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Compartment Syndrome
WHO Guidelines for essential trauma care
The Guidelines for essential trauma care seek to set achievable standards for trauma treatment services which could realistically be made available to almost every injured person in the world. They then seek to define the resources that would be necessary to assure such care. These include human resources (staffing and training) and physical resources (infrastructure, equipment, and supplies).
Compartment Syndrome
Acute compartment syndrome:
- Remains a clinical diagnosis
- Occurs most often from fractures, especially tibial diaphyseal fractures, though can also occur secondary to a variety of soft tissue injuries
- Evaluation can be supplemented by compartment pressures; perfusion pressure < 30 mmHg has better diagnostic accuracy than absolute intra-compartment pressure.
Compartment Syndrome
- Compartment syndrome is a life and limb threatening emergency that requires early recognition, prompt diagnosis and immediate management with fasciotomy
- While clinical evaluation is flawed, pain out of proportion to injury and pain with passive stretch of muscles within the compartment are the best screening tools.
- Do not wait for the development of pallor, absence of pulse or paralysis to consult surgery. These are late findings that may only arise once the limb is non-salvageable.
- In unconscious patients, there should be a low threshold to measure compartment pressure in patients who are at risk as clinical signs cannot be evaluated
- When measuring compartment pressures, look for an absolute pressure > 30 mm Hg and perfusion pressure (DBP – compartment pressure) of < 30 mm Hg. All patients with a clinical suspicion and normal pressures should have repeat pressures measured.
Acute Compartment Syndrome
Pain out of proportion is the most common and possibly most sensitive sign.
