A 22-Year-Old Man Involved in a Motor Vehicle Collision Undergoes

A 22-year-old man involved in a motor vehicle collision undergoes a prolonged surgery to repair a left tibial fracture and popliteal artery injury.  The day after surgery he has increasing pain in the left leg and is treated with intravenous fluids and morphine.  Two hours later, the patient continues to have pain that worsens with passive leg movement and has a "pins and needles" sensation.  Examination shows tense, tender swelling of the left calf.  There is sensory loss between the great and second left toes.  The lower-extremity pulses are palpable bilaterally.  Which of the following is the most important next step in management of this patient?

A) Elevate the leg and apply ice packs
B) Initiate patient-controlled analgesia
C) Obtain a Doppler ultrasound of the lower extremity
D) Obtain x-rays of the lower extremity
E) Return to the operating room for fasciotomy

Correct Answer:

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