Approach to postoperative hypotension Quiz: Ace Your Exams

A 70-year-old man is evaluated in the post-anesthesia care unit for abrupt onset of hypotension after surgery. The patient underwent emergent exploratory laparotomy for a strangulated inguinal hernia. Peripheral intravenous access was lost after extubation and a left subclavian central venous catheter was subsequently placed. The patient’s past medical history is significant for severe chronic obstructive lung disease and hypertension. Current medications include albuterol, budesonide-formoterol, lisinopril, and tiotropium. Temperature is 37.0 ºC (98.6 ºF), pulse is 114/min, respiratory rate is 26/min, blood pressure is 79/41 mmHg, and SpO₂ is 86% on room air. On physical examination, the patient is in respiratory distress. A left subclavian central line is in place. The trachea is deviated to the right. Heart sounds are distant but are normal with no murmurs. Lung sounds are absent at the left apex. The abdominal surgical dressing has scant serosanguineous discharge and the abdomen is mildly tender to palpation at the incision sites. Which of the following tests would confirm the underlying diagnosis?