What should you do for a 13-year-old male with a pencil impaled in his arm and no detectable radial pulse?

In cases of an impaling injury, like a pencil lodged in the arm, the first priority is to assess and manage circulation, especially when there is no detectable radial pulse. The absence of a radial pulse could indicate compromised blood flow, which may be caused by pressure from the impaled object or vascular injury. Therefore, an appropriate initial response is to reposition the arm gently to relieve any pressure on the blood vessels, which could potentially restore pulse circulation. It is crucial to handle the situation with care because repositioning does not risk further injury or displacement of the object.

In contrast, removing the pencil may exacerbate the injury and cause significant bleeding or further damage; it should only be done in a controlled environment by medical professionals if necessary. Applying a tourniquet is typically reserved for severe, life-threatening limb bleeding and is not appropriate unless there is uncontrollable hemorrhage. Immediate transport may not be the best initial action without first attempting to restore circulation, as the patient could benefit from immediate stabilization measures before transport. Thus, repositioning is the correct initial response in this scenario to address the potential vascular compromise.