schmsuz
Guest
I haven't frequently coded pulm angio and would like some input for this report...I think it should be coded as 93451-26, 93568, 37211-50. Thank you.
PROCEDURES
1. Right femoral venous access x2.
2. Right heart hemodynamics.
3. Oxygen saturation run, pulmonary artery.
4. Bilateral pulmonary angiography.
5. Physician management of sedation and ventilation.
6. Cardiopulmonary resuscitation.
7. EKOS catheter placement x2 in the right upper lobe and left lower lobe, pulmonary arteries.
HEMODYNAMICS:
AORTA: 102/62 (on multiple pressor agents).
RIGHT ATRIUM: A equals 32, V equals 34, mean equals 28 mmHg.
RIGHT VENTRICLE: 78/27 mmHg.
PULMONARY ARTERY: 72/37 with a mean of 50 mmHg.
PCWP: A equals 35, V equals 35, mean equals 30 mmHg.
PULMONARY ANGIOGRAPHY: Multiple segmental pulmonary angiograms were obtained in the right and left system. These all demonstrated extensive thrombus. There was no easily identified thrombus in the outflow tract.
INTERVENTIONAL PROCEDURE: The patient was brought to catheterization laboratory. He was on multiple pressors agents, but had a relative degree of stability, compared to his earlier ER course. Right femoral access was achieved. Baseline hemodynamics were obtained utilizing a Swan-Ganz catheter. There was evidence for severe pulmonary hypertension. Multiple pulmonary angiograms were obtained. An exchange guidewire was utilized and an EKOS catheter system was placed in the right upper pulmonary artery. A second catheter was then positioned in the left pulmonary artery. Additional pulmonary angiograms were obtained, also documenting extensive thrombus. A second EKOS catheter system was positioned. The patient had improvement in his hemodynamics and actually became hypertensive on multiple inotropic agents. These were weaned down. The patient had an additional episode of marked sinus bradycardia with heart rates in the 30s and a very low blood pressure. He was treated with atropine, mechanical " bagging" and brief CPR. He received additional epinephrine. He had a quick return to his baseline status and inotropic therapy was reintroduced at a moderate level. The patient was transferred to the ICU for further management.
CONCLUSIONS
1. Severe bilateral pulmonary emboli with an extensive thrombus burden, complicated by cardiopulmonary arrest.
2. Severe resting pulmonary hypertension.
3. Systemic hypotension requiring inotropic therapy.
4. Successful and uneventful EKOS catheter placement in the right and left pulmonary arteries.
DISCUSSION: The patient will be treated with the EKOS system with TPA per protocol. Further recommendations will be based on his clinical course. There is no data to support systemic infection.
PROCEDURES
1. Right femoral venous access x2.
2. Right heart hemodynamics.
3. Oxygen saturation run, pulmonary artery.
4. Bilateral pulmonary angiography.
5. Physician management of sedation and ventilation.
6. Cardiopulmonary resuscitation.
7. EKOS catheter placement x2 in the right upper lobe and left lower lobe, pulmonary arteries.
HEMODYNAMICS:
AORTA: 102/62 (on multiple pressor agents).
RIGHT ATRIUM: A equals 32, V equals 34, mean equals 28 mmHg.
RIGHT VENTRICLE: 78/27 mmHg.
PULMONARY ARTERY: 72/37 with a mean of 50 mmHg.
PCWP: A equals 35, V equals 35, mean equals 30 mmHg.
PULMONARY ANGIOGRAPHY: Multiple segmental pulmonary angiograms were obtained in the right and left system. These all demonstrated extensive thrombus. There was no easily identified thrombus in the outflow tract.
INTERVENTIONAL PROCEDURE: The patient was brought to catheterization laboratory. He was on multiple pressors agents, but had a relative degree of stability, compared to his earlier ER course. Right femoral access was achieved. Baseline hemodynamics were obtained utilizing a Swan-Ganz catheter. There was evidence for severe pulmonary hypertension. Multiple pulmonary angiograms were obtained. An exchange guidewire was utilized and an EKOS catheter system was placed in the right upper pulmonary artery. A second catheter was then positioned in the left pulmonary artery. Additional pulmonary angiograms were obtained, also documenting extensive thrombus. A second EKOS catheter system was positioned. The patient had improvement in his hemodynamics and actually became hypertensive on multiple inotropic agents. These were weaned down. The patient had an additional episode of marked sinus bradycardia with heart rates in the 30s and a very low blood pressure. He was treated with atropine, mechanical " bagging" and brief CPR. He received additional epinephrine. He had a quick return to his baseline status and inotropic therapy was reintroduced at a moderate level. The patient was transferred to the ICU for further management.
CONCLUSIONS
1. Severe bilateral pulmonary emboli with an extensive thrombus burden, complicated by cardiopulmonary arrest.
2. Severe resting pulmonary hypertension.
3. Systemic hypotension requiring inotropic therapy.
4. Successful and uneventful EKOS catheter placement in the right and left pulmonary arteries.
DISCUSSION: The patient will be treated with the EKOS system with TPA per protocol. Further recommendations will be based on his clinical course. There is no data to support systemic infection.