Neurovascular

Neurovascular assessment determines whether tissue distal to an injury, dressing, splint, or cast still has adequate circulation, sensation, and motor function. It is especially important after fractures, crush injuries, reduction, surgery, or new immobilization because swelling can raise pressure inside a closed muscle compartment. As pressure rises, venous outflow is obstructed first. Fluid then accumulates, capillary perfusion falls, and muscle and nerve ischemia begin before major arterial flow is lost. This is why a distal pulse can remain present in a limb with evolving compartment syndrome. Assess the affected limb and compare it with the unaffected side. Record pain and pain with passive stretch, skin color and temperature, capillary refill, distal pulse quality, sensation, active movement, edema, and whether the compartment feels unusually firm or tense. Document objective findings, not only “neurovascularly intact.” For example: “Right toes warm and pink; dorsalis pedis pulse 2+; decreased light touch in first web space; severe pain with passive great-toe extension.” Capillary refill is one piece of the pattern, not a stand-alone test. It varies with age, ambient temperature, and baseline circulation, so a...