PATIENT: Mara Bell Lee
PHYSICIAN: Randy Greenfield,
MD PREOPERATIVE DIAGNOSIS: Pleural effusion with unknown cause. POSTOPERATIVE DIAGNOSIS: Pleural effusion with unknown cause. PROCEDURES PERFORMED:
Four-quadrant pleural biopsy,
Pleural drainage with small catheter temporary chest tube.
PROCEDURE: With the usual Betadine scrub to the area marked by ultrasound, the area was anesthetized with approximately 15 cc of 1% lidocaine, and then a small-caliber #21-gauge needle was inserted into the space. Fluid was removed for appropriate bacteriological, hematological, and chemical analyses.Once this was accomplished, then a larger tube using a Cope pleural biopsy needle was inserted into the space, and four quadrants were biopsied and sent for appropriate pathological specimens. Once that was accomplished, then using a small-caliber temporary chest tube from the Cope, as well as the pneumothorax set, the space was entered, and 1.5 liters of bloody fluid was removed. A small bandage was attached afterward. There was no pain involved, and the chest x-ray will be taken afterward to assure ourselves that we had a reasonable effect without any ill consequences. PATHOLOGY REPORT PATIENT: MaraBell Lee
PHYSICIAN:Randy Greenfield, MD CLINICAL HISTORY: Pleural effusion.GROSS DESCRIPTION: 1650 ml bloody fluid received in two glass Vacutainers.SPECIMEN RECEIVED: Pleural fluid.SPECIMEN ADEQUACY: Specimen satisfactory for cytologic evaluation.DIAGNOSIS: No cytologic evidence of malignancy. ICD-9-CM Code__________________
4. OPERATIVE REPORT
PATIENT: Gordon Miller SURGEON: Robert C. Downey, MD PROCEDURE PERFORMED: Central venous access placement. INDICATION: Massive gastrointestinal bleed. The procedure was done emergently because of the patient’s critical condition. His right IJ area was prepped in the usual fashion. It was very difficult to visualize his right IJ vein, even though his habitus should have allowed us to do so, but the patient was, I believe, severely intravascularly volume depleted, and his vein was collapsing. I have attempted to access the right internal jugular vein multiple times, both under real-time ultrasound guidance and even later on blindly. I was able to get blood return and hit the vein; however, I was not able to advance the guidewire. I was able to advance it one time and put the catheter in, and it was nonfunctioning. I had to take the catheter out and tried multiple other times on the right IJ vein without success. That procedure was terminated. Pressure was applied. There was no cervical hematoma whatsoever. The patient was uncomfortable because of the length of the procedure but did well otherwise. Hemodynamically, he was unchanged, and his oxygen saturations remained stable.I prepped the IJ vein area in the usual fashion. One percent lidocaine was used for local anesthesia. Again, the left IJ vein was collapsing. With deep inspiration, the vein could be well visualized on the real-time and ultrasound guidance, after which I could get access to the left IJ vein. A wire was advanced without difficulty while the patient was holding his breath. A triple-lumen trauma line was advanced with a dilator over the guidewire without difficulty using the Seldinger technique. The three ports had good blood return, and the three of them were flushed with normal saline.The line was secured to the skin.The patient tolerated the procedure well without any immediate complications, and chest x-ray was ordered.I CD-9-CM...