Extremity Fracture, Long Bone Open Fracture — Neurovascular Assessment — Clinical Pathway: Emergency
Neurovascular Assessment
Patients with the following injuries are at risk for Acute Limb Compartment Syndrome (ALCS):
- Displaced tibia or forearm fracture (before and after reduction)
- Displaced supracondylar humerus fractures, especially with an associated distal radius fracture/compromised pulses
- Soft tissue crush injuries
- Re-vascularized limbs
- Following orthopedic surgery for the above injuries or osteotomies
- Subfascial IV infiltrates (such as with intraosseous lines)
- Limb gunshot wounds
Neurovascular Exam
- Children are difficult to examine, especially when they are in pain.
- Choose motor/sensory tests that are easy to perform quickly.
- When testing sensation ask in simple terms: "Does this feel the same on both sides?"
- Dopplers are available to aid in identifying pulses (located in trauma room)
- Neurovascular Examination Upper Extremity
- Neurovascular Examination Lower Extremity
Reassess and document:
- After splinting, casting and reduction
- Increasing pain in spite of adequate analgesia
- Patient complaint of paresthesias
- For patients at risk for ACS
- RN: Assess NV status hourly
- MD: Assess every 2-4 hours
Perfusion
Skin color | Well-perfused, pink, pallor, dusky |
---|---|
Capillary refill | < 2 seconds |
Pulses |
|
Upper Extremity | Radial, Ulnar |
Lower Extremity | Dorsalis Pedis, Posterior Tibial |