Compartment Syndrome Pearls A vicious cycle of increased pressure within a facial compartment leading to compression of structures. Pathophysiology: • Injury → Hematoma → Swelling within compartment → Tissue pressure >> perfusion pressure → Blood flow compromised → Tissue hypoxia → Ischemia → Necrosis → Swelling 2° to necrosis → Further pressure → Worsening muscle damage → Myoglobinuria & Tubular necrosis Diagnosis: PAIN, PAIN and PAIN... 6 P's: • Pain disproportionate to injury (worse on passive stretching) • Pallor • Perishingly cold • Paraesthesia (pinprick, light touch + 2 point discrimination) • Pulselessness • Paralysis • Presence of muscle swelling and tense to touch PAIN is key, the rest are late signs. The absence of other signs does NOT exclude the diagnosis! Ischemic injury to muscles and nerves is irreversible 4 hours after the onset of ischemia Treatment: • Elevate & remove anything constrictive • Reduce fracture (if applicable) • Analgesia • Monitor for rhabdomyolysis • Early referral for fasciotomy PeterboroughEM @PeterboroughEM #Compartment #Syndrome #diagnosis #management #pathophysiology
