By Sam Brooks
Compartment syndrome is an acute medical condition when blood
vessels and nerves are compressed causing tissue death and nerve
damage.
 The “compartment” is the thick layers of fascia that surround
muscle groups. This connective tissue does not stretch. With any
bleeding or swelling of the muscle inside the compartment, this
will cause pressure to increase dramatically.
 Pressure is normally almost zero mmHg. When the pressure is
thirty mmHg or more it starts to cause damage. When the
difference between diastolic blood pressure and the compartment
pressure is less than 30mmHg, it is considered an emergency. This
pressure is tested by inserting a needle connected to a pressure
meter directly into the muscle.
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Mainly Tibia and forearm fractures, but can include other fractures
Ischemic reperfusion following injuries
Hemorrhages
Vascular punctures
Intravenous drug injection
Casts
Prolonged limb compression
Crush injuries
Burns
Creatine monohydrate
Repetitive heavy muscle use (Chronic Compartment Syndrome)
High velocity injuries
5 P’s associated with Compartment Syndrome
Pain: Deep, constant, poorly localized pain, out of proportion
pain to what is expected, stretching specific muscles causes
immense pain, analgesia pain medications have almost no
effect.
 Paraesthesia: Pins and needles sensation.
 Pallor: Pale or pasty looking skin.
 Paralysis: Complete loss or impairment of voluntary
muscles, or sensation of “falling asleep”.
 Pulselessness: No pulse palpated, its usually one of the last
signs.
Affected area is usually firm and feels stiff.
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The main treatment for almost all compartment syndrome cases is
fasciotomy. There is subcutaneous and open fasciotomy.
In this surgery cuts are made along the fascia to relieve the pressure.
Usually 48 to 72 hours the swelling will go down and the wound is sutured.
Sometimes skin grafts are needed to completely close the wound.
Conservative treatment for compartment syndrome includes:
Rest
Anti-Inflammatory drugs
Elevation of limb
Manual decompression
Acupuncture
If compartment syndrome is left untreated, tissue death and
amputation can happen.
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Chronic Compartment
Syndrome (CCS) is
fairly rare, but treated
mainly with
conservative
treatment. CCS is
usually caused by
running or extensive
weightlifting. Pain and
disability is usually
associated with CCS.
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Office of Rare Diseases (ORD)of the National
Institutes of Health declared compartment
syndrome as a rare disease.
Compartment syndrome affects less than
200,000 people in the US population each
year.
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As EMS workers we can be aware of the
possibility of compartment syndrome, and
give a good assessment and report. We can
give conservative treatment but ultimately
fasciotomy is needed. Compartment
syndrome is usually secondary to other
injuries which need to be treated first.
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