07-10-2008, 04:18 AM
A 36-year-old man is brought to the emergency department after being extricated from a motor vehicle
crash. He is brought in by ambulance and it is reported that he was a restrained passenger in a
high-speed motor vehicle accident. He was conscious at the scene but his legs were pinned under the
collapsed car. After being cut free, he was transported to the hospital. A rapid assessment reveals that
the patient has no drug allergies and had not drunk alcohol prior to the crash. He is awake and alert
with a Glasgow Coma score of 15/15. His temperature is 37.0 C (98.6 F), blood pressure is 160/100
mm Hg, pulse is 110/min, and respirations are 24/min. He denies pain in his neck on palpation and
has full range of motion. Physical examination shows clear lungs, regular heart sounds, an open right
humerus fracture, and bilateral lower extremity injuries. His left leg is intact but swollen and
erythematous. The medical technicians report that the left leg was the pinned leg. His right leg appears
to have an open femur fracture. He has 2+ radial pulses bilaterally. His left foot is cool compared with
his right. The most ominous physical finding would be
A. loss of deep tendon reflexes on the left
B. loss of dorsalis or posterior tibial pulses
C. pale color
D. paraesthesias to touch
E. tenderness on palpation
crash. He is brought in by ambulance and it is reported that he was a restrained passenger in a
high-speed motor vehicle accident. He was conscious at the scene but his legs were pinned under the
collapsed car. After being cut free, he was transported to the hospital. A rapid assessment reveals that
the patient has no drug allergies and had not drunk alcohol prior to the crash. He is awake and alert
with a Glasgow Coma score of 15/15. His temperature is 37.0 C (98.6 F), blood pressure is 160/100
mm Hg, pulse is 110/min, and respirations are 24/min. He denies pain in his neck on palpation and
has full range of motion. Physical examination shows clear lungs, regular heart sounds, an open right
humerus fracture, and bilateral lower extremity injuries. His left leg is intact but swollen and
erythematous. The medical technicians report that the left leg was the pinned leg. His right leg appears
to have an open femur fracture. He has 2+ radial pulses bilaterally. His left foot is cool compared with
his right. The most ominous physical finding would be
A. loss of deep tendon reflexes on the left
B. loss of dorsalis or posterior tibial pulses
C. pale color
D. paraesthesias to touch
E. tenderness on palpation