“Head.And my leg.”He winced.His hand reached down.“My right leg really hurts.”
Meg’s medical instincts sharpened.She’d been so focused on his head injury—the visible wound, the obvious concern—that she hadn’t done a thorough assessment of the rest of him.
“Don’t move it.Let me look.”She shifted position and shone her headlamp down Alex’s body.The beam caught dust motes floating in the still air.
His jeans were torn at the right knee and covered in dirt.She carefully cut away the fabric with her trauma shears and exposed his lower leg.
Her stomach dropped.
The leg was swollen—massively swollen from midcalf down to the ankle.The skin was tight and shiny.Mottled with dark purple bruising that spread like spilled ink across the tissue.This was the type of damage that happened when something was crushed.She remembered the rock that had pinned his pant leg.It must have had a solid hit.
Meg’s mind raced through differential diagnoses.
Closed tibial fracture, definitely.
But the degree of swelling, the rate at which it seemed to be increasing even as she watched, the mottled discoloration that spoke of compromised circulation?—
This wasn’t normal post-fracture edema.
She pressed her fingers against the dorsalis pedis—the main artery that got blood to the foot.She searched for a pulse, her own pulse hammering in her ears as she waited to feel that telltale throb.
Weak.Thready.
She pressed on his toenail—watching the pink flush white beneath her thumb—then let go and counted in her head.One Mississippi.Two Mississippi.Three Mississippi.Four Mississippi.
The pink color took four seconds to return.
Far too long.Should have been two seconds.Three at most.
“How bad?”Alex’s voice was strained.She realized he was watching her face.
Meg forced her expression to stay neutral.“Your leg is broken.I need to splint it, but first I need to check a few things.This is going to hurt.I’m sorry.”
She ran her fingers lightly over his foot.“Can you feel that?”
“Barely.”
“Wiggle your toes.”
The movement was weak and made him gasp in pain.
She kept hoping for anything to point to something other than what it was.Some other explanation.
But he had all the classic signs of compartment syndrome.
The fracture had caused bleeding into the closed compartments of his lower leg.And the pressure was building.Like a tourniquet tightening from the inside.The soft tissue expanding within the unyielding fascia that wrapped around muscle groups.
Without intervention soon, the pressure would cut off blood flow entirely.And he would lose his leg.
He needed a fasciotomy.
The word echoed in her mind like a death sentence.
To relieve the pressure, she’d need to make long incisions through the skin and fascia and open the compartments to let them decompress.
It was a surgical procedure that required sterile conditions, proper instruments, anesthesia, and an operating room with bright lights and trained nurses and backup if something went wrong.
And she was in a cave with limited supplies.
