0071643192.pdf

■ Proper needle placement can be confirmed by seeing a rise in pressure
during digital compression of the compartment just proximal or distal to
the needle insertion site, or by contraction of muscle in compartment
being measured.
■ Compartment pressure of 30 mm Hg is considered by some to be diagnos-
tic of compartment syndrome. However, this is an imperfect test with both
false positives and false negatives. Interventions should be informed by his-
tory, exam, and compartment pressure measurements.
■ Fasciotomy is the standard treatment for compartment syndrome. How-
ever, compartment syndrome may be treated with hyperbaric O 2 therapy.
Additionally, compartment syndrome resulting from snake bites should
not be treated with fasciotomy.

SUPRAPUBIC CATHETERIZATION

INDICATIONS

■ Men with urethral stricture or complex prostatic disease
■ Trauma patient with evidence of urethral injury including blood at the
meatus, a high-riding prostate, or scrotal or perineal hematoma: Tradi-
tionally, in these patients no attempt at urethral catheterization should be
made until a retrograde urethrogram is performed to evaluate the integrity
of the urethra.

PROCEDURES AND SKILLS

Extensor digitorum

muscle

Extensor digitorum

(comm.) muscle

Extensor carpi

radialis brevis

and longus muscle

Pronator teres

muscle

Brachioradialis

muscle

Radial artery, vein,

and nerve Flexor carpi

radialis Palmarislongus

muscle

Median artery, vein,

and nerve

Flexor pollicis

longus muscle

Ulnar artery, vein

and nerve

Flexor carpi

ulnaris muscle

Flexor digitorum

profundus muscle

Extensor carpi

ulnaris muscle

Extensor carpi

radialis brevis muscle

Radial nerve

(profundus)

Extensor carpi radialis

longus muscle

Radial nerve (superficial)

and vein

Ulnar nerve

Flexor carpi radialis

and palmaris longus

and flexor digitorum

superficialis muscle

Median nerve

Ulnar artery and

nerve

Extensor carpi

ulnaris muscle

Flexor carpi

ulnaris muscle

Flexor carpi radialis Median nerve Ulnar nerve and artery

muscle

Radial artery,

vein, and nerve

Pronator

quadratus muscle

Extensor carpi

radialis longus

and brevis muscles

Extensor digitorum muscle

FIGURE 19.12. Forearm compartments at various levels.

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Tintinalli’s
Emergency Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:1747.)