Management

Compartment pressures between 15 and 20 mmHg are problematic. If the problem is acute and the patient is reliable, the patient can be told to return for repeat measurement if symptoms do not improve. A pressure of 20 mmHg can be damaging if it persists for several hours; therefore, admission or surgical consultation will be needed for unreliable patients. Pressures greater than 20 mmHg demand admission and surgical consultation. A pressure of 30 to 40 mmHg is generally considered grounds for emergent fasciotomy in the operating room. Fasciotomy is accomplished by making a longitudinal skin incision over the compartment. The underlying fascia is then split the length of the compartment, allowing the contained muscle to expand. Do not recommend ice cooling, because muscle perfusion may be decreased by it. Do not recommend elevation of the limb, because the resulting decrease in arterial perfusion pressure may also decrease muscle perfusion. Bed rest would provide the best chances for improvement when conservative management seems to be in order.

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