Is Postop Lethargy Cause for Concern?

A 65-year-old man is transported to your emergency department from a local rehabilitation hospital. He is three weeks status post cardiac bypass surgery as well as “some other valve procedure.” In the past two to three days, staff members report, the patient has been less active and has not participated in therapy. This morning, he was found to be lethargic, and that is what prompted the call to 911. Examination reveals a lethargic male who has little verbal communication beyond moaning and groaning. His vital signs include a temperature of 36°C; blood pressure, 90/40 mm Hg; and heart rate, 135 beats/min. His O₂ saturation is 90% on room air. Inspection of the patient’s chest reveals a recent, healing midline sternotomy incision. There is no overt redness or swelling. On auscultation, you note decreased breath sounds on the left side, with some coarse crackles. As you initiate your facility’s sepsis protocol order set, a stat portable chest radiograph is obtained. What is your impression?