Neurovascular Assessment: The Six P's

A neurovascular assessment, also known as a circ check, is performed to determine adequate circulation and sensation in an extremity. The assessment focuses on six key factors, famously known as the Six P's.

1. Pain

• Universal symptom in compartment syndrome.
• Causes:
  • Edema
  • Movement of bone fragments
  • Muscle spasms
• Increases as pressure within the limb compartment rises.
• Represented by the "pain bolt."

2. Paresthesia

• First sign of an impending problem.
• Described as "pins and needles" sensation, including numbness or tingling.
• Result of inadequate circulation.
• May indicate nerve damage and professing compartment syndrome.
• Represented by the "Paris t-shirt" for pins and needles.

3. Pulse

• Compare pulse rate and quality on both unaffected and injured extremities.
• Diminished or absent pulse distal to the injury may indicate:
  • Vascular dysfunction
  • Insufficiency
• Should be reported immediately to the provider.
• Represented by the "heart timer."

4. Pallor

• Refers to the color of the extremity:
  • Pink
  • Pale
  • Cyanotic
• Assess along with temperature:
  • Hot
  • Warm
  • Cool
  • Cold
• Pale, shiny skin distal to injury may indicate compartment syndrome.
• Warm, cyanotic extremity may indicate poor venous return.
• Represented by the "pail with pallor."

5. Pressure

• Increased pressure may indicate compartment syndrome.
• Related to swelling within the cavity.
• May result in:
  • Numbness or loss of sensation
  • Severe pain
• Represented by the "pressure cooker."

6. Paralysis

• Partial or full loss of sensation or function is a late sign of neurovascular damage.
• Complete inability to move the limb distal to the injury may indicate:
  • Compartment syndrome
  • Significant muscle and nerve damage
• Represented by the "wheelchair."

Memorization Tip

• Use memorable characters or symbols to help remember the Six P's of neurovascular assessment. Consider using visual aids or mnemonic resources such as Picmonic for easier recall.

This framework is crucial for detecting issues related to circulation and sensation in extremities following injuries or surgeries.