Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Compartment Syndrome

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In one line

·Pressure inside a muscle compartment rises so high that blood cannot flow in, starving the muscle and nerve of oxygen.

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Normal physiology

·Muscles live inside sealed sleeves of fascia—tough tissue that does not stretch. Blood flows into the compartment through arteries and out through veins. Normally the pressure inside is much lower than the pressure pushing blood through the arteries, so oxygen-rich blood feeds the muscle and nerve without trouble.

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What goes wrong

·Something makes the compartment swell or bleed, but the fascia cannot stretch, so pressure climbs until it squeezes the blood vessels shut—first the veins, then the arteries.

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Hallmark signs

·Very bad pain that gets much worse when you stretch the muscle
·The compartment feels firm and tight, like a blown-up balloon
·Numbness or tingling in the area past the swelling
·Weakness or trouble moving the fingers or toes beyond the injury
·Pale or shiny skin over the area
·Pain that does not get better with rest or usual pain medicine
·A pulse that is hard to feel or missing below the injury

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Red flags · escalate now

·Pain that keeps getting worse even after rest, ice, or pain medicine
·Numbness, tingling, or cannot feel light touch in the fingers or toes beyond the swelling
·Cannot move fingers or toes, or movement is very weak
·Skin looks very pale, blue, or feels cold past the injury
·Pulse is weak or cannot be felt below the injured area

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Workup

·Compartment pressure measurement (handheld manometer or needle probe)
·Creatine kinase (CK) level in blood
·Serum potassium
·Urine myoglobin or urine color (dipstick for blood without RBCs under microscope)
·Serum creatinine and blood urea nitrogen (BUN)
·X-ray of the injured limb

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Treatment

·Remove or loosen any tight cast, dressing, splint, or wrap immediately
·Emergency fasciotomy (surgical cuts through the fascia to open all compartments)
·Keep the limb at heart level (NOT elevated)
·Give aggressive IV fluids (normal saline or lactated Ringer's at 200–300 mL/hour) and monitor urine output closely
·Treat high potassium (hyperkalemia) if potassium is dangerously high (calcium gluconate 1 g IV, insulin 10 units + dextrose 25 g IV, sodium bicarbonate if acidotic)
·Plan delayed wound closure or skin graft days later, after swelling resolves
·Avoid giving opioids in escalating doses without re-examining the limb

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NCLEX trap

·Call surgery right away when you see pain that seems way too strong for the injury and pain that shoots through the muscle when you gently stretch it. Compartment syndrome is diagnosed by what you see and feel at the bedside, not by waiting for tests. Muscle starts dying in 4 to 6 hours, so every minute counts.
·Keep the limb at heart level — the same height as the chest. Raising it too high lowers the push of blood trying to get into the limb, and that makes the damage worse. The limb needs all the blood pressure it can get to fight the squeezing pressure inside.
·Pain medicine helps the patient feel a little better, but it does NOT fix compartment syndrome. The only real treatment is fasciotomy — a surgery where the surgeon cuts open the tight covering around the muscle to let the pressure out. Until that happens, the pain will not truly go away.
·A normal pulse does NOT mean compartment syndrome is ruled out. In the early hours, the pulse stays normal because the pressure in the artery is still higher than the pressure squeezing the compartment. But the muscles and nerves are already dying. Use the pain signs — pain that is too strong and pain with gentle stretch — to catch it early, before the pulse disappears.
·A tight cast, bandage, or splint is one of the causes of compartment syndrome. Loosen it or cut it off right away — this is the first thing you do. It may lower the pressure enough to save some time before surgery.
·After compartment syndrome is diagnosed, watch the urine color (it may turn dark brown like tea or cola), check potassium levels, and monitor how well the kidneys are working. Dead muscle releases a protein called myoglobin and also potassium. High potassium can make the heart stop, and myoglobin can clog the kidneys and cause kidney failure. Treat this with IV fluids and sometimes dialysis.

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