بعد ٤ ساعات من تجبير الساعد، يشتكي المريض من ألم شديد لا يخف بالمورفين ويزيد عند تحريك أصابعه سلبياً، والأصابع متورمة. ما التصرف الصحيح؟

Four hours after a forearm cast is applied, the client has severe pain not relieved by morphine that worsens with passive finger movement, and the fingers are swollen. What is the correct action?

1. Notify the provider now and keep the arm at heart level
2. Give another morphine dose and reassess in an hour
3. Encourage active finger exercises to improve circulation
4. Elevate the arm well above the heart and apply ice

Answer: A) Notify the provider now and keep the arm at heart level. Pain out of proportion that worsens on passive stretch is the earliest sign of compartment syndrome, an emergency that may need cast splitting or fasciotomy. The arm stays at heart level because high elevation reduces arterial perfusion, and more analgesia delays diagnosis.