A 72-Year-Old Man Undergoes Coronary Artery Bypass Graft (CABG) for Severe

A 72-year-old man undergoes coronary artery bypass graft (CABG) for severe coronary artery disease.  He is extubated on the second postoperative day.  His temperature is 36.6° C (97.9° F) , blood pressure is 120/70 mm Hg, pulse is 80/min, and respirations are 12/min.  On the third postoperative day, he complains of dyspnea and worsening retrosternal pain despite continuous analgesia with morphine.  His temperature is 38.6° C (101.5° F) , blood pressure is 112/52 mm Hg, pulse is 125/min and irregularly irregular, and respirations are 28/min.  Examination shows normal heart sounds.  A small amount of cloudy fluid is present in the sternal wound drain.  His ECG shows atrial fibrillation with rapid ventricular response.  An x-ray film of the chest shows widening of the mediastinum.  Echocardiography reveals a small amount of pericardial fluid.  Laboratory studies show: Which of the following will this patient most likely require?

A) Anticoagulation and electrical cardioversion
B) Broad-spectrum antibiotics alone
C) Nonsteroidal antiinflammatory agents alone
D) Pericardial puncture and nonsteroidal antiinflammatory agents
E) Surgical debridement and antibiotic therapy

Correct Answer:

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