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110/60 mmHg
1%
50/4804
115/55 mmHg
54%
2593/4804
92/64 mmHg
5%
263/4804
both a and b
30%
1431/4804
a, b and c
9%
420/4804
Select Answer to see Preferred Response
A reported indication to perform fasciotomy includes an ICP measurement that is elevated to 30 mm Hg below the diastolic blood pressure. This would be the case if this patient's blood pressure was consistently around 115/55 mmHg (dBp=55; ICP=30; delta p = dBp-ICP = 25 mmHg). Given the poor outcomes associated with missed compartment syndromes, it is important to obtain both clinical and objective data when determining if a patient needs fasciotomies. A clinical assessment is the diagnostic cornerstone of acute compartment syndrome. However, the intracompartmental pressure measurement has been advocated to help confirm the diagnosis in patients where there remains uncertainty after clinical exam - especially with intubated patients. An absolute compartment pressure >30 mm Hg or a difference in diastolic pressure and compartments pressure (delta p) <30 mm Hg may help to confirm the necessity for fasciotomy. McQueen et al. prospectively reviewed 116 patients with tibia fractures that had continuous monitoring of their anterior compartment for 24 hours. They found that using an absolute pressure of 30 mmHg would have resulted in 50 patients (43%) treated with unnecessary fasciotomies. They conclude using a differential pressure of 30 mmHg is a more reliable indicator of compartment syndrome. Olson et al. provide a review of compartment syndrome for the lower extremity. They discuss a variety of injuries and medical conditions that may initiate acute compartment syndrome, including fractures, bleeding disorders, and other trauma. Although the diagnosis is primarily a clinical one, they also recommend supplementation with compartment pressure measurements in equivocal cases. Figure A shows a closed comminuted tibial shaft fracture. Incorrect Answers: Answer 1: dBp=60; ICP=30; dBp-ICP = 30 mmHg. Therefore delta is not <30, which would not definitely prove to be compartment syndrome. Both the absolute and delta p measurements are not greater, and less than, the published parameters. Answer 3: dBp=64; ICP=30; dBp-ICP = 34 mmHg. Therefore delta is not <30
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