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

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

Correct Answer:

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