A 23-year-old male has a deformed right knee after falling from a ladder. The hospital is 45 minutes away and distal pulses are absent. What is the most appropriate action?

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When a knee injury is deformed and distal pulses are absent, the priority is to protect the limb and get definitive care quickly because arterial injury is a real concern. Do not try to manipulate the joint to “restore” pulses; moving a fracture with possible vascular damage can worsen vessel injury, cause further bleeding, or dislodge a clot. The safest action is to immobilize the limb in the position found using a rigid splint and secure it well to prevent movement, then arrange rapid transport to a facility equipped to assess and treat vascular compromise. Elevating the limb or trying to restore pulses by manipulation isn’t helpful here. Tourniquets are only for life-threatening external bleeding, which isn’t described. If transport time is long and conditions allow, a faster transfer method could be considered, but it does not replace the need for proper immobilization and rapid transport.