You are caring for a 58-year-old woman, who is complaining of pain in the elbows and fingers. Which of the following changes in a patient's neurovascular examination should be reported as a critical sign of arterial insufficiency?
a. pain unrelieved by analgesics c. hypersensation below the injury
b. reduced motion in affected extremity d. pale extremity that is cool to touch
D
A pale and cool extremity following a musculoskeletal injury is the classic indication of arterial insufficiency and must be immediately reported. Hypersensation below the injury, as well as other abnormal sensations, may be experienced but they are not the priority finding. An evaluation of a potential problem, including a comparison of the affected and unaffected extremity, will prove beneficial. Pain unrelieved by analgesics is indicative of compartment syndrome. Reduced movement in the affected extremity should be investigated as potential damage to the motor component of the affected nerves.
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