Page 61 - PJ MED OPS Handbook 8th Ed

4. Check neurovascular status after any manipulation
5. Hypotensive patients are at increased risk of developing compartment syndrome
6. Non-Surgical Treatment
a. Pain Management: See Pain Management Protocol
i) Increasing pain medication requirements may indicate a developing compartment
syndrome
ii) Aggressive analgesia or sedation may decrease a patient’s level of consciousness such
that the increasing pain of a compartment 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 Sedation Protocol prior to doing procedures
b. Only consider fasciotomy if:
i) Evacuation is delayed 6 hours or longer
ii) AND the following indications exist
1) Pain with passive motion of the involved muscle group
i. Increasing pain with decreasing response to pain meds
ii. Increasing swelling and tightness in the involved compartment
c. Fasciotomy may be a limb saving procedure in the proper clinical setting. When done for the
wrong reasons, or done incorrectly, the potential for serious complications exists.

Procedure:
1. Leg/calf
a. LATERAL Incision
i) Identify lateral aspect of the tibia and the fibula further laterally. Perform incision one
finger breadth (about 2cm) in front of fibula, between this bone and the tibia.
ii) Incise the skin first, down the level of the fascia, which will appear as a white shiny surface
relative to the surrounding subcutaneous soft tissues superficially.

The incision location anterior to the fibula Identify the tibia, fibula, and the intermuscular septum.
Make the Fasciotomy incisions anterior and posterior to
the septum.

Chapter 6. Surgical and Medical Procedures n 59