■ Paresthesias with decreased sensation
■ Paresis
■ Distal pulses, perfusion, and capillary refill are unreliable (arterial insuffi-
ciency is a late finding).
DIAGNOSIS
■ Primarily a clinical diagnosis
■ Measurement of tissue pressures is confirmatory and defines the involved
compartments. Measurements should be made within 5 cm of a fracture.
TREATMENT
■ Always remove any external wrapping or compressive force.
■ <15 mmHg: No treatment is needed.
■ 20–30 mmHg: Maintain close observation and repeat measurements.
■ >30 mmHg: Consider fasciotomy.
■ An elevated pressure on its own may not require fasciotomy. In an observa-
tional study of consecutive patients with lower extremity fractures who did
not have compartment syndrome and did well without fasciotomy, a large
portion of patients had initial pressures > 30 mmHg.
■ With strong clinical suspicion fasciotomy may be required even when
compartment pressures are normal as this is a clinical diagnosis.
■ Some cases (ie, compartment syndromes of the hand) may be treated with
hyperbaric O 2 andlimb elevation.
■ Avoid fasciotomy following snake bites. Extremity snake bites may cause
increased compartment pressure, but animal studies show worse outcomes
with fasciotomy.
Rhabdomyolysis
Rhabdomyolysis is a syndrome characterized by injury to skeletal muscle fol-
lowed by release of intracellular contents.
CAUSES
Most common causes in adults include:
■ Alcohol and drug abuse
■ Toxin ingestion
■ Trauma (typically crush injury)
■ Infection (most frequently Legionella)
■ Prolonged immobility
■ Heat-related injury
■ Strenuous physical activity (especially when poorly conditioned, older age,
excessive heat/humidity, or inadequate fluid intake)
■ Myoglobin (released from dying muscle) has a toxic effect on the kidneys
and may cause renal failure in extreme cases.
SYMPTOMS/EXAM
■ Myalgias
■ Weakness
■ Fever
■ Dark/brown urine
■ Occasional altered mental status (urea-induced encephalopathy)
TRAUMAPain out of proportion to
exam:
■Compartment syndrome
■Mesenteric ischemia
■Necrotizing fasciitis