Evaluation and Management of Acute Compartment Syndrome in the Emergency Department

Background: Acute compartment syndrome (ACS) is a time-sensitive surgical emergency caused by increased pressure within a closed compartment. ACS can lead to significant morbidity and mortality if it is not rapidly identified and treated. Objective: This article provides an evidence-based review of the diagnosis and management of ACS, with focused updates for the emergency clinician. Discussion: ACS is the result of decreased perfusion within a compartment and is associated with a number of risk factors, but it occurs most commonly after fractures or trauma to the involved area. It can present with a variety of findings, including pain out of proportion to the injury, paresthesias, pain with passive stretch, tenseness or firmness of the compartment, focal motor or sensory deficits, or decreased pulse or capillary refill time. Pain is typically the earliest finding in patients with ACS. Unfortunately, history and physical examination are typically unreliable and cannot rule out the diagnosis. Measurement of intracompartmental pressures using a pressure monitor is the most reliable test, though noninvasive means of diagnosis are under study. Treatment involves surgical consultation for emergent fasciotomy, as well as resuscitation and management of complications, such as rhabdomyolysis. Conclusion: ACS is a dangerous medical condition requiring rapid diagnosis and management that can result in significant complications if not appropriately diagnosed and treated. Emergency clinician awareness and knowledge of this condition is vital to appropriate management.