A 22-year-old male presents to the emergency department with severe pain and swelling in his lower leg following a motorcycle accident. Despite administration of analgesics, the patient reports excruciating pain that is out of proportion to the initial injury. Physical examination reveals a tense, swollen leg that is painful on passive stretching of the toes. The emergency nurse recognizes these signs as indicative of which condition, and understands immediate intervention is crucial to prevent permanent damage?
The symptoms described are classic for compartment syndrome, which includes severe pain, especially with passive stretch, pallor, paresthesia, pulselessness, and paralysis (the '5 P's'). Pain out of proportion to the injury and pain on passive stretching are particularly indicative of this condition. Early recognition and treatment are critical to prevent irreversible muscle and nerve damage. An x-ray is useful for diagnosing fractures but does not diagnose compartment syndrome. While deep vein thrombosis (DVT) and cellulitis can also manifest with pain and swelling, the pain from DVT is often not out of proportion nor exacerbated by passive stretching, and cellulitis typically presents with redness and warmth, which are not characteristic of compartment syndrome.
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BCEN CEN
Musculoskeletal and Wound Emergencies
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