A 62-year-old man presents to the emergency department with sudden onset of severe left leg pain accompanied by numbness and weakness. His medical history is remarkable for hypertension and hyperlipidemia. His vital signs include a blood pressure of 155/92 mm Hg, a temperature of 37.1°C (98.7°F), and an irregular pulse of 92/min. Physical examination reveals absent left popliteal and posterior tibial pulses. His left leg is noticeably cold and pale. There is no significant tissue compromise, nerve damage, or sensory loss. Which of the following will most likely be required for this patient's condition?
AAntibiotics
BWarfarin
CFasciotomy
DAmputation
EThromboembolectomy
A 27-year-old soldier stationed in Libya sustains a shrapnel injury during an attack, causing a traumatic above-elbow amputation. The resulting arterial bleed is managed with a tourniquet prior to transport to the military treatment facility. On arrival, he is alert and oriented to person, place, and time. His armor and clothing are removed. His pulse is 145/min, respirations are 28/min, and blood pressure is 95/52 mm Hg. Pulmonary examination shows symmetric chest rise. The lungs are clear to auscultation. Abdominal examination shows no abnormalities. There are multiple shrapnel wounds over the upper and lower extremities. A tourniquet is in place around the right upper extremity; the right proximal forearm has been amputated. One large-bore intravenous catheter is placed in the left antecubital fossa. Despite multiple attempts, medical staff is unable to establish additional intravenous access. Which of the following is the most appropriate next step in management?
AIrrigate the shrapnel wounds
BPerform endotracheal intubation
CEstablish intraosseous access
DEstablish central venous access
EReplace the tourniquet with a pressure dressing
A 38-year-old man is brought to the emergency department 35 minutes after he sustained a gunshot wound to the right thigh. He has type 1 diabetes mellitus. On arrival, his pulse is 112/min, respirations are 20/min, and blood pressure is 115/69 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. There is an entrance wound on the anteromedial surface of the right thigh 2 cm below the inguinal ligament. There is no bruit or thrill. There is no exit wound. The pedal pulse is diminished on the right side compared to the left. The abdomen is soft and nontender. The remainder of the examination shows no abnormalities. Laboratory studies show: Hematocrit 46% Serum Urea nitrogen 24 mg/dL Glucose 160 mg/dL Creatinine 3.1 mg/dL Which of the following is the most appropriate next step in management?
ADigital subtraction angiography
BWound cleaning and tetanus toxoid
CCT angiography
DDuplex ultrasonography
EFasciotomy
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