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Acute Compartment Syndrome

Also known as: compartment syndrome · ACS

Raised pressure within a closed fascial compartment cuts off perfusion — a limb-threatening surgical emergency. Pain out of proportion and pain on passive stretch are the earliest signs; fasciotomy is the treatment.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Fractures (especially tibial), crush and reperfusion injury, tight casts or bandages, burns, bleeding (anticoagulation) and prolonged limb compression.

Red flags — escalate / refer

Pain out of proportion, pain on passive stretch, a tense swollen compartment and paraesthesia — pulselessness is a LATE sign, do NOT wait for it → emergency fasciotomy.

Work-up / diagnosis

1Primarily a clinical diagnosis; the classic 'late Ps' are unreliable and late.
2Compartment-pressure measurement helps in the obtunded or equivocal patient (a raised absolute or narrow delta pressure); remove tight casts/dressings and keep the limb at heart level.

Management — overview

Emergency: remove all constricting casts/dressings, keep the limb at heart level (not elevated), give oxygen, analgesia and IV fluids.
Urgent surgical fasciotomy to decompress every affected compartment.
Treat rhabdomyolysis and acute kidney injury; monitor closely.

In-depthFull dosing & advanced protocol

Drug dosing

IV fluids + analgesia

Supportive; prevent rhabdomyolysis-related AKI (definitive care is surgical)

Adult dose: Fluid resuscitation per protocol; analgesia to effect
Route: IV

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Clinical diagnosis beats pressures; time-critical fasciotomy

Do not wait for pulselessness or full sensory loss — these are late and mean established damage.
The delta pressure (diastolic minus compartment pressure) is more useful than an absolute cut-off.
Watch for rhabdomyolysis and hyperkalaemia after decompression.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Acute AppendicitisAcute inflammation of the appendix — the commonest surgical acute abdomen. Classically peri-umbilical pain that migrates to the right iliac fossa. Prompt surgery prevents perforation.Acute Cholecystitis & Biliary ColicInflammation of the gallbladder, usually from an obstructing gallstone — constant right-upper-quadrant pain, fever and a positive Murphy's sign. Biliary colic is transient pain from a stone WITHOUT inflammation.Acute Limb IschaemiaSudden loss of arterial perfusion to a limb — a surgical emergency. The 6 Ps: Pain, Pallor, Pulselessness, Paraesthesia, Paralysis and Perishing cold. Muscle and nerve injury begin within hours.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV fluids + analgesia

📈 Clinical diagnosis beats pressures; time-critical fasciotomy

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV fluids + analgesia

📈 Clinical diagnosis beats pressures; time-critical fasciotomy

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Clinical diagnosis beats pressures; time-critical fasciotomy

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Clinical diagnosis beats pressures; time-critical fasciotomy

References