A 42-Year-Old Woman Is Evaluated in the Postoperative Care Unit

A 42-year-old woman is evaluated in the postoperative care unit for sudden-onset tachycardia and dyspnea 15 minutes after surgery.  The patient underwent a dilation and curettage for gestational trophoblastic diseases complicated by intraoperative bleeding that required 2 units of packed red blood cells.  The bleeding was controlled, and the remainder of the procedure and subsequent extubation were uneventful.  The patient has a 10-pack-year smoking history but no other medical conditions or prior surgeries.  She takes no daily medications.  Temperature is 37.8 C (100 F) , blood pressure is 160/110 mm Hg, pulse is 134/min, and respirations are 38/min.  The patient appears diaphoretic and has shallow, labored breathing.  Cardiac examination shows sinus tachycardia with no rubs or murmurs.  The lungs are clear to auscultation bilaterally.  The abdomen has no marked distension, rebound, or guarding.  Bilateral extremities have generalized rigidity.  The Foley catheter is draining brown-appearing urine.  Which of the following is the most likely diagnosis for this patient?

A) Disseminated intravascular coagulation
B) Malignant hyperthermia
C) Neuroleptic malignant syndrome
D) Pulmonary embolism
E) Transfusion-related acute lung injury

Correct Answer:

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