system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
One day after undergoing an open colectomy, a 65-year-old man with colon cancer experiences shivers. The procedure was originally scheduled to be done laparoscopically, but it was converted because of persistent bleeding. Besides the conversion, the operation was uneventful. Five years ago, he underwent renal transplantation because of cystic disease and has been taking prednisolone since then. He has a history of allergy to sulfonamides. He appears acutely ill. His temperature is 39.2°C (102.5°F), pulse is 120/min, respirations are 23/min, and blood pressure is 90/62 mm Hg. Abdominal examination shows a midline incision extending from the xiphisternum to the pubic symphysis. There is a 5-cm (2-in) area of purplish discoloration near the margin of the incision in the lower abdomen. Palpation of the abdomen produces severe pain and crackling sounds are heard. Laboratory studies show:
Hemoglobin 12.5 g/dL
Leukocyte count 18,600/mm3
Platelet count 228,000/mm3
Erythrocyte sedimentation rate 120 mm/h
Serum
Na+ 134 mEq/L
K+ 3.5 mEq/L
Cl- 98 mEq/L
HCO3- 22 mEq/L
Glucose 200 mg/dL
Urea nitrogen 60 mg/dL
Creatinine 3.2 mg/dL
Creatine kinase 750 U/L
Which of the following is the most appropriate next step in management?"
assistant
Surgical debridement