# 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.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=393496&lang=en  
> language: en  
> subject: Reduction of Risk Potential  
> category: ROR

## Question

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.

| Time | Data |
| --- | --- |
| 06:00 (cast applied) | Pain 4/10, distal pulses 2+, capillary refill

## 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.

## In-depth explanation

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.

## Clinical scenario

**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.

## Key concepts

- **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.

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