A 24-Year-Old Man Comes to the Physician with Cold Extremities

question 409

Multiple Choice

A 24-year-old man comes to the physician with cold extremities and loss of feeling in his hands.  He is a mountaineer who was on an expedition to climb Mt. Rainier.  His group became lost in a storm and was stranded at high altitude due to reduced visibility and high winds.  The patient had several hours of exposure to very low ambient temperatures before being rescued.  He had on 2 pairs of gloves, including a woolen inner pair and an outer shell.  However, the outer shell was damaged during the climb.
Vital signs are within normal limits.  Examination shows that the first through third digits are white, cold, numb, and firm distal to the first interphalangeal joint.
The fingers are immersed rapidly in water heated to 38 C (100.4 F) .  After 30 minutes, the fingers are purplish-red between the proximal interphalangeal and distal interphalangeal joints.
Which of the following is the best next step in managing this patient?

• A)Hyperbaric oxygen
• B)Intravenous thrombolytic therapy
• C)Nonadherent gauze dressings
• D)Occlusive dressing
• E)Prophylactic antibiotics

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