Abstract Background Often, acute compartment syndrome (ACS) is diagnosed using a pressure measuring device. Conventional measuring pressure and newer devices such as continuous near infrared spectroscopy (NIRS) can aid in diagnosis, but are often limited by cost and availability. In this case, we discuss an economical and approachable technique employing an arterial line setup to measure compartment pressures. Case Presentation 41-year-old male with a significant history of intravenous polysubstance abuse who presented after being found unresponsive following a fentanyl overdose. He was resuscitated with naloxone and ondansetron and subsequently admitted to the intensive care unit for acute metabolic encephalopathy, pancreatitis, acute kidney injury, rhabdomyolysis and high anion gap metabolic acidosis. Initially, he was oriented and alert with only complaints regarding numbness and weakness in his left lower extremities. Urgent bilateral venous and arterial dopplers were obtained, which demonstrated no acute findings. During his hospital course, he had worsening lactic acidemia, which worsened his hyperkalemia eventually leading to unstable bradycardia. Given ongoing concern for his lower extremities, NIRS monitoring was performed, but was inconclusive. Despite nondiagnostic imaging and NIRS results, clinical suspicion for ACS remained high due to worsening acidosis and elevated lactic acid levels. While awaiting surgical consultation, compartment pressures were measured using an arterial line transducer. The patient’s right lower leg compartments measured 12 mmHg posteriorly and 14 mmHg anteriorly and laterally, whereas the left lower leg measured 70 mmHg posteriorly and 120 mmHg anteriorly and laterally, confirming the diagnosis of acute compartment syndrome. At the time of these measurements, his diastolic pressure was affected by the use of multiple vasopressors; therefore, delta pressure was not calculated. Discussion The incidence of acute compartment syndrome is relatively low, particularly in cases of nontraumatic ACS. However, the diagnosis of ACS is crucial for prognostication in these cases as they are associated with higher complications and delay of treatment.1 Often, nontraumatic ACS presents with subtle or nonspecific findings and adjunct diagnostic modalities like NIRS and ultrasound may be inconclusive. In our case, the arterial line technique helped guide our suspicion to make the diagnosis, necessitating further management. Although this technique is not widely studied or standardized, it offers a methodical approach to aid in informed decision making and early diagnosis. However, further studies are warranted to validate the reliability of this approach compared to other pressure measuring systems. This abstract is funded by: None
Vu et al. (Fri,) studied this question.