catheter, IV tubing, and fluid bags revealed that epinephrine-containing solution had also been administered through this intravenous site.

Diagnostic Studies

Plain radiographs of the elbow, forearm, and hand showed no fractures or other bony abnormalities. There was no gas or contrast media in the soft tissues.

Compartment pressures of the dorsal and superficial volar forearm compartments were checked. The dorsal compartment pressure was 131 mm Hg and the volar compartment pressure was 125 mm Hg. Clear fluid began leaking from both puncture sites after compartment pressures were measured. No other diagnostic studies were pursued at that time.

Pregnancy And Childbirth

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