Need help coding this. This patient had multiple stab wounds and needed balloon tamponade for 2 larger stab wounds. The wounds were in her clavicle area. How should these be coded? Here is the op report.
PROCEDURE:
1. Right femoral central venous catheter/Cordis catheter.
2. Balloon tamponade of larger stab wounds to trunk x2 using Foley catheter.
3. Electrocautery and closure of multiple lacerations to the right side of head, neck, and upper chest, using electrocautery and skin staples.
PROCEDURE IN DETAIL:
The patient was in the Emergency Room and apparently in hypovolemic shock before I got there. We then decided to place a central venous catheter, Cordis catheter into the right femoral vein. This was done by placing a Cook needle into the femoral vein. Dark red nonpulsatile blood was noted in the syringe. The syringe was removed. The guidewire was then inserted. The dilator and Cordis was then placed after the needle was removed over the guidewire. The guidewire was then removed. There was good back bleeding. We then connected this to the rapid infuser and multiple liters of blood products, platelets, and medicines were then infused through this. Attention was then carried back to the chest, neck, and head were multiple liters of blood was just oozing out. The patient was bleeding and then eventually would go into DIC over 3-1/2 hours including multiple rounds of coding using the ACLS protocol.
With ENT, we then decided to use electrocautery to abate some of the bleeding and also the skin staples were then used to close these. There were multiple lacerations, approximately 1-2 cm in length. I closed 9 of these with skin staples and Bovie electrocautery. There were 2 large stab wounds, 1 in zone 3 on the right side above the clavicle, 1 just adjacent to the clavicle mid nipple line just below the clavicle.
I examined the chest x-ray both times, there appeared to be no widening of the mediastinum and no pneumothorax. The chest was not explored. I placed 2 balloon Foleys to tamponade this bleeding as it was not arterial, not brisk, and there was a chest x-ray that was taken after placement of these Foley balloons that appeared to not have any venous bleeding after these were inflated. I explored them before digitally and there appeared to be no extremely deep penetrating laceration to the great vessels and there was no large hematoma after they were balloon tamponaded off with the Foley catheter. The patient then underwent multiple rounds of bandages and wrapping. We went through multiple liters of blood, FFP, and platelets all to no avail. The case was then turned back over to the Emergency Department as all surgical interventions were exhausted by multiple specialities.
PROCEDURE:
1. Right femoral central venous catheter/Cordis catheter.
2. Balloon tamponade of larger stab wounds to trunk x2 using Foley catheter.
3. Electrocautery and closure of multiple lacerations to the right side of head, neck, and upper chest, using electrocautery and skin staples.
PROCEDURE IN DETAIL:
The patient was in the Emergency Room and apparently in hypovolemic shock before I got there. We then decided to place a central venous catheter, Cordis catheter into the right femoral vein. This was done by placing a Cook needle into the femoral vein. Dark red nonpulsatile blood was noted in the syringe. The syringe was removed. The guidewire was then inserted. The dilator and Cordis was then placed after the needle was removed over the guidewire. The guidewire was then removed. There was good back bleeding. We then connected this to the rapid infuser and multiple liters of blood products, platelets, and medicines were then infused through this. Attention was then carried back to the chest, neck, and head were multiple liters of blood was just oozing out. The patient was bleeding and then eventually would go into DIC over 3-1/2 hours including multiple rounds of coding using the ACLS protocol.
With ENT, we then decided to use electrocautery to abate some of the bleeding and also the skin staples were then used to close these. There were multiple lacerations, approximately 1-2 cm in length. I closed 9 of these with skin staples and Bovie electrocautery. There were 2 large stab wounds, 1 in zone 3 on the right side above the clavicle, 1 just adjacent to the clavicle mid nipple line just below the clavicle.
I examined the chest x-ray both times, there appeared to be no widening of the mediastinum and no pneumothorax. The chest was not explored. I placed 2 balloon Foleys to tamponade this bleeding as it was not arterial, not brisk, and there was a chest x-ray that was taken after placement of these Foley balloons that appeared to not have any venous bleeding after these were inflated. I explored them before digitally and there appeared to be no extremely deep penetrating laceration to the great vessels and there was no large hematoma after they were balloon tamponaded off with the Foley catheter. The patient then underwent multiple rounds of bandages and wrapping. We went through multiple liters of blood, FFP, and platelets all to no avail. The case was then turned back over to the Emergency Department as all surgical interventions were exhausted by multiple specialities.