Patient handout

Acute Extremity Compartment Syndrome

PRODUCTION

1. Your condition

This handout is for acute extremity compartment syndrome. Your care team identified this based on: pain out of proportion to injury (earliest sign) (aaos 2019).

Other reasons your team may use this plan: pain with passive stretch of compartment muscles (early) (aaos 2019); tense, woody compartment on palpation (aaos 2019); high-energy trauma (tibial / forearm fracture, crush injury) (aaos 2019).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
fasciotomy_all_compartments	OR within hours; all 4 leg compartments (anterior / lateral / superficial posterior / deep posterior) or 3 forearm (volar / dorsal / mobile wad)	surgical	one-time	DEFINITIVE — pharmacotherapy does not treat ACS; only decompression. <6h = ~100% recovery; >12h = poor outcome (AAOS 2019; McQueen 1996 PMID 8898137)
remove_circumferential_compression	Bivalve cast / cut bandage / escharotomy for circumferential burn	procedure	one-time	Often resolves ACS without fasciotomy if cast / bandage is sole cause (AAOS 2019)

Plan: Acute compartment syndrome — fasciotomy + rhabdo / AKI prevention (AAOS 2019; McQueen 1996)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Delta-P (DBP minus compartment pressure) <30 mmHg in awake or sedated patient — fasciotomy within 6 hours (McQueen 1996 PMID 8898137)(life-threatening)
Pallor + paresthesia + paralysis + pulselessness — late ACS with poor recovery expected (AAOS 2019)(life-threatening)
CK >5000 + myoglobinuria + rising creatinine — rhabdomyolysis-induced AKI (AAOS 2019)
Pediatric patient with anxiety + agitation + escalating analgesic requirement (3-A sign) — high-suspicion ACS even without classic Ps (AAOS 2019)
Intubated / sedated / obtunded patient with high-risk mechanism (tibia fracture, crush, reperfusion) — REQUIRES compartment pressure measurement (cannot self-report pain) (AAOS 2019)

5. Follow-up

Delayed primary closure / skin graft, PT for nerve recovery (Volkmann prevention), orthopedic follow-up at 2 weeks, peroneal nerve assessment (AAOS 2019)

6. Sources

Guideline: AAOS Clinical Practice Guideline on the Management of Acute Compartment Syndrome 2019 + McQueen 1996 J Bone Joint Surg Br — delta-P <30 mmHg threshold for fasciotomy