Page 143 - ATP-P 11th Ed

Management
1. Orthopedic/Compartment Syndrome Management.
2. Apply traction splints as necessary.
3. Assess fractures and splint in position of function. SECTION 1
4. Check neurovascular status after any manipulation.
5. Use compartment pressure monitor if available.
a. Perfusion pressure = diastolic blood pressure – measured intramuscular pressure
i. Perfusion pressure <30mmHg is diagnostic for compartment syndrome
ii. Hypotensive patients have a lowered diastolic pressure and may have increased
susceptibility to developing a compartment syndrome.
b. Repeat measurements if clinically indicated or if patient is obtunded due to narcotic
use or head injury.
6. Nonsurgical Treatment
a. Pain Management: See Pain Management Protocol (TMEP)
i. Increasing pain medication requirements may mask development of a com-
partment syndrome.
ii. Narcotic doses which decrease the Soldier’s level of consciousness and
cause drowsiness will oversedate a patient so that the increasing pain of a com-
partment syndrome is not recognized.
b. Elevation—Maintain extremity at level of the heart. DO NOT ELEVATE.
c. Loosen encircling dressings
7. Surgical (Fasciotomy)
a. See Procedural Analgesia Protocol (TMEP) prior to doing procedures
b. Only consider fasciotomy if:
i. Evacuation is delayed 6 hours or longer
ii. AND fasciotomy is within the scope of practice of the treating medic
iii. AND the following indications exist:
(a) Pain with passive motion of the involved muscle group
• Increasing pain with decreasing response to pain meds
• Increasing swelling and tightness in the involved compartment
iv. OR There are elevated compartment pressures as defined above (#5).
c. Fasciotomy may be a limb saving procedure in the proper clnical setting. When
done for the wrong reasons, or done incorrectly, the potential for serious complica-
tions exists.
d. Procedure: Utilize Procedural Analgesia Protocol (TMEP).
i. Thigh: anterior skin incision, ID muscle fascia and split fascia only
ii. Lower leg/Calf:
(a) Anterior and Lateral Compartments:

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