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Zorluk: KolayPreoperative and Postoperative Care

A 6464-year-old woman is evaluated on postoperative day 55 following a right total knee arthroplasty. She reports new-onset right calf pain that worsens when she attempts to walk. Her temperature is 38.2∘C38.2^\circ\text{C} (100.8∘F100.8^\circ\text{F}), blood pressure is 130/80 mm Hg130/80\text{ mm Hg}, pulse is 88/min88/\text{min}, and respirations are 16/min16/\text{min}. Physical examination reveals right calf swelling, warmth, and tenderness to palpation. The surgical incision site is well-approximated, clean, and without purulent discharge or surrounding erythema. Her breath sounds are clear bilaterally. Which of the following is the most appropriate next step in the management of this patient?

  1. Compression ultrasonography of the lower extremitiesCevap
  2. B
    Empiric therapy with broad-spectrum intravenous antibiotics
  3. C
    Computed tomography pulmonary angiography
  4. D
    Plain radiography of the chest
  5. E
    Surgical re-exploration and wound drainage

Cevap

The most appropriate next step is compression ultrasonography of the lower extremities to evaluate for a deep vein thrombosis.
The correct answer is compression ultrasonography of the lower extremities. This patient presents with a fever and localized right calf symptoms (pain, swelling, warmth, tenderness) on postoperative day 5 following a major orthopedic surgery (total knee arthroplasty). This presentation is classic for a deep vein thrombosis (DVT), which typically manifests between postoperative days 4 and 6 (the 'Walking' in the 5 Ws of postoperative fever). Compression ultrasonography is the preferred initial diagnostic modality because it is highly sensitive, specific, and non-invasive.

Adım Adım Çözüm

1
Analyze the patient's timeline and vital signs.
The patient developed a new-onset fever on postoperative day 5 following a major orthopedic surgery.
The '5 Ws' mnemonic (Wind, Water, Walking, Wound, Wonder drugs) helps categorize postoperative fevers by timeline. Day 5 aligns with 'Walking' (venous thromboembolism) or 'Wound' (surgical site infection).
2
Evaluate the localized physical examination findings.
The patient has unilateral calf swelling, warmth, and pain. The surgical incision is clean, and the lungs are clear.
These focal findings strongly point toward a deep vein thrombosis (DVT) rather than an incisional infection or pneumonia.
3
Determine the most appropriate diagnostic test.
Compression ultrasonography of the lower extremities is selected.
It is the standard, first-line non-invasive imaging modality used to confirm the presence of a DVT in a symptomatic patient.

Anahtar Kavram

Patients who develop a fever and unilateral leg swelling around postoperative day 5 after major surgery should be evaluated for deep vein thrombosis (DVT) using lower extremity compression ultrasonography.
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Preoperative and Postoperative Care

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