Definition
Compartment syndrome is a limb- and life-threatening condition caused by elevated pressure within a closed fascial compartment, leading to impaired tissue perfusion, ischemia, and potential irreversible muscle and nerve damage. It is a surgical emergency requiring rapid recognition and intervention.
Pathophysiology
- Increased compartment pressure (from bleeding, edema, or external compression)
- Reduced capillary blood flow
- Cellular hypoxia → muscle necrosis and nerve injury
- Irreversible damage may occur within 4–6 hours
Common Causes
- Long bone fractures (especially tibia, forearm)
- Crush injuries or reperfusion injury
- Tight casts, splints, or dressings
- Burns
- Anticoagulation-associated bleeding
- Prolonged limb compression (e.g., immobilization, surgery)
Clinical Presentation
Early and key signs
- Pain out of proportion to injury
- Pain with passive stretch of muscles
- Tense, swollen compartment
Late signs (often irreversible)
- Paresthesia
- Pallor
- Paralysis
- Pulselessness (very late finding)
Diagnosis
- Primarily clinical
- Compartment pressure measurement:
- Absolute pressure ≥30 mmHg or
- Δ pressure (diastolic BP − compartment pressure) ≤30 mmHg
- Do not delay treatment for confirmatory testing if suspicion is high
Pharmacist’s Role & Clinical Pearls
- Urgent surgical fasciotomy is definitive treatment
- Remove constrictive dressings or casts immediately
- Keep limb at heart level (not elevated)
- Optimize hemodynamics and oxygenation
Pharmacotherapy Considerations
- Analgesia: Opioids (avoid masking worsening pain)
- IV fluids: Prevent acute kidney injury from rhabdomyolysis
- Electrolyte management:
- Monitor potassium, calcium, CK
- Avoid vasoconstrictors if possible (may worsen ischemia)
Complications to Monitor
- Rhabdomyolysis → acute kidney injury
- Hyperkalemia
- Metabolic acidosis
- Infection
- Permanent nerve or muscle damage
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