Page 60 - PJ MED OPS Handbook 8th Ed

Fasciotomy and Compartment Syndrome

WARNING
1. Do not attempt these procedures if not trained or qualified. NOT ALL PJs are taught, or
qualified, to perform this procedure. Pararescue Medical Directors will authorize prop-
erly trained Pararescuemen to perform this procedure.
2. Compartment syndromes require a high index of suspicion.
3. PJs are only authorized to perform lower leg fasciotomy (below the knee) with medial and
lateral incisions. Do not perform thigh or upper extremity fasciotomies.

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 patients with com-
partment syndrome
iv) Paresthesia (numbness)
v) Paralysis
b. Findings that will drive the decision to perform fasciotomy:
i) Increasing pain
ii) Pain out of proportion to the physical findings, and sometimes the injury
iii) Pain with passive motion of muscles in the involved compartment
iv) Progressive tension to palpation in the involved compartment by fingertip palpation
c. Increasing swelling, decreasing motion, and increasing pain not responsive to pain medica-
tion in the appropriate clinical setting should raise the possibility of a developing compart-
ment syndrome.
d. Compartment Syndromes may take hours or days to develop. For patients with suspected
Compartment Syndromes, re-evaluate every 4–6 hours for 48 hours.
e. Compartment Syndromes may occur in the: thigh, lower leg/calf, foot, forearm, or hand.

Management:
1. Orthopedic/Compartment Syndrome Management
2. Apply traction splints as necessary for mid femur fractures
3. Assess fractures and splint in position of function

58 n Pararescue Medical Operations Handbook / 8th Edition