Compartment Syndrome


Occurs when a compartment pressure gets high enough to prevent adequate perfusion

MECHANISMS

PATHOPHYSIOLOGY

SYMPTOMS/EXAM

DIAGNOSIS

Pain out of proportion to exam:
■ Compartment syndrome
■ Mesenteric ischemia
■ Necrotizing fasciitis

Loss of pulse is a late finding in compartment syndrome. Do not exclude the diagnosis based on the presence of a pulse.
 

TREATMENT

  1. O2, Correct hypotension, remove cast/splint, place the affected limb at the level of the heart.
  2. <15 mmHg: No treatment is needed.
  3. 20–30 mmHg: Maintain close observation and repeat measurements.
  4. >30 mmHg: Consider fasciotomy.
  5. An elevated pressure on its own may not require fasciotomy.
  6. With strong clinical suspicion fasciotomy may be required even when compartment pressures are normal as this is a clinical diagnosis.
  7. Some cases (ie, compartment syndromes of the hand) may be treated with hyperbaric O2 and limb elevation.
  8. Avoid fasciotomy following snake bites. Extremity snake bites may cause increased compartment pressure, but animal studies show worse outcomes with fasciotomy.