Points:
(1) A raised compartment pressure is due to the effect of venom. Antivenom is often effective in reducing the compartment pressure. Failure to administer sufficient antivenom is a common problem.
(2) Management should be started promptly if a compartment syndrome is suspected. If a fasciotomy is deemed necessary, it should be performed as early as possible prior to irreversible ischemic necrosis.
Clinical findings associated with a compartment syndrome:
(1) pain, which may be severe
(2) compartment is tense to palpation
(3) numbness and loss of sensation may occur but this often a late sign
(4) raised compartment pressure, as measured using the Whiteside or other protocol
The level of pressure indicating an elevated level depends on the compartment. For the lower leg, an elevated pressure is considered > 30 mm Hg.
Initial management:
(1) Elevate the limb.
(2) If the patient can tolerate a high osmotic load, then mannitol is administered IV, with 1-2 g per kilogram body weight administered over 30 minutes.
(3) Administer antivenom, giving multiple vials IV over 60 minutes.
If these measures fail to reduce the compartment pressure, consider fasciotomy.
