A 55-Year-Old Man Is Brought to the Emergency Department Due

question 342

Multiple Choice

A 55-year-old man is brought to the emergency department due to a gunshot wound to the left abdomen.  He undergoes an exploratory laparotomy involving a partial small bowel resection and a left nephrectomy.  His postoperative hemoglobin is 10.4 mg/dL.  The patient has no other medical history and takes no medications.  Recovery is uneventful until postoperative day 4 when he develops fever, tachypnea, and shortness of breath.  The patient is lethargic but responsive.  Temperature is 38.9 C (102 F) , blood pressure is 75/50 mm Hg, pulse is 110/min and regular, and respirations are 22/min.  There is no jugular venous distention.  Lung auscultation reveals crackles at the right lung base.  There are no cardiac murmurs.  Abdominal examination shows a well-healing abdominal wound and a soft, nondistended abdomen.  His urine output over the last 12 hours is 100 mL.  Laboratory results are as follows: Broad-spectrum antibiotics are started.  Which of the following additional treatments is the most appropriate next step in management of this patient?

• A)Hemodialysis
• B)Intravenous lactated Ringer
• C)Intravenous albumin infusion
• D)Intravenous dopamine
• E)Intravenous hydrocortisone
• F)Intravenous sodium bicarbonate
• G)Red blood cell transfusion

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Definitions:

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