Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Acute compartment syndrome is an immediate surgical emergency
Raised pressure within a closed myofascial space compromises muscle and nerve microcirculation; delay causes necrosis, contracture, rhabdomyolysis, renal failure, infection, amputation and death even while distal pulses remain palpable.
Action: Call a senior orthopaedic decision-maker immediately, release circumferential dressings and expose the limb, correct hypotension, elevate safely and reassess within 30 minutes, perform hourly documented examinations or concurrent pressure monitoring if findings are incomplete, and proceed to NCEPOD-1 decompression as soon as the diagnosis is made.
Synopsis
Recognise evolving compartment ischaemia from serial clinical change, release external pressure, use concurrent blood-pressure and compartment-pressure data when examination is uncertain, and achieve immediate complete decompression before irreversible injury.
Suspect acute compartment syndrome from the trajectory: worsening pain, passive-stretch pain, swelling, sensory change and analgesic escalation matter more than any single normal earlier examination.
Do not use palpable pulses to exclude it. Pulselessness is late or indicates a separate arterial emergency and should prompt simultaneous vascular and orthopaedic action.
BOASt requires hourly assessment of an at-risk patient, documenting time, mechanism, consciousness, neurology, circulation, pain, analgesic dose and response, interpretation and management rationale.
Key red flags
Increasing pain out of proportion to the injury, pain on passive stretch of muscles crossing the compartment, a tense swollen segment or rapidly rising opioid requirement requires immediate reassessment and escalation.
Investigation priorities
01
First-line serial clinical examinationFirst stepFirst line
Detect change early enough for limb-saving decompression.
Management branches
SuspectedRelease pressure and reassess
An at-risk limb develops disproportionate pain, passive-stretch pain, tension, analgesic escalation or neurological change.
Contact senior orthopaedics immediately and record examination, time, analgesia, blood pressure and the change that triggered concern.
Remove circumferential dressings to skin, correct hypotension, expose and position the limb safely and re-evaluate within 30 minutes.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.