A 22-year-old with a tibia fracture in a long leg cast reports increasing pain unrelieved by opioids 8 hours p…

Question

A 22-year-old with a tibia fracture in a long leg cast reports increasing pain unrelieved by opioids 8 hours postop, worsened with passive toe extension. The toes are pale and cool. Which action is the priority?

Accepted Answer

Option 1: Notify provider and prepare for emergent bivalve of cast and fasciotomy

Acute compartment syndrome is an orthopedic emergency. The cardinal early sign is pain OUT OF PROPORTION to injury, especially with passive stretch. Late signs (pulselessness, paralysis, pallor) indicate already established ischemic damage. Compartment pressure over 30 mmHg or delta P (DBP - compartment pressure) under 30 mmHg confirms diagnosis. Cast must be bivalved IMMEDIATELY — not delayed. Fasciotomy within 6 hours of symptom onset prevents permanent damage. Elevation ABOVE the heart in established compartment syndrome can WORSEN perfusion (limb at heart level). Ice may decrease perfusion. Increased opioids mask symptoms — never the answer.

Answer

Option 2: Elevate the leg above heart level to reduce swelling

Answer

Option 3: Apply ice packs to the affected limb

Answer

Option 4: Increase opioid dosing and reassess in 1 hour

A 22-year-old with a tibia fracture in a long leg cast reports increasing pain unrelieved by opioids 8 hours postop, worsened with passive toe extension. The toes are pale and cool. Which action is the priority?

In-depth explanation

Clinical scenario

Key concepts

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A 22-year-old with a tibia fracture in a long leg cast reports increasing pain unrelieved by opioids 8 hours postop, worsened with passive toe extension. The toes are pale and cool. Which action is the priority?

In-depth explanation

Clinical scenario

Key concepts

Master the NCLEX-RN with MyMerci