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MMLU / A 72-year-old man is admitted to the intensive care unit for pain management and…

Problem

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question

A 72-year-old man is admitted to the intensive care unit for pain management and observation of ventricular ectopy 4 hours after undergoing uncomplicated left total knee replacement. He is receiving fentanyl via systemic patient-controlled analgesic pump for pain management. Medical history is remarkable for coronary artery disease, for which he takes atorvastatin, furosemide, carvedilol, lisinopril, and 81-mg aspirin. Baseline echocardiogram showed an ejection fraction of 0.20. Vital signs now are temperature 38.0°C (100.4°F), pulse 90/min, respirations 16/min, and blood pressure 130/90 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Physical examination discloses no unexpected abnormalities. Which of the following regimens for prophylaxis of deep venous thrombosis will likely be most beneficial in this patient?

choices

  1. Continuous application of bilateral lower extremity pneumatic compression devices
  2. Continuous intravenous infusion of heparin titrated to a PTT of 1.5 to 2.0 times the control value
  3. Oral warfarin
  4. Subcutaneous enoxaparin

subject

professional_medicine

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