In a patient with an obvious arterial injury, what is the next step in management?

• A. Apply pressure and observe
• B. Operative wound exploration
• C. CT angiography
• D. Antibiotics only

Answer: (B)

When there are clear, hard signs of an arterial injury, the priority is urgent surgical exploration to control the bleeding and assess the vessel. An obviously injured artery means ongoing hemorrhage or threatened limb viability, and delaying for imaging or observation can lead to massive blood loss, worsening ischemia, or loss of the limb. Opening the wound allows rapid proximal and distal control of the vessel, debridement of nonviable tissue, and definitive repair or ligation as needed. Imaging studies like CT angiography would only delay life- and limb-saving intervention when the injury is already obvious. Antibiotics alone do not address the vascular threat, and simply applying pressure without attempting definitive control is unlikely to stabilize the situation.