Forearm Compartment Pressures

[OnePunchBiopsy]

You’re on hand call and are consulted to evaluate a patient for forearm compartment syndrome.

Does your team see the patient and perform the compartment pressure assessment, or do you tell the primary team to call general or vascular surgery to do the measurements?

I think we all know what the proper approach is, but just curious to hear how things run at other hospitals.

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[DarkHorizon]

I would see the patient and examine and treat accordingly.

 

[OrthoTraumaMD]

We see the patient.

 

[Miles Gloriosus]

You’re on hand call and are consulted to evaluate a patient for forearm compartment syndrome.

Does your team see the patient and perform the compartment pressure assessment, or do you tell the primary team to call general or vascular surgery to do the measurements?

I think we all know what the proper approach is, but just curious to hear how things run at other hospitals.

If they are calling you, then I assume they want you to handle it. Otherwise they would have called vascular or gen surg first.

In an awake patient who can reliably follow commands and communicate, I do not measure pressures. If I’m worried enough to need to measure then I go straight to surgery. I will measure in an intubated/obtunded/sedated patient or patient who is psychotic or mentally impaired for some reason.

Edit: I’ll measure in the above not with it patient if I’m not sure. If a sedated patient with an arm swollen like a ballon in florid renal failure from rhabdo, then of course don’t need to measure.

 

[OnePunchBiopsy]

If they are calling you, then I assume they want you to handle it. Otherwise they would have called vascular or gen surg first.

Regarding gen surg/vascular being called first, shouldn’t forearm compartment syndrome rule out be a call to hand first?

Concern being that if it was forearm compartment syndrome, hand would be the ideal surgical team. Traditionally speaking (with infrequent exceptions) general surgeons and vascular surgeons don’t routinely perform forearm fasciotomies.

 

[Miles Gloriosus]

Regarding gen surg/vascular being called first, shouldn’t forearm compartment syndrome rule out be a call to hand first?

Concern being that if it was forearm compartment syndrome, hand would be the ideal surgical team. Traditionally speaking (with infrequent exceptions) general surgeons and vascular surgeons don’t routinely perform forearm fasciotomies.

Often times this is the case. All the vascular surgeons I have met do not do anything distal to elbow. In residency, hand got consulted to do forearm fasciotomies intraop by vascular if they did a brachial artery recon. Often times no heads up was given. The hand fellows got really annoyed by the 3 am call from vascular saying “we’re done, you need to come and do the forearm fasciotomies.”

 

[ChiDO]

PP here. No residents. Level 2 and 3 trauma/general call. ER Doc or Trauma team needs to have compartment measurements when you call me for compartment syndrome. If they call and say I think they have compartment syndrome, my first question is what is the pressure. If they don't have one, call me back when you have them.

Last week, I was called with "probably compartment syndrome" by the ED doc....then I got called back 20 mins later with a pressure of 12.

 

[OrthoTraumaMD]

PP here. No residents. Level 2 and 3 trauma/general call. ER Doc or Trauma team needs to have compartment measurements when you call me for compartment syndrome. If they call and say I think they have compartment syndrome, my first question is what is the pressure. If they don't have one, call me back when you have them.

Last week, I was called with "probably compartment syndrome" by the ED doc....then I got called back 20 mins later with a pressure of 12.

Except that most people don’t know how to measure compartment pressures correctly, compartment syndrome is a primarily clinical diagnosis, not a pressure-based one, and you are literally being paid for call, not to be a phone consult but to get out of bed and help them determine what is going on, particularly if it is something limb threatening.