Immobility and the two orthopedic emergencies
A supine body silhouette with eight leader lines to the sites immobility damages, over a time axis running from hours to weeks showing when each complication becomes visible.
The bed is a treatment with side effects, and those side effects arrive on a schedule you can write down in advance.
1 · Circulation Venous stasis, vessel injury, and altered clotting together produce deep vein thrombosis and pulmonary embolism. Unilateral calf swelling and warmth, or sudden dyspnea with pleuritic chest pain and tachycardia, are the tested cues.
2 · Lungs Shallow breathing and pooled secretions collapse alveoli and seed pneumonia. Incentive spirometry, turning, and early ambulation are prevention, not comfort measures.
3 · Skin Unrelieved pressure over bony prominences begins tissue damage within hours. Reposition, offload the heels entirely, manage moisture, and assess the skin every shift.
4 · Muscle and bone Strength is lost measurably within days of bed rest, joints tighten toward contracture, and bone demineralizes, releasing calcium into the blood. Passive range of motion protects function before therapy ever arrives.
5 · Gut and bladder Peristalsis slows into constipation and ileus. Urine pooling in a supine bladder invites infection and stone formation. Bowel and bladder assessment belongs in the daily plan for every immobile patient.
6 · Upright again Orthostatic hypotension appears the first time the patient stands, because vascular tone has deconditioned. Dangle first, measure sitting and standing, and never mobilize a deconditioned patient alone the first time.
7 · Compartment syndrome Pressure inside a fascial compartment cuts off perfusion. The cue is pain out of proportion to the injury, unrelieved by analgesia, with early paresthesia. Do not elevate the limb above the heart, do not apply cold, loosen or bivalve a constricting cast, and escalate. A pulseless limb is a late finding, so waiting for it is the wrong answer.
8 · Fat embolism After a long bone or pelvic fracture, typically within one to three days, the patient becomes dyspneic and confused and develops a petechial rash across the chest, neck, and axillae. Petechiae plus confusion is what separates this from a pulmonary embolism on the exam.
Margin notethe bed is a treatment with side effects.
Watch outpain unrelieved by opioids after a fracture or casting is compartment syndrome until it is ruled out.
TakeawayImmobility damages every system on a schedule, so the prevention plan is written before the damage appears.
→ BOOK 15 · P7 for positioning and mobility technique · → BOOK 09 · P8 for embolism management · → P51