During assessment of a 29-year-old female with significant deformity to the left elbow and an absent radial pulse, with about 40 minutes transport time, you should

• A. Apply gentle manual traction in line with the limb and reassess for a pulse
• B. Immobilize the limb and avoid any movement
• C. Immediately attempt to reduce the deformity with full traction
• D. Notify hospital and wait without manipulating the limb

Answer: (A)

When a limb shows a deformity with a missing distal pulse, the priority is to restore perfusion by relieving any compression from the injury. Gently applying traction in line with the limb aims to realign the bones just enough to release pressure on the brachial artery, which can allow blood to return to the radial artery. After doing this, immediately reassess the pulse and the limb’s color, temperature, and sensation. If perfusion improves, immobilize the limb to prevent further displacement and continue rapid transport while monitoring neurovascular status.

This approach minimizes ongoing ischemia while avoiding aggressive manipulation that could cause more damage. Immobilizing and avoiding movement wouldn’t address the cause of the absent pulse, and attempting a full, forceful reduction could injure nerves or vessels. Waiting and simply notifying the hospital without attempting any alignment would delay relief of ischemia.