A 22-year-old man presents to the emergency department with an open fracture of the forearm. He spent the day scuba diving at a local quarry. After emerging from the last dive, he fell on his outstretched hand, sustaining the injury for which he seeks treatment. He complains of diplopia and appears intoxicated (i.e., slurred speech, disorientation). Physical exam reveals mottled skin on his extremities and a gait disturbance. The surgeon wants to operate immediately. After initiation of supportive care and administration of 100 percent oxygen by face mask, which of the following is the best initial step in his management?

There are approximately 4 million sport divers in the United States alone, and the number worldwide is growing. During the past 20 years, the number of diving certifications awarded annually has tripled. Due to the ease of travel, patients...

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