ICU · Resuscitation

Acute limb compartment syndrome

Also known as Compartment syndrome · Fasciotomy · The 6 Ps · Delta pressure · Volkmann contracture · Two-incision fasciotomy · Crush syndrome · Perfusion pressure

Acute limb compartment syndrome is elevated pressure within a fascial compartment causing ischaemia and necrosis of muscles and nerves. Causes: fracture (1 — tibial shaft, forearm), crush injury, burns (circumferential), prolonged immobility, reperfusion injury (post-vascular repair), tight casts/dressings, bleeding into compartment (anticoagulated). The 6 Ps: Pain (disproportionate, worse on passive stretch — the EARLIEST and most sensitive sign), Pallor, Paraesthesia, Paralysis, Pulselessness (LATE — absence of pulse means it's too late), Poikilothermia. Diagnosis: clinical + compartment pressure measurement (delta pressure = diastolic BP - compartment pressure <30 mmHg = positive). Treatment: EMERGENT FASCIOTOMY (within 6 hours to prevent irreversible necrosis). Untreated → Volkmann ischaemic contracture, amputation, rhabdomyolysis, renal failure.