A 19 year old right handed lady is skiing in the back country when she gets lost and is found 12 hours later after being exposed to subfreezing temperatures the entire time. On initial physical exam, the fingers of her right hand are completely cold and blue. After gentle re-warming, there are still no palpable radial, ulnar, or digital pulses in the right hand. There are no detectable Doppler signals in these vessels either. What would be the best therapy for this patient? a. Antiplatelet therapy
b. Conservative wound care
c. Emergent amputation of the right hand
d. Urgent angiogram and thrombolysis
e. Several week clinical observation to permit demarcation of necrosis