Compartment Cody — Fractures & Compartment Syndrome
Pain out of proportion, unrelieved by opioids — pallor and pulselessness are late
Cody's leg is casted after a motorcycle crash, and by midnight he is crying through his PCA pump. His toes still look pink, but he screams when the nurse just wiggles them.
Cody breaks his tibia and gets a tight cast. Swelling inside the fascial compartment cuts off perfusion, and pressure builds faster than anyone expects. The classic 6 P's — pain, pallor, paresthesia, pulselessness, poikilothermia, paralysis — but pain unrelieved by opioids and pain on passive stretch come first, long before the pulse ever disappears. Waiting for a lost pulse means the muscle is already dying.
Read Compartment Cody's full story →The story arc
The setup
A tibia-fibula fracture is casted snugly in the emergency department, and Cody is sent to the unit for observation.
The turn
Two hours later his pain is 9/10 despite a full dose of morphine, and it worsens when the nurse passively extends his toes.
The crisis
His foot feels tight as a drum, paresthesia spreads across his toes, and compartment pressure reads 42 mmHg.
The save
The nurse loosens the cast to the skin immediately, keeps the leg level with the heart, withholds ice, and calls the surgeon for an emergency fasciotomy.
NCLEX study section — Fractures & Compartment Syndrome
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Health Assessment
Take this chapter into practice questions on the same topic.