Measurement of Compartment Pressures

• Compartment pressures are not required to make the diagnosis of compartment syndrome however emergency physicians, surgeons will almost always get them to avoid uncessary fasciotomies. 
• Measure compartment pressures whenever you suspect acute compartment syndrome based on risk factors and clinical exam findings.
• There are no major complications of measuring compartments and choosing not to obtain measurements can lead to missed diagnoses and permanent disability/dysfunction. 
• Zero measurements are needed if the diagnosis of acute compartment syndrome is clinically obvious. Alternatively, serial measurements may be necessary if clinical findings change.

• Situations where clinical exam is limited:

1. Young children
2. Obtunded patients
3. Critically ill patients
4. Patients emergence from anesthesia

Stryker Device

• The Stryker Device is a type of hand-held manometer which performs direct measurements of compartment pressures.
• While there are other methods for direct measurement of compartment pressure, the hand-held manometer method is most commonly used due to portability, simplicity, and accuracy.

Below is a demonstration by Dr. Stephanie Wilsey and Dr. Richard Byrne of the Department of Emergency Medicine at Cooper University Hospital demonstrating how to use a Stryker Device:

ALTERNATIVE TO STRYKER DEVICE: If you don't have a Stryker Device available, insert an 18 gauge needle into the compartment and attach an arterial line pressure monitor to measure compartment pressures. This can prevent delays in diagnosis.

References:

1. Stracciolini, A MD et al. "Acute Compartment Syndrome of the Extremities." UpToDate, Inc. May 2016. 
2. Photo Credit