TY - JOUR T1 - Dangerous parking deck JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2019-000327 VL - 4 IS - 1 SP - e000327 AU - David V Feliciano Y1 - 2019/05/01 UR - http://tsaco.bmj.com/content/4/1/e000327.abstract N2 - A 53-year-old woman standing next to a car in a parking deck was struck by another car when the driver lost control. The patient’s right knee and leg were crushed between the bumpers of both cars. The patient was ‘fortunate’ in that a Level I trauma center was only six blocks away.On arrival in the trauma room, the patient was awake and alert with a heart rate of 120 beats per minute and a systolic blood pressure of 90 mm Hg. The right lower extremity was mangled with a dislocation of the knee, large wound in soft tissue with oozing behind the knee, and disrupted muscles in the exposed posterior compartments. No arterial pulses were present in the right foot, but there was sensation and some weak dorsiflexion and plantar flexion in the ankle joint.The most appropriate first step in the management of this patient in addition to resuscitation is:CT arteriography.Administer unfractionated heparin.Obtain consent for amputation.Move patient to operating room.The patient was moved to the operating room to control bleeding from disrupted soft tissue, assess the magnitude of injuries to the right knee and leg and to obtain X-rays of the same. After preparation of the skin from the umbilicus to the toenails bilaterally, the right foot was placed in a plastic bag to allow for later observation of skin color changes and palpation of pedal pulses. The remainder of both lower extremities was draped in the usual fashion.As there was no major arterial hemorrhage from disrupted soft tissues, X-rays of the right knee and leg were performed. A Grade IIIC open dislocation of the right knee joint was confirmed, and there was a Grade II open transverse fracture of the right tibia, as well. A distal medial right popliteal incision was … ER -