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MMLU / A 49-year-old man, who is recovering in the hospital 2 days after uncomplicated…

Problem

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question

A 49-year-old man, who is recovering in the hospital 2 days after uncomplicated left femoral-popliteal bypass grafting for claudication, has now developed increasing pain in his left foot. Until now, the patient's postoperative course had been unremarkable and he has been treated with low-dose morphine for pain control. Medical history is remarkable for type 2 diabetes mellitus controlled with metformin and diet. Vital signs now are temperature 36.8°C (98.2°F), pulse 80/min and regular, respirations 20/min, and blood pressure 150/92 mm Hg. The surgical incision appears clean and well approximated without abnormal erythema or swelling. The left lower extremity and foot appear pale. Palpation of the left lower extremity discloses a strong femoral pulse, a weak popliteal pulse, and a cool, pulseless foot. Which of the following is the most appropriate management?

choices

  1. Bedside compartment pressure measurements
  2. Doppler ultrasonography of the left lower extremity
  3. Intra-arterial tissue plasminogen activator (tPA) therapy
  4. Intraoperative angiography

subject

professional_medicine

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