Compartment syndrome

Question 1

Investigations for compartment syndrome?

Answer 1

Serum creatinine kinase = Reflects muscle cell lysis and muscle necrosis

Urine myoglobin = Reflects muscle cell lysis and muscle necrosis

Tonometry - to assess the pressure of the compartment

Question 2

What is the classical physical finding in compartment syndrome?

Answer 2

• pain out of porportion
• other
  
  • muscle weakness
  • swelling
  • firmness of the compartment
  • paresthesia
  • loss of pulses = late sign

Question 3

Management of compartment syndrome

Answer 3

• emergency fasciotomy - decompression
• fluid resus - decrease the effects of AKI and rhabdomyolysis

Question 4

List some causes of compartment syndrome

Answer 4

• trauma with bony or crush injury (most common)
• bleeding
• anticoagulation therapy
• electrical injury
• infection
• reperfusion injury
• envenomation
• extremely vigorous exercise
• IV infiltration
• constrictive dressings
• thermal injuries
• tight fascial closures
• lying on a limb - drug OD, surgery etc
• DVT (rare)

Question 5

Differentials for compartment syndrome

Answer 5

• necrotising fasciitis
• cellulitis
• arterial insufficiency
• muscle tear
• DVT
• fracture

Question 6

What are the 5 Ps of Compartment Syndrome

Answer 6

Pain: out of proportion for injury and not
relieved by analgesics
• Increased pain with passive stretch of
compartment muscles
Pallor: late finding
Paresthesia
Paralysis: late finding
Pulselessness: late finding