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A time-sensitive surgical emergency, is characterized by the elevation of pressure within an anatomic compartment that is above normal perfusion pressure.

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Increase in compartment volume (e.g., from edema or bleeding), a decrease in compartment size (e.g., from a restrictive cast), or aspects of both. When the pressure within an affected compartment rises above normal, perfusion to the tissues is impaired, causing cell death, which may lead to tissue necrosis and permanent dysfunction. The most common cause is fractures, with tibial fractures having the highest risk.

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Most common among young adults, and although it may take up to 48 hours for symptoms to present, it typically has a rapid progression of symptoms and signs over a few hours after the initial injury or fracture repair

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Patients with compartment syndrome typically presents with severe pain that is out of proportion to the injury, which is considered the cardinal symptom. Additionally, patients often describe this pain as deep and burning, and that it is unrelieved by medications.

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With continued nerve ischemia and edema, the patient experiences diminished sensation followed by complete numbness. Motor weakness may occur as a late sign of nerve ischemia. Paralysis is a late finding after prolonged ischemia and is associated with neurovascular injury.

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Peripheral circulation is evaluated by assessing color, temperature, capillary refill time, edema, and pulses. Cyanotic nail beds suggest venous congestion. Pallor or dusky and cold digits, prolonged capillary refill time, and diminished pulses suggest impaired arterial perfusion. Edema may obscure the function of arterial pulsation, and Doppler ultrasonography may be used to verify a pulse. Pulselessness is a late sign.

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The surgeon may measure tissue pressure by inserting a tissue pressure-monitoring device, such as a handheld direct injection device, into the muscle compartment (normal pressure is 8 mm Hg or less). Nerve and muscle tissues deteriorate as compartment pressure increases. Prolonged pressure of more than 30 mm Hg can result in irreversible changes

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A. Cross-section of normal lower leg with muscle compartments. B. Cross-section of lower leg with compartment syndrome.

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Lab values that were found to be directly associated with compartment syndrome includes:

-Creatinine kinase level of greater than 4000 U/L

-Chloride levels greater than 104mg/dL

-BUN levels less than 10mg/dL.

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Affected vital signs also include an increase in heart rate, as well as a decrease in blood pressure - this is due to the elevated pressure buildup within the muscles.

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Do not elevate the limb, as this decreases arterial blood flow. Keep the limb at heart level.

Remove tight bandages, casts, splints, etc., to help relieve pressure.

Anticipate surgery - prepare and educate patient about purpose of fasciotomy

Monitor for signs of infection post-fasciotomy

Monitor for signs of Rhabdomyolysis

Administer analgesics for pain control

Educate patient on the importance of physical therapy, and help patient modify their activity routine.

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Weingart, G. S., Jordan, P., Yee, K. L., & Green, L. (2020). Utility of laboratory markers in evaluating for acute compartment syndrome in the emergency department. Journal of the American College of Emergency Physicians open, 2(1), e12334. https://doi.org/10.1002/emp2.12334

Overbaugh, J.L.H.K.H.C. K. (2021). Lippincott CoursePoint Enhanced for Brunner & Suddarth's Textbook of Medical-Surgical Nursing (15th ed.). Wolters Kluwer Health. https://coursepoint.vitalsource.com/books/9781975186722