Trauma Skills 1:
Compartment Pressure Measurement
Rural emergency care teams should be aware of the possibility of compartment syndromes developing in any trauma or at-risk patient. Compartment syndromes may occur from an external pressure (tight cast, tight burn eschar, comatose patients lying on their arms, etc.) or because of increased fluid within a compartment (bleeding from an injury, edema from an injury, coagulopathy, etc.).
Tissues within the compartments most sensitive to lack of capillary blood flow are nerves and muscles. These tissues may be permanently damaged before the pressure reaches the point of decreasing blood flow through the arteries so diminished pulse is not a criteria for the presence of compartment syndrome. If the patient is awake, he or she experiences severe pain over the compartment, which is exacerbated by either passive or active muscle movement. Paresthesias occurs in the distribution of the nerves traversing the compartment. Compartments themselves feel tense to the touch.
Many trauma surgeons will perform fasciotomies of the muscle compartments based purely on clinical grounds. Tenseness, pain, paresthesias, and weakness are hallmarks of these syndromes.
Devices for quickly and accurately determining compartment pressure are available. The Styker STIC Monitor and the Ace Intracompartmental Pressure Monitor are examples. A compartment pressure reading of 30 mm Hg is generally considered grounds for immediate surgical decompression. Compartment pressures of 20 to 25 mm Hg are worrisome, but can be watched. Pressures of 25 to 30 mm Hg may demand surgical decompression based on clinical findings.
Compartments most frequently involved are those of the leg and thigh. The following diagrams show their positions and contents:
The thigh compartments are the next most frequently involved compartments. Tense swelling and pain are prominent findings.