A 24-year-old patient is admitted with a closed mid-shaft tibial fracture and a fiberglass long-leg cast applied 6 hours ago. The nurse documents serial neurovascular checks of the right lower extremity. Review the trend and answer the questions.
Trend
Choose your responses, then check the answer.
Explanation
The trend shows the classic 6 Ps of acute compartment syndrome: progressively worsening Pain (out of proportion, refractory to opioids), Pressure (tense compartment), Paresthesia, Pallor, eventual Pulselessness, Paralysis. Action: STAT bivalve or remove the cast at the bedside, elevate to heart level (NOT above heart — this reduces arterial flow), keep extremity at neutral, and notify the orthopedic surgeon for fasciotomy evaluation. Compartment pressures > 30 mmHg or delta pressure (DBP minus compartment pressure) < 30 mmHg confirm the diagnosis. Time to fasciotomy is muscle viability.
Compartment syndrome is the classic NCLEX trauma trap. The single most diagnostic finding is "pain out of proportion to injury, unrelieved by opioids" — far more important than late findings (pulselessness, paralysis) which signify irreversible damage. Never elevate a suspected compartment ABOVE heart level — that worsens ischemia.
24-year-old with closed right mid-shaft tibial fracture; long-leg fiberglass cast applied 6 hours ago. Serial neurovascular assessments documented Q1H. Pain is escalating despite scheduled hydromorphone.
Acute compartment syndrome — Increased pressure within a closed muscle compartment compromising perfusion; surgical emergency.
6 Ps — Pain (out of proportion), Pressure, Paresthesia, Pallor, Pulselessness, Paralysis — early Ps drive diagnosis.
Fasciotomy — Surgical incision of the fascia to relieve compartment pressure; ideally within 6 hours of symptom onset.