ACS

Q: Early prophylactic fasciotomy is indicated in acute compartment syndrome (ACS) of an extremity if compartment pressure is within? 

A) 10 mmHg of diastolic pressure
B) 20 mmHg of diastolic pressure
C) 30 mmHg of diastolic pressure
D) 40 mmHg of diastolic pressure
E) 50 mmHg of diastolic pressure


Answer: C

In ICU, the most commonly used method to measure the compartment syndrome is through the arterial measure transducer and an 18G catheter inserted into the tissue compartment. This measurement is not accurate and should be read with clinical findings. The normal compartment pressure is between 0 and 8 mmHg, and ischemia starts to occur when the tissue pressure approaches diastolic pressure. Early prophylactic fasciotomy is indicated if ACS delta pressure (diastolic blood pressure ‒ measured compartment pressure) is less than 20 to 30 or if compartment pressure is within 30 mmHg of diastolic pressure.

The objective of this pearl is to highlight another compartment pressure measurement which may not be well known to ICU staff i.e, via manometer which is relatively more accurate. It is measured after injecting a small quantity of saline into a closed compartment and measuring the resistance through hand-held manometer. Simultaneously measuring Blood Pressure (BP) in non-effected extremity via manometer and compartment pressure via manometer may give a better perception of acuity to a clinician.

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#procedure


References:

1. Uliasz A, Ishida JT, Fleming JK, Yamamoto LG. Comparing the methods of measuring compartment pressures in acute compartment syndrome. Am J Emerg Med 2003; 21:143.

2. Dahn I, Lassen NA, Westling H. Blood flow in human muscles during external pressure or venous stasis. Clin Sci 1967; 32:467.