1) PREOPERATIVE DIAGNOSIS: Solid food dysphagia POSTOPERATIVE… 1) PREOPERATIVE DIAGNOSIS:

1) PREOPERATIVE DIAGNOSIS: Solid food dysphagia POSTOPERATIVE… 1) PREOPERATIVE DIAGNOSIS: Solid food dysphagia       POSTOPERATIVE DIAGNOSIS: Esophagitis, gastritis, Barrett’s esophagus with stricture at 41 cm PROCEDURE PERFORMED: EGD with biopsy and dilation of the esophageal stricture OPERATIVE TECHNIQUE: The patient was placed in the left lateral decubitus position. Intravenous sedation medication was given. Blood pressure, heart rate, and O2 saturation were continuously monitored. A bite block was inserted. The Olympus upper panendoscope was placed through the bite block into the hypopharynx and under direct visualization was advanced down into the esophagus. There was noted to be mild distal esophagitis as well as a Barrett’s ulcer at 41 cm. A mild stricture was also noted at the site of the Barrett’s ulcer in the distal esophagus. Biopsies of this area were taken. The scope was then advanced into the stomach through the pylorus and into the second portion of the duodenum. The scope was then slowly withdrawn. No changes were noted in the duodenum or the pyloric area. Once the scope was brought back into the stomach mild gastritis was noted, which was biopsied. The scope was then withdrawn into the esophagus where a 20 mm balloon was inserted and the distal esophageal stricture was then dilated. The scope was then completely withdrawn. The patient tolerated the procedure well and left the endoscopy suite in good condition. 3 DX codes and 3 PCS CODES   2) PREOPERATIVE DIAGNOSIS: Ischemic cardiomyopathy.          POSTOPERATIVE DIAGNOSIS: Ischemic cardiomyopathy. PROCEDURE PERFORMED: 1. Orthotopic heart transplantation.    2. Removal of pacemaker.  3. Cutdown of radial artery with arterial line insertion.    4. Swan Ganz catheter insertion.  Code only the first two procedures. ANESTHESIA TYPE: General. INDICATIONS:  The patient is a 24-year-old with a history of ischemic cardiomyopathy, listed as 1A for cardiac transplantation a heart became available for the patient. The risks and possible complications were discussed with the patient, and he agreed to undergo the procedure. PROCEDURE: The full procedure will be dictated by primary surgeon. Upon arrival with the donor heart, the patient was already on cardiopulmonary bypass and his heart had been explanted. The donor heart was removed from the cooler and was inspected and found to be intact. The left atrium was first anastomosed. This was followed by the IVC and SVC. Next, the pulmonary artery was re-anastomosed with a running 4-0 suture. The aorta was then anastomosed. The Swan Ganz catheter was directly placed into the pulmonary artery prior to the pulmonary artery anastomosis. The patient was then rewarmed. The cross clamp was removed and the heart began to beat in sinus rhythm. Echocardiogram revealed good cardiac function. At this time hemostasis was ensured. Pacer wires were placed. Bilateral pleural spaces were entered and a large right pleural effusion was drained. Three chest tubes were then inserted with one in each pleural space and a third in the mediastinum. Again hemostasis was checked and ensured. At this time sternal wires were then placed in a figure-of-eight fashion. The soft tissue was then approximated in layers. The skin was then closed with a running 3-0 Vicryl suture. The patient’s pacemaker was removed from the left chest pocket. Hemostasis was achieved in a pocket. This wound was then closed in multiple layers as well. The chest tubes were then watched for approximately 30 minutes in the operating room. There was no evidence of any significant bleeding. At this time the patient was then transferred to the cardiovascular intensive care unit in fair condition.1 DIAGNOSTIC CODE AND  2 PROCEDURE CODES  3) Sick Sinus Syndrome __________________dx  Open Insertion dual chamber pacemaker into the chest, with percutaneousf insertion of leads in the right ventricle  and right atrium ______________________px    _____________________px                  __________________________px     4)A1 .Right and left diagnostic cardiac catheterization _________________-px   (PCS)A2.   Occlusion of the right coronary artrery ________________dx  B 1. Ligation of esophageal varicies(endoscopic)______________________px  (PCS)B2 Bleeding Esophageal varicies____________________________dx           Health Science Science Nursing Share QuestionEmailCopy link Comments (0)

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