A 34-Year-Old Man Is Brought to the Emergency Department After

question 505

Multiple Choice

A 34-year-old man is brought to the emergency department after being shot in the right thigh during an attempted robbery.  The patient is awake, alert, and in moderate distress.  Blood pressure is 101/49 mm Hg and pulse is 122/min.  Records indicate that his last tetanus vaccine was a year ago.  Physical examination shows a gunshot entry wound on the anteromedial upper right thigh with an exit wound on the lateral thigh.  There is a hematoma at the entry site but no active bleeding from either wound.  The right lower extremity is cool to the touch and distal pulses are feeble.  Radiography of the lower extremity shows no fracture.  Which of the following is the most appropriate next step in management of this patient?

• A)Blood transfusion and close observation
• B)Compression dressing and prophylactic antibiotics
• C)CT angiography of the right lower extremity
• D)Doppler ultrasonography of the lower limb vessels
• E)Urgent surgical exploration of the wound

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