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Review Question - QID 7044

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QID 7044 (Type "7044" in App Search)
A 62-year-old woman who underwent a primary total knee arthroplasty under a combined spinal-epidural anesthetic presents 5 hours postoperatively with severe pain in the extremity that is unresponsive to narcotic pain medication. A tourniquet was used during the procedure. On examination, the patient is unable to dorsiflex or plantar flex the foot and the pulses appear to be asymmetric. What is the next most appropriate step in management?

Discontinuation of the epidural and serial neurologic exams

3%

14/465

Loosening of the surgical bandages and elevation of the extremity

22%

103/465

MRI of the spine to evaluate for an epidural hematoma

2%

11/465

Return to the operating room for angiography and vascular bypass

3%

15/465

Return to the operating room for angiography, vascular bypass, and four-compartment fasciotomy

69%

320/465

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The patient has clinical evidence of vascular injury and compartment syndrome. An emergent vascular consult and a return to the operating room for an angiogram and revascularization are needed. In these situations, thrombectomy alone is often not sufficient and a bypass is typically required. A four-compartment fasciotomy should be done following revascularization of the extremity.

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