TWilliam2019
Guru
'what to charge explanation of pocket, cantery of bleeders, suturing of bleeders?
bleeding in pacer/defib pocket?
indication for procedure
the pt is status post extraction of 3 leads from a dehisced pocket and had been on heparin. A wound VAC was applied last niught. He has now developed profuse bleeding from the poacket and brought to the lab for exploration. Contributory factors to the bleeding obviously included the pt's low platlet count(chronic), heparin and the suction of the would VAC. His hemoglobin had dropped, BP is likewise dropping. He is brought to the lab with people holding manual pressure on the open wound to stem the flow of blood.
PROCEDURES
1. Exploration of the pocket, chronice suturing of margins, multiple cauterization points applied and ultimately the wound packed with Floseal and iodoform gauze
2. Sedation
Description of Procedure
As mentioned the pt was brought w manual pressure being applied to the wound. At the last moment, a hasty draping was performed. The pt received Versed 6 mg and fentanyk 100 mcg. His blood pressure transiently was in the 70s. A Neo-Synephrine drip was begun. A unit of blood was started. There were multiple bleeding points, but no major artery or vein. A number of places were cauterized. Some chronic sutures were placed to obliterate part of the edge where some bleedig was emanating from. When it appeared that wound had gotten considerably drier, we applied FloSeal and iodoform gauze to the would
Aquacel dressing then applied and over this a pressure dressing.
blodd pressure was already coming up and in part likely was due to the sedation. Neo-Synephrine was being weaned. We cont to give __ and transfer him to CCU for observation
Disposition
1. We will paln to let the wound granualte for 2 days we will also have to hokd heparin for 48 hrs We will attempt to reapply the would VAC and reinititate the heparin on Monday
2. We will recheck his CBC and BMP in the morning
bleeding in pacer/defib pocket?
indication for procedure
the pt is status post extraction of 3 leads from a dehisced pocket and had been on heparin. A wound VAC was applied last niught. He has now developed profuse bleeding from the poacket and brought to the lab for exploration. Contributory factors to the bleeding obviously included the pt's low platlet count(chronic), heparin and the suction of the would VAC. His hemoglobin had dropped, BP is likewise dropping. He is brought to the lab with people holding manual pressure on the open wound to stem the flow of blood.
PROCEDURES
1. Exploration of the pocket, chronice suturing of margins, multiple cauterization points applied and ultimately the wound packed with Floseal and iodoform gauze
2. Sedation
Description of Procedure
As mentioned the pt was brought w manual pressure being applied to the wound. At the last moment, a hasty draping was performed. The pt received Versed 6 mg and fentanyk 100 mcg. His blood pressure transiently was in the 70s. A Neo-Synephrine drip was begun. A unit of blood was started. There were multiple bleeding points, but no major artery or vein. A number of places were cauterized. Some chronic sutures were placed to obliterate part of the edge where some bleedig was emanating from. When it appeared that wound had gotten considerably drier, we applied FloSeal and iodoform gauze to the would
Aquacel dressing then applied and over this a pressure dressing.
blodd pressure was already coming up and in part likely was due to the sedation. Neo-Synephrine was being weaned. We cont to give __ and transfer him to CCU for observation
Disposition
1. We will paln to let the wound granualte for 2 days we will also have to hokd heparin for 48 hrs We will attempt to reapply the would VAC and reinititate the heparin on Monday
2. We will recheck his CBC and BMP in the morning