Acute Compartment Syndrome of the Limb
April 7, 2020
Monitoring of the intra-compartmental pressure should be routine in any unconscious, sedated and uncooperative patient. If the delta pressure remains less than 30 mmHg, in the presence of clinical signs and despite conservative measures, fasciotomy should be performed as an emergency to preserve the function of the limb.
Whitesides introduced the concept that the level of intra-compartmental pressure which causes ischemic compromise is related to the perfusion pressure. The “delta p” pressure, comparable to the CPP in brain injury, is the diastolic pressure minus the intra-compartmental pressure. A timely factor is more critical for the neutral structures than it is for the muscle. It is important to consider that there is a dynamic relationship between the level of the intra-compartmental pressure and the duration of the elevated pressure. The longer the delay to fasciotomy, the worse the outcome. If the delay is more than 12 hours, bad results are inevitable.
Brief Case Description
If compartment syndrome is suspected, all circumferential dressings should be removed, normal blood pressure should be achieved by dealing with a cause of hypotension. The extremity should not be elevated, but kept at heart level, to maintain perfusion in the compartment. Supplemental oxygen, to improve the issues oxygenation is also helpful.
Intervention and Outcome Summary
The final clinical outcome of an untreated compartment syndrome diagnosis is the replacement of muscle with scar tissue. This produces a severe fibrosis contracture and a neuropathy of any peripheral nerve traversing the compartment, which can lead to serious dysfunction. Once a patient reaches this stage it becomes impossible to restore normal function within the limb. For early detection of muscle compartment syndrome, it is necessary to educate those taking care of patients at risk, particularly in early signs and symptom.
International Journal of the Care of the Injured
W. Kostler, P.C. Strohm, N.P. Sudkamp