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    Acute Limb Compartment Syndrome: Observation Chart

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    tio
    - Acute limb compartment syndrome can occur in patients with tibial, forearm or distal radius fractures, orthopedic injuries combined with coagulopathies, crush injuries or high impact trauma. - Key signs are pain out of proportion to the injury upon passive movement of muscles in the affected compartment. Changes in pulse, sensation and skin color are late signs. - The observation chart is used to monitor these patients hourly for the first 24 hours and every 4 hours from 24 to 48 hours, with passive movement of fingers or toes to assess pain level. Elevated or worsening pain scores should prompt escalation to the responsible clinician.

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    Acute Limb Compartment Syndrome: Observation Chart

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    tio
    39 views2 pages
    - Acute limb compartment syndrome can occur in patients with tibial, forearm or distal radius fractures, orthopedic injuries combined with coagulopathies, crush injuries or high impact trauma. - Key signs are pain out of proportion to the injury upon passive movement of muscles in the affected compartment. Changes in pulse, sensation and skin color are late signs. - The observation chart is used to monitor these patients hourly for the first 24 hours and every 4 hours from 24 to 48 hours, with passive movement of fingers or toes to assess pain level. Elevated or worsening pain scores should prompt escalation to the responsible clinician.

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    - Acute limb compartment syndrome can occur in patients with tibial, forearm or distal radius fractures, orthopedic injuries combined with coagulopathies, crush injuries or high impact trauma. - Key signs are pain out of proportion to the injury upon passive movement of muscles in the affected compartment. Changes in pulse, sensation and skin color are late signs. - The observation chart is used to monitor these patients hourly for the first 24 hours and every 4 hours from 24 to 48 hours, with passive movement of fingers or toes to assess pain level. Elevated or worsening pain scores should prompt escalation to the responsible clinician.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    39 views2 pages

    Acute Limb Compartment Syndrome: Observation Chart

    Uploaded by

    tio
    - Acute limb compartment syndrome can occur in patients with tibial, forearm or distal radius fractures, orthopedic injuries combined with coagulopathies, crush injuries or high impact trauma. - Key signs are pain out of proportion to the injury upon passive movement of muscles in the affected compartment. Changes in pulse, sensation and skin color are late signs. - The observation chart is used to monitor these patients hourly for the first 24 hours and every 4 hours from 24 to 48 hours, with passive movement of fingers or toes to assess pain level. Elevated or worsening pain scores should prompt escalation to the responsible clinician.

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    © All Rights Reserved
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    of 2

    Acute Limb Compartment Syndrome

    Observation Chart
    • Tibial, forearm or high-energy distal radius fractures. Monitor hourly for the first
    Patients at risk

    • Orthopaedic injury/intervention combined with known 24 hours. From 24 to 48


    coagulopathies/patient taking anticoagulants. hours monitor 4 hourly.
    However, if suspicions arise
    • Crush injuries. at any point revert back to
    • High impact trauma, including open fractures. hourly monitoring.
    Other patients may be monitored following individual assessment. In particular, consider the risk from newly
    applied traction, a restrictive cast or a tight circumferential bandage which does not allow for swelling. Patients
    who start reporting pain out of proportion to the injury/treatment, especially on passive movement, should also
    be considered for monitoring.
    Pain out of proportion to the injury/treatment and pain on passive movement of the muscles of the involved
    compartment are the key clinical findings.
    Patients who have had an anaesthetic nerve block or epidural may not be able to report the pain associated
    with compartment syndrome. In addition the ‘pain’ section should not be used in situations where the patient
    has an impaired ability to report this symptom, for example, when the patient is unconscious.
    Changes in pulse, sensation and skin colour are late symptoms of neurovascular compromise and should not
    be relied upon to diagnose compartment syndrome. However, these may be recorded as part of a ‘well limb’
    assessment.

    Passive movement of the fingers


    Place your fingers underneath
    the patient’s fingers and gently
    extend the fingers.

    Passive movement of the toes


    Place your fingers underneath
    the patient’s toes and gently
    extend the toes.

    An increase in pain when carrying out this


    test may indicate a developing compartment
    syndrome and should be recorded
    appropriately on the chart overleaf.

    A second chart will be required to provide a minimum of 48 hours monitoring.

    September 2016. Publication code: 005 457


    Patient details Circle affected limb and select options
    Name: Nerve block or Left leg Left arm
    epidural
    Hospital no.: Cast/traction/tight Right leg Right arm
    Hospital
    bandaging logo
    Date of birth: A separate chart must be used for each limb
    being assessed

    Date

    Example
    Time

    0 – None
    Pain at rest

    The primary
    symptom is 1 – Mild •
    pain on passive
    2 – Moderate
    extension.
    3 – Severe
    Passively 0 – None
    Pain on passive

    extend the
    movement
    Pain

    fingers or toes 1 – Mild •


    of the affected
    limb (see 2 – Moderate
    images on front
    of chart). 3 – Severe
    0 – No pain/has
    •
    analgesia
    since last

    improved
    Pain

    Pain not
    2 – Is the same
    controlled by
    regular and 3 – Has worsened
    appropriate
    analgesia is Initial EX
    a key clinical
    finding. Time next observation due 1hr
    Score 2

    A total pain score of 5 or above, an individual pain parameter score of 3, or a clinical concern should be escalated immediately
    to the responsible clinician as per trust guidelines, emphasising the severity and/or worsening nature of the pain.

    Tick if applicable: Compartment monitor not available Compartment monitor not clinically indicated
    (DBP) – (IPR) = Delta pressure

    Continuous Diastolic blood


    70
    monitoring in pressure (DBP)
    situ: record Intracompartmental
    Pressures

    pressures pressure reading 15


    hourly. (IPR)
    Intermittent Delta pressure 55
    monitoring:
    times under Difference ≥30 •
    direction of
    lead clinician. Difference ≤29
    Intracompartmental pressure reading greater than 40 or Delta pressure equal/less than 29 should be escalated
    immediately to the responsible clinician as per trust guidelines.

    •
    without doppler)

    Present
    Pulse (with/

    Reduced in volume
    or rate since last
    Neurovascular status

    assessment
    Changes
    in pulse, Not present
    sensation
    and skin Normal •
    Sensation

    colour are late


    symptoms of Abnormal/has
    neurovascular changed from last
    compromise assessment
    (see front of Normal, responsive
    chart for notes). •
    colour

    capillary refill
    Skin

    Pallor and/or slow/


    absent capillary refill
    Any abnormal neurovascular status observations should be escalated immediately to the responsible clinician as per trust
    guidelines.
    Initial EX

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