Acute Compartment Syndrome

Acute compartment syndrome (ACS) develops when pressure rises inside a closed osseofascial compartment and reduces capillary perfusion. The limb may still have a palpable distal pulse because major-artery flow can persist while arteriolar and capillary circulation is failing. The bedside pattern that should change the nurse's priority is escalating pain that is disproportionate to the injury, particularly pain provoked by passive stretch, with a tense compartment or new paresthesia. Do not wait for pallor, paralysis, or pulselessness; these are late findings. Immediately release external constriction that can be safely removed within the RN's competence and local policy, place the limb at heart level, reassess neurovascular status, and obtain urgent surgical consultation. A pressure measurement can support the diagnosis, but a reassuring pressure or pulse must not overrule a deteriorating clinical picture.