A 72-Year-Old Man Is Evaluated on Day 2 After a Coronary

question 541

Multiple Choice

A 72-year-old man is evaluated on day 2 after a coronary artery bypass graft surgery for severe coronary artery disease.  He has no new symptoms except for mild sternal wound discomfort exacerbated by deep breathing.  The patient's surgery was uncomplicated; he was extubated on postoperative day 1.  Medical history is significant for type 2 diabetes mellitus and hyperlipidemia.  He is afebrile.  Blood pressure is 122/75 mm Hg, pulse is 75/min and regular, and respirations are 16/min.  Oxygen saturation is 98% on room air.  The sternal wound appears to be healing normally.  Breath sounds are decreased at the left base.  There is no abdominal distension or peripheral edema.  Chest x-ray reveals a small, left-sided pleural effusion.  Leukocyte count is 9,200/mm³ and serum creatinine is 1.1 mg/dL.  Which of the following is the best next step in management of this patient?

• A)Chest tube placement
• B)Clinical observation
• C)Diagnostic thoracentesis
• D)Intravenous furosemide
• E)Oral antibiotics

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