If a patient has pain under a cast, what is the next appropriate step?

• A. Administer pain medication
• B. Remove the cast to rule out compartment syndrome
• C. Schedule an X-ray
• D. Start physical therapy

Answer: (B)

When a patient experiences pain under a cast, the most appropriate immediate step involves ruling out a serious condition such as compartment syndrome. This condition occurs when there is increased pressure within a muscle compartment, which can compromise blood flow and lead to irreversible muscle and nerve damage if not treated promptly.

Pain that is disproportionate to the injury, along with other signs such as swelling, numbness, or tingling, can suggest the development of compartment syndrome. In this scenario, removing the cast is critical as it can relieve the pressure and prevent further complications. Therefore, the priority is to address the potential urgency of compartment syndrome by removing the cast to assess the situation.

Administering pain medication, while it may alleviate discomfort temporarily, does not address the underlying issue if compartment syndrome is present. Scheduling an X-ray could help evaluate the underlying injury, but it doesn't directly address the immediate concern of potential complications from the cast itself. Starting physical therapy would not be appropriate at this stage, as the underlying issues need to be resolved first for safe mobility and rehabilitation.