Compartments, the Stryker, & You• Consensus is Pcompartment > 30 mm Hg

likely requires intervention• ΔP = (DBP – Pcompartment)

• measure of Pperfusion

• Pts w/ Pcompartment < 40 mm Hg can develop CS if ΔP 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

– Hematoma– Trauma

• fracture• envenomation• burns

– Increased use• exercise• tetany• seizure• eclampsia

– Edema• nephrotic syndrome• ischemia-reperfusion injury

– Iatrogenic• Orthopedic surgery• Intraarterial drug injection

• Decreased volume– 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 ExtensionDigit Flexion

Digit FlexionDigit Extension

Dorsal ForearmVolar Forearm

Hand Interosseus --- Interossei Add/Abduct MCPs Dorsal Hand btwn MCPs

Upper Arm Flexor Extensor

Ulnar / Median N.Radial N.

Biceps / Dist. FlexorsTriceps / Forearm Ext.

Elbow ExtensionElbow Flexion

Anterior Upper ArmPosterior 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 FlexionFoot DorsiflexionToe Extension

Ant. LegCalfDist. 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

Volar Compartment: btwn PL tendon & radial surface of ulna; depth 1-2 cm

Enter compartments at junction of proximal & middle thirds of forearm

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 spaceDP 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 footPT 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.