Compartment pressure measurement

Indications

Compartment Syndrome Indications

• Consider whenever pain or paresthesia occurs in an extremity after:
  • fracture (most common risk factor) - can occur with open fracture
  • crush injury
  • immobilization
  • snake bites
  • burns
  • prolonged tourniquet application
  • fluid extravasation into a limb
  • soft tissue infection
  • extreme exertion

• Immediate threat is viability of nerve and muscle; later threat is infection, gangrene, rhabdomyolysis, renal failure

Procedure

1. Contents of the pressure measurement kit
2. Remove contents from wrapping
3. Attach chamber to the pre-filled saline syringe
4. Place the aforementioned into the monitor/unit
5. Place needle onto chamber
6. Eject excess air, if present, from syringe
7. Zero the assembled unit at the angle you will be entering compartment
8. Insert, inject 2-3 drops of saline, and await measurement

Interpretation of Compartment Pressure

• Normal is <10 mm Hg
• Pressures <20 mmHg can be tolerated w/o significant damage
• Exact level of pressure elevation that causes cell death is unclear. It was previously thought pressure >30 mmHg was toxic although the "delta pressure" may be better predictor than absolute pressure

ΔPressure = [Diastolic Pressure] – [Compartment Pressure]

• ΔPressure < 30 mm Hg is suggestive of compartment syndrome

See Also

Compartment Syndrome

Sources

• Image and procedure text cortesy of SoBro EM http://sobroem.com/2014/04/09/under-pressure/