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A 73-Year-Old Man Is Brought to the Emergency Department After

question 360

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A 73-year-old man is brought to the emergency department after his daughter found him on the floor. The patient says that he fell and now his left hip "hurts a lot," but he does not recall any details of the fall. Over the past several days, he has felt short of breath with a cough and intermittent palpitations that he attributed to "coming down with the flu." His other medical problems include hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and benign prostatic hyperplasia. His temperature is 37.3 C (99.2 F) , blood pressure is 118/76 mm Hg, pulse is 116/min, and respirations are 24/min. Pulse oximetry shows 95% on 2 L/min of oxygen by nasal cannula. Breath sounds are decreased at the right lung base, and crackles are present at the left lung base. The left lower extremity is shortened and externally rotated. Initial laboratory studies, including complete blood count, glucose, and serum chemistries, are normal. The pain improves with a dose of hydromorphone. X-ray findings are shown below. $A 73-year-old man is brought to the emergency department after his daughter found him on the floor. The patient says that he fell and now his left hip hurts a lot, but he does not recall any details of the fall. Over the past several days, he has felt short of breath with a cough and intermittent palpitations that he attributed to coming down with the flu. His other medical problems include hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and benign prostatic hyperplasia. His temperature is 37.3 C (99.2 F) , blood pressure is 118/76 mm Hg, pulse is 116/min, and respirations are 24/min. Pulse oximetry shows 95% on 2 L/min of oxygen by nasal cannula. Breath sounds are decreased at the right lung base, and crackles are present at the left lung base. The left lower extremity is shortened and externally rotated. Initial laboratory studies, including complete blood count, glucose, and serum chemistries, are normal. The pain improves with a dose of hydromorphone. X-ray findings are shown below. Which of the following is the best next step in management of this patient? A) Electrocardiogram, cardiac markers, and chest x-ray B) Hemiarthroplasty for femoral neck fracture C) Intravenous crystalloids D) Lower-extremity skeletal traction E) Skilled nursing care, with hip surgery after the viral syndrome resolves$ Which of the following is the best next step in management of this patient?

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