NOT YET REVIEWED BY A CLINICIAN. Written for this site and cited, but nobody has read it line by line. Check it against your own practice before you use it.
STEPS · ◆ KEY STEP — LOGGED WITH ITS TIME
DECIDE — THE EXAM COMES FIRST
Acute compartment syndrome is a clinical diagnosis. A number supports it and documents it; it does not overrule an exam that indicates fasciotomy.
Reason to measure: the exam is unreliable — obtunded, intubated, regional block, distracting injury, or a child.
Reason to measure: the exam is equivocal and you are deciding about transfer.
A single normal pressure does not exclude an evolving compartment syndrome. Re-examine, and measure again if the limb changes.
Say out loud which limb and which compartments you are about to measure.
SET UP — STRYKER STIC
Get the kit — Room 6 · cabinet.
Open the monitor, seat the diaphragm chamber, and attach the side-port needle.
Attach the pre-filled saline syringe. Hold the assembly at about 45° and purge until fluid reaches the needle tip — no air in the line.
Zero the monitor holding the needle at the same angle you will insert it, at the level of the compartment. ◆ STIC ZEROED
MEASURE — EVERY COMPARTMENT OF THE SEGMENT
Prep the skin. Insert within 5 cm of the fracture — pressure is highest there and falls off with distance.
Inject about 0.3 mL of saline, let the reading settle, then read it. Record the compartment by name with the value. ◆ COMPARTMENT MEASURED
Leg — measure all four: anterior, lateral, superficial posterior, deep posterior. One normal compartment says nothing about its neighbour.
Forearm: volar (superficial and deep) and dorsal. Thigh: anterior, posterior, adductor.
Use the diastolic blood pressure at the same moment.
DECIDE — DELTA PRESSURE
Delta pressure = diastolic BP − compartment pressure.
Work out the delta for each compartment you measured and say the numbers out loud.
The pressure meets the threshold, or the exam indicates fasciotomy regardless of the number → consider fasciotomy. Consult orthopedics or surgery.◆ FASCIOTOMY DECISION MADE
Below the threshold but the limb is evolving → keep the limb at the level of the heart (not elevated), remove circumferential dressings and casts, treat pain, and re-measure.
DOCUMENT & PITFALLS
Record for every compartment: the time, the compartment by name, the pressure, the diastolic, and the delta.
Zeroed at the wrong angle — the single commonest source of a wrong reading.
Measured too far from the fracture — a falsely reassuring number.
Only one compartment measured — the deep posterior compartment of the leg is the one most often missed.
Too much saline injected — raises the number you are about to read.
Elevating the limb lowers perfusion pressure. Keep it at heart level.
EQUIPMENT
Room 6 · Cabinet
Stryker STIC monitor (handheld)
Pre-filled 3 mL saline syringe
Side-port needle 18 G
Diaphragm chamber
Chlorhexidine, gauze, gloves
FIGURE
Measure supports the diagnosis; it does not replace the exam.