A 34-year-old construction worker presents to the emergency department with a nail gun injury to the anterior thigh. The nail remains embedded. Which assessment finding is the most critical and requires immediate intervention?
Localized pain rated 6/10 at the entry site.
Diminished sensation over the anterior knee.
An expanding hematoma around the nail.
Inability to fully extend the knee against resistance.
An expanding hematoma is a 'hard sign' of arterial injury and indicates active, uncontrolled bleeding. This finding represents the most immediate threat to the patient's limb and life, requiring urgent intervention to control hemorrhage. While pain, nerve deficits (diminished sensation), and muscle/tendon injury (inability to extend the knee) are all potential and serious consequences of this injury, the vascular compromise signified by an expanding hematoma takes precedence based on trauma assessment principles.
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Musculoskeletal and Wound Emergencies
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