Initiate an I.V. line. Administer pain medication, as ordered. If your patient has a constricting cast, prepare for immediate cast removal. Don't apply cold or heat unless the physician orders it. Cold application causes vasoconstriction and may further compromise your patient's circulation.
Heat can increase edema.
Prepare your patient for surgery, if indicated, and administer preoperative medications as ordered. The physician may order I.V. mannitol or heparin to prevent reperfusion injury and postoperative edema. Because ischemia and necrosis may ensue rapidly, many practitioners operate when compartment pressure reaches 30 mm Hg. The surgeon may perform a fasciotomy to release the pressure and allow the muscle to expand. During surgery, he may perform an arteriogram to assess blood flow and skin grafting to decrease the risk of sepsis.