Here's one I have not seen before. Any idea how to code a patient whose temp was down to 25C and rewarmed? The Op Note is below:
INDICATIONS: This is a 58-year-old female with multiple medical problems, cardiac, and end-stage COPD that was found down outside, exposed to the elements with a head wound, unresponsive and had refractory hypothermia in the emergency room with an episode of ventricular tachycardia and ventricular fibrillation, and came in at 25 degrees centigrade and was not able to warm any further with peritoneal lavage and IV fluids and external body warmers. The patient had a CT scan of the head that was negative for any intracranial bleed and subsequently was asked to place the patient on bypass for warming.
PREOPERATIVE DIAGNOSIS: Refractive hypothermia.
POSTOPERATIVE DIAGNOSIS: Refractive hypothermia.
PROCEDURE: Cardiopulmonary bypass, fem/fem right groin.
PUMP TIME: 98 minutes.
BLOOD TRANSFUSION: Three units.
URINE OUTPUT: 800 mL.
DRIPS: Dobutamine 2.5 mcg/kg/minute, epinephrine 0.3 mcg/kg/minute.
FINDINGS: Intraoperative TEE showed ejection fraction around 45 percent, moderate MR, and mild AI.
DESCRIPTION OF PROCEDURE: The patient was prepped and draped in surgical fashion. A transverse incision was made in the right groin at the inguinal ligament and dissected down to the common femoral artery and common femoral vein. Once these were dissected out, I was able to then place pursestrings with the 5-0 Prolene circumferentially, common femoral vein and common femoral artery. The patient was fully heparinized by anesthesia. A Cook needle and wire was placed in the common femoral vein and echocardiogram as used for placement and noticed wire going to the superior vena cava. Once this was completed, the femoral venous canula was inserted under direct visualization with the assistance of echo and placed in the superior vena cava and right atrium. Once this was completed, wire and dilator were removed and it was clamped. After this was completed, the arterial cannula, 18-French was inserted with a Cook needle and a wire and an 18-French cannula was inserted. These were sutured in place, hooked to the pump and made sure there was no air in the lines. The patient was placed on cardiopulmonary bypass.
The patient was on bypass for approximately 98 minutes. Once this was completed, the patient was 37.5 degrees at the time of coming off pump. The patient was weaned from cardiopulmonary bypass down a _____ ventilator with normal ventricular function by echo and once the cannulas were removed, the patient was given protamine to reverse his heparinization. After this was completed, the wounds were closed in three layers with 2-0 Vicryl, 3-0 Vicryl, and a 4-0 subcuticular stitch and Dermabond. The patient was taken to the ICU in critical condition.