A 42-year-old man arrives in the ED. He reports not feeling like himself. Three days ago he stepped on a nail, which punctured his foot. He removed the nail and didn’t think he needed medical attention because he received a tetanus booster last year. When the nurse assesses the foot, she finds it tender, cool, and edematous, with erythematous and mottling, which appears to be advancing to the ankle. The nurse notes +2 pulses in both lower extremities with capillary refill <2 seconds.
