Review Question - QID 109322

This patient is presenting with pain, paresthesias, and decreased pulses after trauma, suggesting a diagnosis of compartment syndrome. The best initial step in management is an emergency fasciotomy.

Compartment syndrome typically occurs after a crushing injury to an extremity. The key presenting symptoms are the 6 P’s: Pain, Paresthesias, Poikilothermia, Pallor, Pulselessness, and increased Pressure. Any clinical scenario that suggests the diagnosis of compartment syndrome should immediately be treated with an emergency fasciotomy. Ambiguous cases could have the compartment pressure measured first.

Incorrect Answers:
Answer 1: Detoxification (waiting for the patient to sober up from alcohol consumption) would be inappropriate in the setting of compartment syndrome, which requires an emergency fasciotomy.

Answer 2: IV fluids could be administered; however, this patient’s thready pulses are more likely a result of compartment syndrome rather than internal bleeding given the negative FAST exam.

Answer 3: Analgesics would be inappropriate and would only treat the patient's pain and not the underlying cause.

Answer 5: Measurement of compartment pressure could be appropriate if the diagnosis of compartment syndrome were in question. However, the clinical presentation strongly suggests compartment syndrome, and even a normal compartment pressure should not rule out management with such suggestive clinical symptoms.

Bullet Summary:
Compartment syndrome presents with the 6 P’s: Pain, Paresthesias, Poikilothermia, Pallor, Pulselessness, and increased Pressure, and the best initial step in management is a fasciotomy.