In the ED, their vitals/exam are as above. With*** evidence of neurologic/vascular compromise. With*** evidence of deep tendon/muscle involvement. With*** evidence of deeper space infection.
– Labs/Tests: Lactate, CBC, CMP, PT/INR, Type & Screen
– Imaging: ***
– Treatments: NPO, 2 large-bore IVs (18G or larger), Hemostasis (Simple pressure -> Pressure w/ QuikClot [preferred] or Gelfoam -> Lidocaine 1% w/ epi -> Tourniquet), Type & Cross 4 units pRBCs and give 2 units if symptomatic or H/H < 7/21. Consider anticoagulation reversal if applicable. Consider FFP/Vitamin K if INR elevated. Consider TXA 1g x1 if bleeding continues. IV Ancef, Pain control/antiemetics as needed. Tetanus *** - Consults: *** surgery - Dispo: Pending clinical resolution