shariblove
Contributor
Hi everyone! I am an anesthesia coder and I need help on this dictation. I am so confused, I think I've confused myself the more I've tried to make sense of this, can anyone help? Thanks so much!! My expertise is NOT Cardiovascular Thoracic! 
PREOPERATIVE DIAGNOSES:
1. Open chest, on venoarterial extracorporeal membrane oxygenation, status post cardiotomy.
2. Heart failure.
3. Coronary artery disease.
POSTOPERATIVE DIAGNOSES:
1. Open chest, on venoarterial extracorporeal membrane oxygenation, status post cardiotomy.
2. Heart failure.
3. Coronary artery disease.
PROCEDURES PERFORMED:
1. Removal of foreign body (Kerlix).
2. Chest exploration and washout.
3. Sternal closure.
4. Placement of supervision negative pressure dressing wound VAC.
5. Transesophageal echo.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Less than 20 mL.
SPECIMENS: None.
PROCEDURE FINDINGS: Dilated left ventricle with EF of 20% to 25%. On full flow. With moderate RV dysfunction.
INDICATION: The patient is a 48-year-old gentleman with a low EF who underwent the CABG and was able to come off bypass on a balloon pump and multiple inotropes, who required increasing inotropic support Over next several days needing ECMO. The patient was centrally cannulated and had an open chest and was taken back to the ICU and diuresed with CRRT. The patient presents today needing a washout and to evaluate his heart.
DESCRIPTION OF PROCEDURE: The patient was correctly identified in the CSICU and taken back to the operating room. The chest was prepped in the usual fashion. The sponge was removed and the chest was reprepped again and draped. A timeout was performed, the Ioban was cut, the Kerlix was removed with copious amounts of antibiotic irrigation. Chest retractor was put in in the chest. Both the left and right pleural spaces were then suctioned out. The right 28-French chest tube was then placed in the right pleural space due to persistent pleural effusion on that side. It was sewn in place using 0 silk suture and connected to a Pleur-Evac. A TEE probe was used to evaluate patients function and both the left and right side was evaluated. Dilated LVwith EF of 20% to 25% despite being on the full support. Similarly, the right-side had moderate dysfunction and it was slightly more decompressed than the left side, but not completely decompressed. The remaining chest tubes were washed out and the sternum was manually debrided using Betadine scrub brush. The sternum was then closed using #8, #6 stainless steel wires. The fascia was then closed using 0 Vicryl in a running fashion and the wound VAC was then put on superficially over the fascial closure. This was connected to 100 mmHg continuous. A total of 2 L of antibiotic irrigation was used to wash out the chest. The patient tolerated this well without any issues. The patient was then taken back to CSICU in stable condition.
PREOPERATIVE DIAGNOSES:
1. Open chest, on venoarterial extracorporeal membrane oxygenation, status post cardiotomy.
2. Heart failure.
3. Coronary artery disease.
POSTOPERATIVE DIAGNOSES:
1. Open chest, on venoarterial extracorporeal membrane oxygenation, status post cardiotomy.
2. Heart failure.
3. Coronary artery disease.
PROCEDURES PERFORMED:
1. Removal of foreign body (Kerlix).
2. Chest exploration and washout.
3. Sternal closure.
4. Placement of supervision negative pressure dressing wound VAC.
5. Transesophageal echo.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Less than 20 mL.
SPECIMENS: None.
PROCEDURE FINDINGS: Dilated left ventricle with EF of 20% to 25%. On full flow. With moderate RV dysfunction.
INDICATION: The patient is a 48-year-old gentleman with a low EF who underwent the CABG and was able to come off bypass on a balloon pump and multiple inotropes, who required increasing inotropic support Over next several days needing ECMO. The patient was centrally cannulated and had an open chest and was taken back to the ICU and diuresed with CRRT. The patient presents today needing a washout and to evaluate his heart.
DESCRIPTION OF PROCEDURE: The patient was correctly identified in the CSICU and taken back to the operating room. The chest was prepped in the usual fashion. The sponge was removed and the chest was reprepped again and draped. A timeout was performed, the Ioban was cut, the Kerlix was removed with copious amounts of antibiotic irrigation. Chest retractor was put in in the chest. Both the left and right pleural spaces were then suctioned out. The right 28-French chest tube was then placed in the right pleural space due to persistent pleural effusion on that side. It was sewn in place using 0 silk suture and connected to a Pleur-Evac. A TEE probe was used to evaluate patients function and both the left and right side was evaluated. Dilated LVwith EF of 20% to 25% despite being on the full support. Similarly, the right-side had moderate dysfunction and it was slightly more decompressed than the left side, but not completely decompressed. The remaining chest tubes were washed out and the sternum was manually debrided using Betadine scrub brush. The sternum was then closed using #8, #6 stainless steel wires. The fascia was then closed using 0 Vicryl in a running fashion and the wound VAC was then put on superficially over the fascial closure. This was connected to 100 mmHg continuous. A total of 2 L of antibiotic irrigation was used to wash out the chest. The patient tolerated this well without any issues. The patient was then taken back to CSICU in stable condition.