Master Neurovascular Assessment 6 P's with Picmonic for Physician Assistant

Paresthesia is often the first sign of an impending problem described as the “pins-and-needles” sensation that may include numbness or tingling as a result of inadequate circulation. It may also be a sign of nerve damage or progressing compartment syndrome.

Pulses should be compared for differences in rate and quality on both the unaffected and injured extremities. A diminished or absent pulse distal to the injury may indicate vascular dysfunction and insufficiency and should be reported immediately to the provider.

Pallor refers to the color of the extremity (pink, pale, cyanotic) and should be assessed along with temperature (hot, warm, cool, cold) against the unaffected side. Pale, shiny skin distal to the injury may indicate compartment syndrome, while a warm, cyanotic extremity may point to poor venous return. Normal capillary refill should be within 3 seconds, and anything longer should be investigated for causation.

Increased pressure may indicate compartment syndrome and is related to swelling within the cavity. Depending on the severity, this may result in a feeling of numbness or a loss of sensation in the extremity or cause severe pain.

Partial or full loss of sensation or function may be a late sign of neurovascular damage. The complete inability to move the limb distal to the injury may indicate compartment syndrome, and significant muscle and nerve damage may be present.