Let's say you have a middle aged otherwise healthy patient who, after throwing back a few cold brewskis, decides to "kick it" with a group of skateboarding youths. We'll cut to the chase and state that it doesn't go well, he's now in your ED, and his left calf doesn't look too hot. Maybe he's got a tibial fracture, maybe not. Either way his leg is tense as can be, and despite getting an adequate dose of narcotics he is in E-X-Q-U-I-S-I-T-E pain. You do an exam, and note a tense extremity with pain during passive stretch, some decreased sensation, but a good distal pulse.



Just like Lloyd Bridges in Airplane, you should be shouting, "Stryker! Stryker! Stryker!" Stryker needle that is (it's the most commonly used product, so we'll only refer to that one), to rule out compartment syndrome.



The condition can occur in any extremity, but the most common presentation you'll see is the one stated above. It is an incredibly difficult diagnosis to make clinically, and it is a huge potential pitfall as correct identification can be delayed or even missed entirely. An interesting cohort study from the Canadian Journal of Medicine noted that patients at a hospital in Montreal who underwent fasciotomies noted a concerning "median event-to-operation" duration of 9 hours for traumatic cases and a shocking 34 hours for nontraumatic cases.



We are always taught the classic 5 Ps (pain/swelling, pallor, paresthesias, paralysis, pulselessness), but if you're noting these findings the cat is already out of the bag, and your patient will likely have permanent deficits as a result. If it's early, you'll have to trust your gut and go check the pressure.