Soru

On postoperative day 6 following a coronary artery bypass grafting for severe ischemic heart disease, a 64-year-old man is evaluated for worsening chest pain and progressive shortness of breath over the last 24 hours. The pain is exacerbated by deep inspiration and coughing. His medical history includes type 2 diabetes mellitus, chronic obstructive pulmonary disease, and obesity. Current medications include aspirin, metoprolol, and a sliding-scale insulin regimen. His temperature is $39.1^{\circ}\text{C}$ ($102.4^{\circ}\text{F}$), blood pressure is 108/64 mmHg, pulse is 114/min, and respirations are 24/min. Pulse oximetry shows 94% on room air. Physical examination reveals an erythematous sternal incision that is exquisitely tender to palpation. Purulent fluid can be expressed from the inferior aspect of the wound. There is palpable movement of the sternal edges relative to each other when the patient takes a deep breath. Lung auscultation reveals decreased breath sounds at the bases bilaterally, without wheezing. Cardiac auscultation reveals regular tachycardia without murmurs, rubs, or gallops. Laboratory testing shows a leukocyte count of $19,500/\text{mm}^3$. Which of the following is the most appropriate next step in the management of this patient?