Current Approach to the Evaluation and Management of Acute Compartment Syndrome in Pediatric Patients
Michael Gottlieb1, Shayna Adams, Trevor Landas
1Assistant Professor and Director of Ultrasound (Gottlieb), Resident Physician (Adams), and Resident Physician (Landas), Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.
Insights
Acute compartment syndrome, a dangerous condition of increased compartment pressure, often results from fractures but can have atraumatic origins. Prompt diagnosis via intracompartmental pressure measurement and surgical fasciotomy are critical for treatment.
Area of Science:
- Medicine
- Orthopedics
- Emergency Medicine
Background:
- Acute compartment syndrome (ACS) is a surgical emergency characterized by elevated intracompartmental pressure.
- Commonly associated with fractures, ACS can also arise from various atraumatic etiologies.
- The anterior lower leg and volar forearm are the most frequently affected compartments.
Purpose of the Study:
- To review the etiology, presentation, diagnosis, and management of acute compartment syndrome.
- To emphasize the importance of direct intracompartmental pressure measurement for diagnosis.
- To highlight the critical need for timely surgical intervention.
Main Methods:
- Literature review of atraumatic causes of ACS.
- Analysis of clinical presentation and diagnostic findings.
- Summary of current treatment strategies.
Main Results:
- Fractures are the most common cause, but non-traumatic causes exist.
- Clinical signs include severe pain, swelling, paresthesias, and weakness; no single sign excludes ACS.
- Intracompartmental pressure measurement is the definitive diagnostic tool.
Conclusions:
- Early recognition and diagnosis of ACS are crucial.
- Direct pressure measurement is essential for confirming the diagnosis.
- Emergent fasciotomy is the primary treatment to restore perfusion and prevent irreversible damage.
Abstract:
Acute compartment syndrome is an emergent condition caused by increased pressure within a closed compartment. The most common etiology is fractures, but there a number of atraumatic causes cited in the literature. Acute compartment syndrome occurs most frequently in the anterior compartment of the lower leg, followed by the volar forearm. Patients may present with severe pain, pain with passive stretch, swelling, paresthesias, numbness, weakness, decreased pulses, and delayed capillary refill. No finding in isolation can exclude the diagnosis. Direct measurement of the intracompartmental pressure is the most important diagnostic test. Treatment involves removal of compressive dressings and surgical consultation for emergent fasciotomy.
Related Concept Videos
01:26Acute Coronary Syndrome V: Nursing Management
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:30Acute Coronary Syndrome I: Introduction
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption