Further elevation will reduce perfusion pressures, reduce differential pressures, and thereby increase tissue damage. This includes full resuscitation, optimization of blood pressure and oxygenation, as well as keeping the extremity at slight elevation (heart level). As the provision of tissue oxygenation is key to prevention of a CS, medical optimization of a patient is of paramount importance. This includes removing all constrictive dressings and tight splints. Ĭlose observation with documented hourly repeat exams of a patient with concerns for a pending CS is mandatory. With regard to the most commonly affected deep flexor compartments in UECS, safe techniques for pressure measurement have been described. So standardization of measurement methods and sites is recommended for repeat measurements. In addition, it was shown that pressures measured within a single compartment can vary significantly with regard to distance to fracture site. When using pressure measurement devices, the higher accuracy of side port or slit catheters as compared to straight catheters has been pointed out. The absolute pressure theory as described by Matsen has been replaced by differential pressure models in which fasciotomy is indicated when the delta pressure, measured as the difference between the compartmental pressures and arterial or venous blood pressures, falls to 30 and 20 mmHg, respectively. Pressure measurements – especially in the obtunded patient – remain an important adjunct to CS diagnosis. The classic signs of compartment syndrome (“5 or 6 Ps”) included late irreversible changes and are not recommended in diagnosing early compartment syndrome. Given the importance of early intervention before irreversible damage has incurred, the diagnosis of CS in the upper extremity relies primarily on the recognition of clinical scenarios where a CS can be expected in combination with detection of early clinical signs such as pain to stretch – increasing pain out of proportion and increased analgesic needs.
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