Bones break in patterns you can learn to spot. Every fracture needs a neurovascular assessment, because the broken bone can hurt the nerves, arteries, and veins next to it. Click a fracture type, then review the 5 P's.
The break pattern
A long bone with a nerve (yellow), an artery (red), and a vein (blue) running beside it.
Pick a fracture type.
Pick a fracture type6 common patterns
First checks: the 5 P's
Pain
Can they feel pain? Pain you cannot control is a red flag
Pulse
Is blood still flowing past the injury?
Pallor
Pale, cool skin means poor blood flow (perfusion)
Paresthesia
Can they feel touch? Numbness or tingling points to a nerve
Paralysis
Can they still move it?
When the sixth P applies. The five above are the limb check after a break, and pulse is something you feel for. If any of the five is off, move to the 6 P's and add poikilothermia, a limb that drifts to room temperature. Those six go with compartment syndrome and acute limb ischemia, where the pulse is gone rather than just weak.
Trauma comes first. Run the ABCDE primary survey:Airway (blocked or occluded?), Breathing (in distress? breath sounds?), Circulation (heart rate, pallor, cap refill), Disability (can they respond?), Exposure and environment (such as hypothermia, a low body temperature). Who breaks bones most? Older adults (osteoporosis) and children.