Page 142 - ATP-P 11th Ed

FASCIOTOMY PROTOCOL

SECTION 1 SPECIAL CONSIDERATIONS

1. Compartment syndromes require a high index of suspicion.
2. Do not attempt these procedures if not trained or qualified.

Signs and Symptoms
1. Be suspicious of compartment syndrome in the following conditions:
a. Fractures
b. Crush injuries
c. Vascular injury
d. Circumferential burns
e. Multiple penetrating injuries (fragmentation)
f. Blunt trauma
2. Clinical signs: Accurate diagnosis requires a high rate of suspicion.
a. “Classic: Late Signs – 5Ps”
i. Pain
ii. Pallor
iii. Pulselessness: Be aware that peripheral pulses are present in 90% of pa-
tients with compartment syndrome.
iv. Paresthesia
v. Paralysis
b. More common acute findings
i. Increasing pain
ii. Pain out of proportion to injury
iii. Pain with passive motion of muscles in the involved compartment
iv. Pallor
v. Paresthesia (numbness)
c. Increasing swelling, decreasing motion, and increasing pain not responsive to pain
medication in the appropriate clinical setting should raise the possibility of a devel-
oping compartment syndrome.
d. Compartment syndromes may take hours or days to develop. For patients with
suspected compartment syndromes, reevaluate every 30 minutes for 2 hours, then
ever hour for 12 hours, then every 2 hours for 24 hours, and then ever 4–6 hours for
48 hours.
e. Compartment Syndromes may occur in the: thigh, lower leg/calf, foot, forearm, or
hand.

132 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 133