Physical Exam (Obtunded)
In the absence of reliable evidence, it is the opinion of the work group that without a dependable clinical examination (e.g. in the obtunded patient), repeated or continuous intracompartmental pressure measurements are recommended until acute compartment syndrome is diagnosed or ruled out.
Management of Acute Compartment Syndrome
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense. Endorsed by: ACS, AOFAS, and SOMOS

Rationale

A high suspicion for compartment syndrome should always be maintained in the obtunded patient. In contradistinction to the patient with an unknown clinical timeline leading to compartment syndrome, the timeline of the obtunded patient’s clinical course might be more obvious. Mechanism and/or previous surgical interventions (i.e. vascular repair, ORIF) should alert surgeons to the potential for ACS, and we recommend that surgeons closely monitor these patients and ensure that appropriate perfusion is maintained and hypotension avoided. With at-risk patients and equivocal findings of acute compartment syndrome, fasciotomy is less morbid than the consequences of a missed acute compartment syndrome.

POSSIBLE HARMS OF IMPLEMENTATION

In this patient population, there is limited risk in performing serial examination of the affected extremity. Increased risk may be introduced if an inappropriate threshold is used to diagnosis acute compartment syndrome in these patients allowing acute compartment syndrome to evolve into irreversible intracompartmental damage.

FUTURE RESEARCH

Further studies examining the sensitivity and specificity of pressure measuring methods, techniques and thresholds vs. reference standards that take into account false negatives and positives, as done by McQueen 2013, would be beneficial.


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