Compartment Syndrome on the NCLEX
The 6 Ps, pain out of proportion, positioning, and the fasciotomy window.
Pressure builds inside a closed fascial compartment until perfusion stops. Hours decide the limb.
The 6 Ps
Pain, pressure, paresthesia, pallor, pulselessness, paralysis. The last two are late. If you wait for a lost pulse, the muscle is already dying. Earliest and most reliable: pain out of proportion to the injury, unrelieved by opioids, and worse with passive stretch of the involved muscles. Paresthesia (burning, tingling) comes early too.
Who gets it
Fractures (tibia is classic), crush injuries, tight casts or dressings, circumferential burns, prolonged limb compression. Symptoms typically develop within the first 24-48 hours after injury or casting.
What to do and what not to do
Do NOT elevate the limb above the heart. Elevation drops arterial inflow to a compartment that already has poor perfusion. Keep the limb at heart level. Remove or loosen restrictive dressings; the provider may bivalve the cast. No ice: vasoconstriction worsens perfusion. Notify the provider immediately.
Fasciotomy
Definitive treatment: the surgeon opens the fascia to release pressure. Muscle tolerates ischemia for only a few hours; after about 6 hours the damage becomes irreversible. The wound is left open initially. Watch for rhabdomyolysis: dark tea-colored urine, rising CK, AKI risk. Aggressive IV fluids protect the kidneys.
Frequently asked
Cast patient rates pain 10/10 after IV opioids. Priority?
Assess neurovascular status and call the provider. Unrelieved pain under a cast is compartment syndrome until proven otherwise. Do not just re-medicate.
Why is a present pulse falsely reassuring?
Compartment pressure kills capillary perfusion long before it occludes the main artery. Distal pulses can persist while muscle infarcts.
Quick check
Loading a question…
How ready are you right now?
10 real NCLEX questions, free, in your browser. See how close you are to ready and which subjects are costing you.
Try 10 questions free