Soru

Emergency medical services arrive at the trauma bay with a 28-year-old roofing contractor who fell from a residential building. The fall distance was approximately $4.5$ meters ($15$ feet). The patient is fully conscious and reports agonizing pain in his left leg. Vital signs show a temperature of $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), heart rate of $105/\text{min}$, blood pressure of $130/80\text{ mm Hg}$, and a respiratory rate of $18/\text{min}$. The initial trauma assessment confirms a patent airway, normal breathing, and no clinical evidence of intra-abdominal hemorrhage. Attention to the left lower extremity reveals a visibly angulated mid-shaft tibia. A $5\text{-cm}$ skin tear is present over the medial aspect, oozing dark blood, with underlying bone fragments exposed. The distal foot is noticeably pale and cold compared to the contralateral limb. Palpation of the dorsalis pedis and posterior tibial arteries yields no pulse, and capillary refill in the toes is absent. Neurological evaluation of the foot is limited secondary to extreme pain. Which of the following is the most appropriate initial step in the management of this patient's left extremity?