This is a flowchart on acute compartment syndrome of the limbs, covering the etiology, pathophysiology, and manifestations.
ADDITIONAL TAGS:
X-rays: identify associated fractures
Penetrating injuries:
Risk factors / SDOH
Cell / tissue damage
Structural factors
Acute compartment syndrome
of the extremities
Medicine / iatrogenic
Infectious / microbial
Biochem / metabolic
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Neurological pathology
Genetic / hereditary
Flow physiology
Pathophysiology
Etiology
Manifestations
↑ pressure within a fascial compartment
Obstruction of venous outflow
Collapse of arterioles
↓ tissue perfusion
↓ oxygen supply to muscles
Irreversible damage (necrosis) to muscles, nerves after 4-6 hours
External compression
Internal compression
Burn eschars
Constrictive bandage/cast applied before limb has stopped swelling
Immobility →
poor positioning
Hematoma
Long bone fractures
Gunshot
Stab wounds
Iatrogenic radial artery perforation
Hemorrhage into muscle compartment
Crush → deep tissue injury
Coagulopathy
Spontaneous bleeding
Severe edema
Burns
Venomous animal bites (esp snakes)
IV infusion → extravasation
Seizures
Repetitive muscle use
Excessive running
Ischemia → reperfusion synd
Shock → ↑ capillary permeability
External compression
Early features (within 1-2 hours)
Late features
Pain out of proportion to injury:
“deep”; “burning”; poorly localized
Worse with passive stretch or extension of muscles
Extreme tenderness to touch
Soft tissue swelling
Tight, wood-like muscles
Neuro deficits
Impaired perfusion
Paresthesia (pins and needles sensation)
Muscle weakness or paralysis
Sensory deficits
Cold extremity with pallor
Absent or weak distal pulses
+/- 6 Ps of acute limb ischemia: Pain, Pallor, Paresthesias, Poikilothermia, Pulselessness, and Paralysis
Internal compression
Invasive compartment pressure measurement: Delta pressure = diastolic b.p. - intracompartmental pressure
ΔP = 30 mm Hg ; rising or sustained ΔP
Blood / urine tests for crush injury / rhabdomyolysis:
↑ CK, ↑ LDH, ↑ myoglobin; myoglobinuria