Agenda ICD-9-CM Coordination and Maintenance Committee
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Letters to the Editor
letters to the Editor Porphyria, Cardiopulmonary Bypass, and heart with additional hemorrhage into the pericardial sac (5). Peri- cardiocentesis, however, can be a temporizing measure in the se- Volatile Anesthetics verely compromised patient (4,7,8) until definitive surgical estab- lishment of a pericardial window. A pericardial window can be To the Editor: established under local anesthesia (9) via the subxiphoid or lateral We take issue with Stevens et al’s contentious statements in their thoracotomy approach (1,2,5,8,9). The subxiphoid approach is less discussion of volatile anesthetics in the patient with acute intermit- useful for trauma because limited surgical exposure may preclude tent porphyria undergoing mitral valve replacement (1). repair of cardiac wounds (2). However, a pericardial window dur- In the “pre-propofol” era, the safe and appropriate use of halo- ing awake lateral thoracotomy may be both poorly tolerated and thane and isoflurane in porphyric patients was established (2). dangerous in the distressed, moving patient (7). Recent reports of the successful use of isoflurane in porphyric A blunt trauma victim (2) recently presented for an emergent patients undergoing cardiac surgery also exist (3,4). As the authors surgical pericardial window for recurrent acute pericardial tampon- themselves allude to a report of elevated porphyrins after propofol ade. Although the patient was not hypotensive, jugular venous anesthesia in acute intermittent porphyria, favoring propofol over distention, pulsus paradoxus (1,3,7), patient distress (4), and echo- inhaled anesthetics because of the latter’s implied lack of a “safety cardiographic signs were present. As an alternative to endotracheal record” cannot be supported. -
ABCDE Approach
The ABCDE and SAMPLE History Approach Basic Emergency Care Course Objectives • List the hazards that must be considered when approaching an ill or injured person • List the elements to approaching an ill or injured person safely • List the components of the systematic ABCDE approach to emergency patients • Assess an airway • Explain when to use airway devices • Explain when advanced airway management is needed • Assess breathing • Explain when to assist breathing • Assess fluid status (circulation) • Provide appropriate fluid resuscitation • Describe the critical ABCDE actions • List the elements of a SAMPLE history • Perform a relevant SAMPLE history. Essential skills • Assessing ABCDE • Needle-decompression for tension • Cervical spine immobilization pneumothorax • • Full spine immobilization Three-sided dressing for chest wound • • Head-tilt and chin-life/jaw thrust Intravenous (IV) line placement • • Airway suctioning IV fluid resuscitation • • Management of choking Direct pressure/ deep wound packing for haemorrhage control • Recovery position • Tourniquet for haemorrhage control • Nasopharyngeal (NPA) and oropharyngeal • airway (OPA) placement Pelvic binding • • Bag-valve-mask ventilation Wound management • • Skin pinch test Fracture immobilization • • AVPU (alert, voice, pain, unresponsive) Snake bite management assessment • Glucose administration Why the ABCDE approach? • Approach every patient in a systematic way • Recognize life-threatening conditions early • DO most critical interventions first - fix problems before moving on -
Vantage Total Ankle Replacement
Total Ankle Replacement Find out why the Exactech Ankle may be right for you. UNDERSTANDING ANKLE REPLACEMENT This brochure offers a brief overview of ankle anatomy, arthritis and ankle replacement. This information is for educational purposes only and is not intended to replace the expert guidance of your physician. Please direct any questions or concerns you may have to your doctor. 02 ANKLE ARTHRITIS YOUR ANKLE Your ankle is made up of a variety of bones, ligaments, tendons and cartilage that connect at the junction of your leg and foot. The joint works like a hinge and is responsible for moving your foot up and down. The tibia (shinbone), talus and fibula (smaller bone in the lower leg) are the bones that construct the ankle joint. Your ligaments border these bones on either side, holding them together to provide stability. Meanwhile the tendons connect the muscles to the bone and are responsible for the ankle and toe movements. Covering your bones is a smooth substance called cartilage, which acts as a cushion to reduce the friction between your bones as they move. If your cartilage wears down, arthritis can develop and cause loss of motion and pain. TIBIA FIBULA TALUS CALCANEUS METATARSAL V 03 ARTHRITIC ANKLE HEALTHY ANKLE Nearly half of individuals over the age of 60 have foot or ankle arthritis. 04 ARTHRITIS Nearly half of individuals over the age of 60 have foot or ankle arthritis that may not cause symptoms.1 However, for those suffering from ankle arthritis pain the most reported causes are:2 • Rheumatoid arthritis - It is an autoimmune disease that attacks multiple joints and typically starts in the hands and feet. -
Differential Diagnosis of Pulmonic Stenosis by Means of Intracardiac Phonocardiography
Differential Diagnosis of Pulmonic Stenosis by Means of Intracardiac Phonocardiography Tadashi KAMBE, M.D., Tadayuki KATO, M.D., Norio HIBI, M.D., Yoichi FUKUI, M.D., Takemi ARAKAWA, M.D., Kinya NISHIMURA,M.D., Hiroshi TATEMATSU,M.D., Arata MIWA, M.D., Hisao TADA, M.D., and Nobuo SAKAMOTO,M.D. SUMMARY The purpose of the present paper is to describe the origin of the systolic murmur in pulmonic stenosis and to discuss the diagnostic pos- sibilities of intracardiac phonocardiography. Right heart catheterization was carried out with the aid of a double- lumen A.E.L. phonocatheter on 48 pulmonic stenosis patients with or without associated heart lesions. The diagnosis was confirmed by heart catheterization and angiocardiography in all cases and in 38 of them, by surgical intervention. Simultaneous phonocardiograms were recorded with intracardiac pressure tracings. In valvular pulmonic stenosis, the maximum ejection systolic murmur was localized in the pulmonary artery above the pulmonic valve and well transmitted to both right and left pulmonary arteries, the superior vena cava, and right and left atria. The maximal intensity of the ejection systolic murmur in infundibular stenosis was found in the outflow tract of right ventricle. The contractility of the infundibulum greatly contributes to the formation of the ejection systolic murmur in the outflow tract of right ventricle. In tetralogy of Fallot, the major systolic murmur is caused by the pulmonic stenosis, whereas the high ventricular septal defect is not responsible for it. In pulmonary branch stenosis, the sys- tolic murmur was recorded distally to the site of stenosis. Intracardiac phonocardiography has proved useful for the dif- ferential diagnosis of various types of pulmonic stenosis. -
Pre and Post-Thoracostomy Chest X-Ray Taking; Do We Must Do?
www.revhipertension.com Revista Latinoamericana de Hipertensión. Vol. 15 - Nº 1, 2020 Pre and post-thoracostomy chest x-ray taking; do we must do? 71 Radiografía de tórax antes y después de la toracostomía; Qué debemos hacer? Salaminia, Shirvan; Talebi, Shadi; Mehrabi, Saadat 1Assistant Professor of Cardiac Surgery, Clinical Research Development Unit Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran. [email protected], [email protected], [email protected]. 2General Practitioner, Clinical Research Development Unit Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran. 3Assistant Professor of Thoracic Surgery, Clinical Research Development Unit Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran *corresponding author: Saadat Mehrabi, Assistant Professor of Thoracic Surgery, Clinical Research Development Unit Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran. Email: [email protected] https://doi.org/10.5281/zenodo.4074244 Abstract he prevalence of collision accidents is high in Results: Of the 58 chest tubes with the indication for re- Iran, a developing country. Currently, a plain moval, only one patient needed further observation clini- chest radiograph is routine 6 to 8 hours af- cally after removal. The coincident chest x-ray (CXR) led to ter chest tube removal. In recent years, there have been recurrent chest tube insertion. All thoracostomies had per- doubts about the necessity of routine post-removal chest formed by a trained resident or surgeon. Considering vari- x-ray (CXR) in the absence of clinical symptoms. In chil- able clinical decisions, a comparison of the diagnostic value dren, this is especially imperative because they are more of chest x-ray (CXR) to clinical examination did not differ sensitive to radiation exposure. -
Cardiac Checklist Connecticare
Cardiac Checklist ConnectiCare Please be prepared to provide the applicable information from the following list when requesting prior authorization for a cardiac procedure managed by Magellan Healthcare1: 1. Medical chart notes – all notes from patient chart related to the requested procedure, including patient’s current cardiac status/symptoms, cardiac factors and indications. 2. Relevant patient information, including: a. Patient age, height, weight, and BMI. b. Family history of heart problems (including relationship to member, age at diagnosis, type of event, etc.). c. Medical history (e.g. diabetes, hypertension, stroke, arrhythmia, etc.). d. Cardiac risk factors. e. Previous cardiac treatments, surgeries or interventions (medications, CABG, PTCA, stent, heart valve surgery, pacemaker/defibrillator insertion, surgery for congenital heart disease, etc.). f. Problems with exercise capacity (orthopedic, pulmonary, or peripheral vascular disease; distance, heart rate). 3. Diagnostic or imaging reports from previous tests (exercise stress test, echocardiography, stress echocardiography, MPI, coronary angiography, etc.). a. For pacemaker or Implantable Cardioverter Defibrillator (ICD) requests, include EKG and/or telemetry strips showing bradycardia, EKG showing conduction abnormalities, EP study report, and/or tilt table test report, if applicable. b. For cardiac resynchronization therapy requests, include left ventricular function test report indicating LVEF, documentation of CHF symptoms and NYHA class and/or 12-Lead EKG showing QRS width, if applicable. c. For cardiac catheterization requests, include EKG results showing relevant changes, left ventricular function test reports, documentation of recent ejection fraction, etc. d. Cardiac catheterization requests also require the submission of digital images (e.g. DICOM files) from previous procedures. The digital image from a previous MPI, Stress Echocardiography, Heart PET or other cardiac catheterization is considered to be relevant and necessary clinical information. -
Correlation Between Echocardiography and Cardiac Catheterization for the Assessment of Pulmonary Hypertension in Pediatric Patients
Open Access Original Article DOI: 10.7759/cureus.5511 Correlation between Echocardiography and Cardiac Catheterization for the Assessment of Pulmonary Hypertension in Pediatric Patients Arshad Sohail 1 , Hussain B. Korejo 1 , Abdul Sattar Shaikh 2 , Aliya Ahsan 1 , Ram Chand 1 , Najma Patel 3 , Musa Karim 4 1. Pediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK 2. Cardiology, National Institute of Cardiovascular Disease, Karachi, PAK 3. Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK 4. Miscellaneous, National Institute of Cardiovascular Diseases, Karachi, PAK Corresponding author: Musa Karim, [email protected] Abstract Introduction Cardiac catheterization is widely considered the “gold standard” for the diagnosis of pulmonary hypertension. However, its routine use is limited due to its invasive nature. Therefore, the aim of this study was to evaluate the correlation between pulmonary artery pressures obtained by various parameters of transthoracic echocardiography and cardiac catheterization. Methods This study includes 50 consecutive patients with intracardiac shunt lesions diagnosed with severe pulmonary hypertension on echocardiography and admitted for cardiac catheterization at the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan. Cardiac catheterization and transthoracic echocardiography were performed in all patients simultaneously and systolic (sPAP) and mean pulmonary artery pressure (mPAP) were assessed with both modalities. Correlations -
The Care of a Patient with Fournier's Gangrene
CASE REPORT The care of a patient with Fournier’s gangrene Esma Özşaker, Asst. Prof.,1 Meryem Yavuz, Prof.,1 Yasemin Altınbaş, MSc.,1 Burçak Şahin Köze, MSc.,1 Birgül Nurülke, MSc.2 1Department of Surgical Nursing, Ege University Faculty of Nursing, Izmir; 2Department of Urology, Ege University Faculty of Medicine Hospital, Izmir ABSTRACT Fournier’s gangrene is a rare, necrotizing fasciitis of the genitals and perineum caused by a mixture of aerobic and anaerobic microor- ganisms. This infection leads to complications including multiple organ failure and death. Due to the aggressive nature of this condition, early diagnosis is crucial. Treatment involves extensive soft tissue debridement and broad-spectrum antibiotics. Despite appropriate therapy, mortality is high. This case report aimed to present nursing approaches towards an elderly male patient referred to the urology service with a diagnosis of Fournier’s gangrene. Key words: Case report; Fournier’s gangrene; nursing diagnosis; patient care. INTRODUCTION Rarely observed in the peritoneum, genital and perianal re- perineal and genital regions, it is observed in a majority of gions, necrotizing fasciitis is named as Fournier’s gangrene.[1-5] cases with general symptoms, such as fever related infection It is an important disease, following an extremely insidious and weakness, and without symptoms in the perineal region, beginning and causing necrosis of the scrotum and penis by negatively influencing the prognosis by causing a delay in diag- advancing rapidly within one-two days.[1] The rate of mortal- nosis and treatment.[2,3] Consequently, anamnesis and physical ity in the literature is between 4 and 75%[6] and it has been examination are extremely important. -
Femoral and Sciatic Nerve Blocks for Total Knee Replacement in an Obese Patient with a Previous History of Failed Endotracheal Intubation −A Case Report−
Anesth Pain Med 2011; 6: 270~274 ■Case Report■ Femoral and sciatic nerve blocks for total knee replacement in an obese patient with a previous history of failed endotracheal intubation −A case report− Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea Jong Hae Kim, Woon Seok Roh, Jin Yong Jung, Seok Young Song, Jung Eun Kim, and Baek Jin Kim Peripheral nerve block has frequently been used as an alternative are situations in which spinal or epidural anesthesia cannot be to epidural analgesia for postoperative pain control in patients conducted, such as coagulation disturbances, sepsis, local undergoing total knee replacement. However, there are few reports infection, immune deficiency, severe spinal deformity, severe demonstrating that the combination of femoral and sciatic nerve blocks (FSNBs) can provide adequate analgesia and muscle decompensated hypovolemia and shock. Moreover, factors relaxation during total knee replacement. We experienced a case associated with technically difficult neuraxial blocks influence of successful FSNBs for a total knee replacement in a 66 year-old the anesthesiologist’s decision to perform the procedure [1]. In female patient who had a previous cancelled surgery due to a failed tracheal intubation followed by a difficult mask ventilation for 50 these cases, peripheral nerve block can provide a good solution minutes, 3 days before these blocks. FSNBs were performed with for operations on a lower extremity. The combination of 50 ml of 1.5% mepivacaine because she had conditions precluding femoral and sciatic nerve blocks (FSNBs) has frequently been neuraxial blocks including a long distance from the skin to the used for postoperative pain control after total knee replacement epidural space related to a high body mass index and nonpalpable lumbar spinous processes. -
Diagnostic Direct Laryngoscopy, Bronchoscopy & Esophagoscopy
Post-Operative Instruction Sheet Diagnostic Direct Laryngoscopy, Bronchoscopy & Esophagoscopy Direct Laryngoscopy: Examination of the voice box or larynx (pronounced “lair-inks”) under general anesthesia. An instrument called a laryngoscope is carefully placed into the mouth and used to visualize the larynx and surrounding structures. Bronchoscopy: Examination of the windpipe below the voice box in the neck and chest under general anesthesia. A long narrow telescope is passed through the larynx and used to carefully inspect the structures of the trachea and bronchi. Esophagoscopy: Examination of the swallowing pipe in the neck and chest under general anesthesia. An instrument called an esophagoscope is passed into the esophagus (just behind the larynx and trachea) and used to visualize the mucus membranes and surrounding structures of the esophagus. Frequently a small biopsy is taken to evaluate for signs of esophageal inflammation (esophagitis). What to Expect: Diagnostic airway endoscopy procedures generally take about 45 minutes to complete. Usually the procedure is well-tolerated and the child is back-to-normal the next day. Mild throat or tongue discomfort may persist for a few days after the procedure and is usually well-controlled with over-the-counter acetaminophen (Tylenol) or ibuprofen (Motrin). Warning Signs: Contact the office immediately at (603) 650-4399 if any of the following develop: • Worsening harsh, high-pitched noisy-breathing (stridor) • Labored breathing with chest retractions or flaring of the nostrils • Bluish discoloration of the lips or fingernails (cyanosis) • Persistent fever above 102°F that does not respond to Tylenol or Motrin • Excessive coughing or respiratory distress during feeding • Coughing or throwing up bright red blood • Excessive drowsiness or unresponsiveness Diet: Resume baseline diet (no special postoperative diet restrictions). -
Laryngeal Endoscopy (Rigid, Flexible, and Stroboscopy)
Laryngeal Endoscopy (Rigid, Flexible, and Stroboscopy) Visualization of the larynx can be performed via several different methods. Special tools are required for laryngeal evaluation. Mirror laryngoscopy (1) o While the patient’s tongue is protruded, a mirror is placed in the posterior oropharynx with gentle pressure on the soft palate while light is reflected caudally into the larynx. o Mirror laryngoscopy can be challenging for both the examiner and the patient, has limited magnification, and may require topical anesthesia. o Mirror laryngoscopy provides the most accurate color representation of laryngeal and pharyngeal tissue because there is no light or digital distortion. Flexible laryngoscopy (2) o A flexible laryngoscope is placed into the nasal cavity, through the naso- and oropharynx and positioned cephalad to the larynx for a full laryngeal assessment. o Nasal anesthesia (lidocaine) and/or nasal decongestants (oxymetazoline/phenylephrine) may be applied to the nose for the purpose of improving patient comfort and tolerance o Supplemental procedures such as dynamic voice assessment (comprehensive laryngeal movement evaluation), functional endoscopic evaluation of swallowing (+/- sensory testing), and other laryngeal procedures (ex. injections, laser surgery, biopsies) can be performed during flexible laryngoscopy. o Flexible laryngoscopy is ideal for evaluating vocal fold weakness, real-time/unencumbered evaluation of task-specific abnormalities (ex. my voice is problematic when I do this), and assessing the intensity of glottal attack. Rigid Laryngoscopy (3) o Rigid laryngoscopy is performed by placing a rigid 70- or 90-degree telescope into the oropharynx during tongue protrusion. o Sometimes, oropharyngeal and/or tongue application of anesthesia (ex. lidocaine, cetacaine) can be helpful for patient tolerance. -
Arthroscopic Versus Open Debridement of Penetrating Knee Joint Injuries
ARTHROSCOPIC VERSUS OPEN DEBRIDEMENT OF PENETRATING KNEE JOINT INJURIES John R. Raskind, M.D.* Richard A. Marder, M.D. ABSTRACT included in this study. The group treated with arthroscopic Arthroscopic debridement of penetrating knee joint debridement consisted of seven motor vehicle "dash- injuries has become a common treatment method. A board" injuries, five motorcycle/moped/bicycle injuries and comparative study was undertaken to compare this two low velocity gun shot wounds. The mean wound size method with open joint debridement. Fourteen penetrat- in this group was 3.8 centimeters (cms) (range one to ing knee joint injuries (fourteen patients) were treated by twelve cms) and the mean patient age was 26.6 (range arthroscopic examination and debridement and were com- nine to fifty-twelve years). The open debridement group pared to sixteen penetrating knee joint injuries (fifteen consisted of eight motor vehicle "dashboard" injuries, five patients) treated by open debridement. There were no motorcycle/moped injuries, one low velocity gunshot resultant infections or operative complications in either wound, one weed-trimmer laceration, and one power-saw group. Of note, the arthroscopic debridement group had a laceration. The mean wound size in this group was 4.6 cms shorter postoperative hospital stay [mean of 1.6 days (range one to twelve cms) and the mean patient age was compared to a mean of 2.6 days in the open debridement 26.9 years (range fifteen to forty-three years). group (p < 0.02)], a significant incidence of additional Diagnosis was based upon examination of the wound, intra-articular injuries detected (p < 0.01), less postoper- AP, lateral, and notch radiographic views of the knee, and ative pain, and a superior cosmetic result.