EngageMed2
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- 11
- Location
- Little Rock, AR
Can someone help with this please? I have never done one of these before.
So far I have 36225-LT, 36222-50,92928-LC, 93454-26,XU.
Procedure Performed:
Selective coronary angiography, Percutaneous coronary intervention, and Moderate sedation
Selective right brachiocephalic angiogram
Selective left carotid angiogram
Selective left subclavian angiongram
Anesthesia Used: moderate sedation with versed and fentanyl, local 2% lidocaine
Estimated Blood Loss: <30 mL
Blood Products Administered: None
Condition: Stable
Fluoroscopy time: 25.5 mins
IV Contrast Used: 320 cc
PROCEDURE
Preparation: The procedure was described to the patient including benefits, risks, and alternatives to the procedure. The patient confirmed understanding. The patient signed the informed consent. Patient was brought into the cath lab. Patient identity, procedure, and site were verified with a pre-procedure time-out with all relevant team members present. The right groin and wrist were prepped in a sterile fashion, and a sterile drape was placed over the patient.
Access: Right common femoral Artery
The right femoral artery was palpated and the region above the artery was anesthetized with 2% local lidocaine. Using the Seldinger Technique vascular access was obtained with micropuncture whereby a 5 Fr sheath was placed without difficulty.
Selective Coronary Angiography (SCA)
A 5 Fr diagnostic JL4 was advanced over a J-tipped wire to the ascending aorta. The J wire was removed, the catheter aspirated to ensure no air was in the system and flushed in the usual fashion. The diagnostic catheter engaged the left main coronary artery without difficulty. Angiograms of the left coronary system were taken in several various orthogonal angles.
The 5 Fr diagnostic JR4 catheter engaged the right coronary artery without difficulty. Angiograms of the right coronary system were taken in several various orthogonal angles. The diagnostic RCA catheter was removed from the descending aorta over a J wire.
Selective Arch vessel Angiography
Right brachiocephalic is occluded. Collaterals feed the right vertebral artery which is widely patient. The right common carotid is occluded. Collaterals fill the right axillary artery.
The left common carotid Is occluded ostially.
The left subclavian is widely patent. There is a large, dominant vertebral which collateralizes the brain
Coronary Angiography:
Findings
LMCA Large caliber vessel without angiographic disease
LAD Large caliber vessel with 30% stenosis in the mid vessel. There is small diagonal branch with subtotal occlusion ostially.
LCx Large caliber vessel which is occluded in the mid vessel into a large OM branch with TIMI 0 flow. There is a collateral from the RCA. There is another smaller OM that is chronically occluded that also fills from the right
RCA Large caliber vessel with mild luminal irregularities
Impression:
Plan:
Percutaneous Coronary Intervention Report
Pre-Procedure Diagnosis: NSTEMI
Post-Procedure Diagnosis: NSTEMI
Procedure(s) Performed
Moderate sedation (63 minutes)
Coronary arteriogram of the native coronary arteries
Coronary intervention (PCI) with drug eluting stent (DES) placement in the LCX/OM
Bilateral carotid arteriogram
Arteriogram with selective catheter placement in the left subclavian artery
Case Log
Anesthesia Lidocaine 2% SQ, Moderate Sedation (63 min)
Contrast 320 mL
Specimens None
Grafts/Implants Coronary Artery Stent(s) - see table below
Estimated Blood Loss 10 mL
Blood Products Administered None
Complications
None
Description of procedure
Presentation to Cath Lab
Indication(s) Acute Coronary Syndrome (NSTEMI - after 24 hr of symptom onset).
Priority Status Urgent
Chest Pain Symptoms Typical Angina
CV Instability None
Ventricular Support None
Vascular Access
Vessel Size Closure
Right common femoral artery 6F Mynx
Percutaneous Coronary Intervention
We exchanged the 5F sheath for a 6F sheath over a J wire.
For PCI of the LCX/OM we used a 6F XB3.5 guide catheter which provided adequate support. The lesion was cross using a PT choice 0.014 inch coronary wire. The lesion ws predilated with an emerge 2.5 x 12 mm compliant balloon. The lesion was stented using a Synergy 3.0 x 24 mm and 3.0 x 12 mm DES. The stent was post dilated using an NC emerge 3.5 x 8 and 3.5 x 12 mm NC balloon. Final angiography revealed no residual stenosis, dissection, perforation, or thrombus with TIMI 3 flow.
Medications administered during procedure or within 24 hours prior:
Antiplatelet: Aspirin and Prasugrel
Anticoagulant: heparin
Condition on Transfer
Chest Pain None
Cardiac Rhythm Normal sinus rhythm.
ST-Segment Deviation None
Hemodynamic Status Stable
Access Site Concerns None
Recommendations
DAPT -- ASA 81mg daily, Effient 10 mg daily. Would probably continue DAPT indefinitely given severe arch branch disease from previous arteritis.
Bedrest x 2hr
Cardiac rehab discussed
So far I have 36225-LT, 36222-50,92928-LC, 93454-26,XU.
Procedure Performed:
Selective coronary angiography, Percutaneous coronary intervention, and Moderate sedation
Selective right brachiocephalic angiogram
Selective left carotid angiogram
Selective left subclavian angiongram
Anesthesia Used: moderate sedation with versed and fentanyl, local 2% lidocaine
Estimated Blood Loss: <30 mL
Blood Products Administered: None
Condition: Stable
Fluoroscopy time: 25.5 mins
IV Contrast Used: 320 cc
PROCEDURE
Preparation: The procedure was described to the patient including benefits, risks, and alternatives to the procedure. The patient confirmed understanding. The patient signed the informed consent. Patient was brought into the cath lab. Patient identity, procedure, and site were verified with a pre-procedure time-out with all relevant team members present. The right groin and wrist were prepped in a sterile fashion, and a sterile drape was placed over the patient.
Access: Right common femoral Artery
The right femoral artery was palpated and the region above the artery was anesthetized with 2% local lidocaine. Using the Seldinger Technique vascular access was obtained with micropuncture whereby a 5 Fr sheath was placed without difficulty.
Selective Coronary Angiography (SCA)
A 5 Fr diagnostic JL4 was advanced over a J-tipped wire to the ascending aorta. The J wire was removed, the catheter aspirated to ensure no air was in the system and flushed in the usual fashion. The diagnostic catheter engaged the left main coronary artery without difficulty. Angiograms of the left coronary system were taken in several various orthogonal angles.
The 5 Fr diagnostic JR4 catheter engaged the right coronary artery without difficulty. Angiograms of the right coronary system were taken in several various orthogonal angles. The diagnostic RCA catheter was removed from the descending aorta over a J wire.
Selective Arch vessel Angiography
Right brachiocephalic is occluded. Collaterals feed the right vertebral artery which is widely patient. The right common carotid is occluded. Collaterals fill the right axillary artery.
The left common carotid Is occluded ostially.
The left subclavian is widely patent. There is a large, dominant vertebral which collateralizes the brain
Coronary Angiography:
Findings
LMCA Large caliber vessel without angiographic disease
LAD Large caliber vessel with 30% stenosis in the mid vessel. There is small diagonal branch with subtotal occlusion ostially.
LCx Large caliber vessel which is occluded in the mid vessel into a large OM branch with TIMI 0 flow. There is a collateral from the RCA. There is another smaller OM that is chronically occluded that also fills from the right
RCA Large caliber vessel with mild luminal irregularities
Impression:
Plan:
Percutaneous Coronary Intervention Report
Pre-Procedure Diagnosis: NSTEMI
Post-Procedure Diagnosis: NSTEMI
Procedure(s) Performed
Moderate sedation (63 minutes)
Coronary arteriogram of the native coronary arteries
Coronary intervention (PCI) with drug eluting stent (DES) placement in the LCX/OM
Bilateral carotid arteriogram
Arteriogram with selective catheter placement in the left subclavian artery
Case Log
Anesthesia Lidocaine 2% SQ, Moderate Sedation (63 min)
Contrast 320 mL
Specimens None
Grafts/Implants Coronary Artery Stent(s) - see table below
Estimated Blood Loss 10 mL
Blood Products Administered None
Complications
None
Description of procedure
Presentation to Cath Lab
Indication(s) Acute Coronary Syndrome (NSTEMI - after 24 hr of symptom onset).
Priority Status Urgent
Chest Pain Symptoms Typical Angina
CV Instability None
Ventricular Support None
Vascular Access
Vessel Size Closure
Right common femoral artery 6F Mynx
Percutaneous Coronary Intervention
We exchanged the 5F sheath for a 6F sheath over a J wire.
For PCI of the LCX/OM we used a 6F XB3.5 guide catheter which provided adequate support. The lesion was cross using a PT choice 0.014 inch coronary wire. The lesion ws predilated with an emerge 2.5 x 12 mm compliant balloon. The lesion was stented using a Synergy 3.0 x 24 mm and 3.0 x 12 mm DES. The stent was post dilated using an NC emerge 3.5 x 8 and 3.5 x 12 mm NC balloon. Final angiography revealed no residual stenosis, dissection, perforation, or thrombus with TIMI 3 flow.
Medications administered during procedure or within 24 hours prior:
Antiplatelet: Aspirin and Prasugrel
Anticoagulant: heparin
Condition on Transfer
Chest Pain None
Cardiac Rhythm Normal sinus rhythm.
ST-Segment Deviation None
Hemodynamic Status Stable
Access Site Concerns None
Recommendations
DAPT -- ASA 81mg daily, Effient 10 mg daily. Would probably continue DAPT indefinitely given severe arch branch disease from previous arteritis.
Bedrest x 2hr
Cardiac rehab discussed