ACS and pulse-ox

Q: A good pulse-oximetry waveform indicates that the patient does not have acute compartment syndrome (ACS)?

A) Yes

B) No

Answer: B

Despite prolonged and severe ACS, arterial pulses and capillary refill can stay normal and should not be read as negative indicators of ACS. On the same note, open fractures should not be automatically assumed as contradicting ACS. 

Any suspicion of ACS should be properly evaluated clinically, radiologically, and ideally quantified by measurement.

#trauma

References:

1. Mars M, Hadley GP. Failure of pulse oximetry in the assessment of raised limb intracompartmental pressure. Injury 1994; 25:379.

2. DeLee JC, Stiehl JB. Open tibia fracture with compartment syndrome. Clin Orthop Relat Res 1981; :175.

3. Elliott KG, Johnstone AJ. Diagnosing acute compartment syndrome. J Bone Joint Surg Br 2003; 85:625.