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HWN Suggests

Is delta pressure accurate for compartment syndrome?

As you sit down at your workstation to finally catch up on some of those notes you’ve been putting off until the end of your shift, one of the nurses comes to notify you… “You remember that patient in room 4 with the leg pain? This is her urine…”

You take a quick look over and immediately appreciate her concern. She’s holding a sample of urine that’s so dark, it looks like it came straight out of that Coca-Cola(TM) bottle you have sitting on your desk! You immediately review her presentation… “68-year-old woman with cerebral palsy, normally ambulatory, presenting with left lower extremity pain, swelling, and difficulty walking. Her ‘legs buckled’ and she fell while trying to sit…

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Featured

 A Crushing Case – Compartment Syndrome

Severe pain out of proportion to the examination and pain with passive stretching are the first symptoms of ACS to occur. While the early signs are 97% specific for ACS they are only 19% sensitive in the absence of other findings. Compartment syndrome is an important not to miss diagnosis. It should be considered in any hard to control limb pain, especially when associated with fracture.

Articles of Interest

Acute Compartment Syndrome—An Urgent Care Review

The take-home is that history and mechanics of the injury are essential clues in determining whether a patient is at risk for ACS. Cases of potential knee dislocation should always be approached with a high index of suspicion and thorough history guided, but not dictated, by a careful physical exam.

Compartment Syndrome in Children – a little bit trickier

It is important to realize that Compartment Syndrome is a dynamic process and potentially evolving as you are evaluating the patient. Serial examinations is paramount. The goal is to detect the condition before it progresses to the state of having all 5 P’s and, thus, improve outcome.

Compartment Syndrome with Rhabdomyolysis in a Marathon Runner

Acute compartment syndrome is a serious disease, which can result in severe morbidity and even mortality. Outcomes are progressively worse with delayed recognition of the diagnosis and the associated delayed treatment. The vast majority of compartment syndrome-associated injuries occur in relation to high-velocity trauma, fractures, and crush injuries.

Forearm Strangulation: An Interesting Cause of Compartment Syndrome

While compartment syndrome is a clinical diagnosis, measuring compartment pressures can assist in its diagnosis. There are very few orthopedic emergencies, but compartment syndrome is without a doubt one of them.

Resources

emDOCs

ACS is most common in patients < 35 years of age. These patients have increased risk of high-energy injuries, stronger fascia, and greater muscle bulk. Males are 10x more likely to experience ACS compared to females.

EP Monthly

Acutely, it usually occurs post-traumatically, although there are cases of acute compartment syndrome (ACS) from hereditary angioedema and even malignant infiltration of muscles. There is also a condition known as chronic compartment syndrome, although this is poorly understood.

Life in the Fastlane

Pain is the key symptom. It occurs early, is persistent, tends to be disproportionate compared with the original injury and is not relieved by immobilisation.

NUEM Blog

Acute compartment syndrome (CS) of the extremity is a clinical diagnosis. However, patients without the ability to convey a good history (e.g., children, altered mental status/intubated patients) increase our reliance on objective measures of compartment syndrome.

NHS

Compartment syndrome is a painful and potentially serious condition caused by bleeding or swelling within an enclosed bundle of muscles – known as a muscle compartment.

StatPearls

Measurement of intracompartmental pressure is not required but can aid in diagnosis if uncertainty exist.

Teach Me Surgery

Compartment syndrome is defined as a critical pressure increase within a confined compartmental space. Any fascial compartment can be affected. The most common sites affected are in the leg, thigh, forearm, foot, hand and buttock.