1. A 54-year-old patient is seen by the physician in the outpatient clinic setting for CLL that is currently in remission. The patient's WBC counts, particularly lymphocytes remain within normal limits 2. Susan Oster, 45, is admitted to the hospital with a temperature of 38.5º C, heart rate 102 beats/min, respiration 20/min with septicemia and SIRS. WBC 12,500. Documentation states respiratory and acute hepatic failure are due to septicemia. 3. OPERATIVE REPORT
PATIENT: Mara Bell Lee
PHYSICIAN: Randy Greenfield,
MD PREOPERATIVE DIAGNOSIS: Pleural effusion with unknown cause.
POSTOPERATIVE DIAGNOSIS: Pleural effusion with unknown cause.
Four-quadrant pleural biopsy,
Pleural…show more content…
Downey, MD PROCEDURE PERFORMED: Central venous access placement. INDICATION: Massive gastrointestinal bleed.
The procedure was done emergently because of the patient’s critical condition. His right IJ area was prepped in the usual fashion. It was very difficult to visualize his right IJ vein, even though his habitus should have allowed us to do so, but the patient was, I believe, severely intravascularly volume depleted, and his vein was collapsing. I have attempted to access the right internal jugular vein multiple times, both under real-time ultrasound guidance and even later on blindly. I was able to get blood return and hit the vein; however, I was not able to advance the guidewire. I was able to advance it one time and put the catheter in, and it was nonfunctioning. I had to take the catheter out and tried multiple other times on the right IJ vein without success. That procedure was terminated. Pressure was applied. There was no cervical hematoma whatsoever. The patient was uncomfortable because of the length of the procedure but did well otherwise. Hemodynamically, he was unchanged, and his oxygen saturations remained stable.I prepped the IJ vein area in the usual fashion. One percent lidocaine was used for local anesthesia. Again, the left IJ vein was collapsing. With deep inspiration, the vein could be well visualized on the real-time and ultrasound guidance, after which I could get access to the left IJ vein. A wire was advanced without difficulty while the