Emergency and Toxicologycommon
A 35-year-old man is admitted six hours after a house fire with burns to 25% of his body surface area, including a burn encircling the entire right forearm where the skin is pale, dry, firm and insensate to pinprick. Intravenous fluid resuscitation is running according to protocol and urine output is 60 mL/hr. Over the past hour the right hand has become cool with a capillary return of four seconds, and he reports pins and needles in the fingers; the radial pulse is palpable but weaker than the left. Which one of the following is the most appropriate next step in management?