Compartment Syndrome

Question 1

What is compartment syndrome?

Answer 1

Critical pressure increase within a confined compartment space

Question 2

Causes of compartment syndrome

Answer 2

High-energy trauma 
Crush injuries
Fractures with vascular injury 
Post-reperfusion swelling 
Tight casts

Question 3

Pathophysiology of compartment syndrome

Answer 3

Fascial compartments are closed - cannot be distended

Fluid that is deposited - increases intra-compartmental pressure

Veins compressed - increases hydrostatic pressure - fluid moves out of veins into compartment - increases pressure further

Nerves compressed

Intra-compartmental pressure ~ diastolic BP - arterial inflow compromised

Question 4

Clinical features of compartment syndrome

Answer 4

Severe pain - disproportionate to injury
Pain not improved by analgesia

Paraesthesia distally

Question 5

Management of compartment syndrome

Answer 5

EARLY RECOGNITION

Initial management

• keep limb at neutral level
• high flow oxygen
• IV fluid bolus
• remove dressings/casts
• opioid analgesia

Fasciotomy

Question 6

What do you need to monitor patient with compartment syndrome for?

Answer 6

Rhabdomyolysis + reperfusion injury

Monitor renal function