Compartments, the Stryker, & You Consensus is Pcompartment > 30 mm Hg likely requires intervention P = (DBP Pcompartment) measure of Pperfusion Pts w/ Pcompartment < 40 mm Hg can develop CS if P elevated (i.e. > 30) Keeping extremity level w/ heart decreases limb MAP w/o increasing Pcompartment Ischemic injury is basis for CS Supplement O2 to increase pPO2 6 hrs ischemic time is currently accepted upper viability limit

Myonecrosis assoc. w/ CS s/p envenomation is multifactorial fasciotomy may not prevent myonecrosis aggressive Rx w/ antivenom decreases limb hypoperfusion consider delayed fasciotomy, if at all Possible Etiologies Increased contents Decreased volume Hematoma Trauma fracture envenomation burns Increased use

exercise tetany seizure eclampsia Edema nephrotic syndrome ischemia-reperfusion injury Iatrogenic Orthopedic surgery Intraarterial drug injection Hematoma Trauma crush injury & entrapment compression during sleep/intoxication Iatrogenic

prolonged lithotomy MAST, casts, splints, dressings excessive traction in line tight closure of fascial defect IV infiltration Compartment Sensory Motor Painful Passive Motion Tenseness Forearm Dorsal Volar --Ulnar / Median N. Digit Extension Digit Flexion

Digit Flexion Digit Extension Dorsal Forearm Volar Forearm Hand Interosseus --- Interossei Add/Abduct MCPs Dorsal Hand btwn MCPs Upper Arm Flexor Extensor Ulnar / Median N. Radial N.

Biceps / Dist. Flexors Triceps / Forearm Ext. Elbow Extension Elbow Flexion Anterior Upper Arm Posterior Upper Arm Leg Anterior Sup. Posterior Deep Posterior Deep Peroneal N. --Posterior Tibial N. Toe Ext. / Tib ant. Soleus / Gastroc. Toe Flex. / Tib post. Toe Flexion Foot Dorsiflexion Toe Extension

Ant. Leg Calf Dist. Med. Leg (btwn Tib. & Achilles tendon) Gluteal Sciatic (rare) Gluteals, piriformis, tensor fascia lata Hip Flexion Buttock Foot Digital Nerves Foot Intrinsics Toe Flex. / Ext. Dorsal / Plantar Foot

Open sterile assembly Place needle on tapered end of well chamber and syringe on opposite side Place assembly into monitor, clear side of well chamber up Purge assembly of air Injecting NS w/ Stryker at 450 Zero unit in position in which measurement will be taken Sterile prep of site Infiltrate local superficially Enter compartment perpendicularly, level w/ heart Inject ~ 0.3 of 1 cc saline Read measurement on display when equilibrates Re-Zero unit for each new measurement Enter compartments at

junction of proximal & middle thirds of forearm Volar Compartment: btwn PL tendon & radial surface of ulna; depth 1-2 cm Dorsal Compartment: 1-2 cm lat to posterior aspect of ulna; depth 1-2 cm Mobile Wad Compartment: lateral to radius; depth 1-1.5 cm Enter compartments at junction of proximal & middle thirds of lower leg Lateral compartment: posterior border of fibula; depth 1-1.5 cm Deep posterior compartment: posterior to medial border of tibia in direction of posterior border of the fibula; depth 2-4 cm Superficial posterior compartment: posteriorly

directly over center of gastrocnemius; depth 1-1.5 cm Anterior compartment: 1 cm lateral to anterior tibial border; depth 1-3 cm Compartment Contents Evaluation Anterior Deep Peroneal N. Anterior Tibial Art. Dorsal Flex. Ankles & Toes Sensation at 1st dorsal web space DP Pulse Lateral

Superficial Peroneal (fibular) N. Foot Everters Sensation at dorsal foot Superficial posterior Sural N. Plantar Flex. of Ankle Sensation to lat. portion of inf. 1/3 of leg, lat. portion of 5th digit Deep posterior Tibial N. Posterior Tibial & Peroneal Art. Plantar Flex. of toes Sensation to plantar foot PT Pulse Additional Compartments

Foot Medial, Lateral, Interosseous Gluteal 18-G spinal needle Depth 4-8 cm Insert perpendicularly at point of max. tenderness Improvised mercury or saline/sterile H2O manometers may also be zeroed & used to measure Pcompartment Convert mmHg cm H2O & back! References: JR Roberts and J Hedges, eds. Clinical Procedures in Emergency Medicine, 4th ed. Saunders; October 24, 2003. CB Custalow. Color Atlas of Emergency Department Procedures, 1st ed. Saunders; August 27, 2004.

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