Compartment Syndrome
BOAST Diagnosis and Management of Compartment Syndrome of the Limbs. Last reviewed: Dec 2016.
Guidelines
Investigation and Diagnosis
Clinical diagnosis (do not delay management to obtain the following)
If diagnostic uncertainty: measure intracompartmental pressure + diastolic blood pressure
- Diastolic blood pressure minus compartment pressure (aka delta pressure) <30 mmHg suggests increased risk → surgical decompression is generally indicated
- Absolute compartment pressure >40 mmHg + clinical symptoms → urgent surgical decompression
Management
Immediate management:
- Release all circumferential dressings to skin
- Elevate the limb to heart level
Surgical decompression should be performed within 1 hour
- Immediate open fasciotomy (the wound is typically left open for delayed closure)
- Excise any necrotic muscle
- Re-exploration at ~48 hours (or earlier if clinically indicated)
Delays in decompression can result in irreversible tissue necrosis within 6–10 hours