[Expert Solution]: PREOPERATIVE DIAGNOSIS: Respiratory…

PREOPERATIVE DIAGNOSIS: Respiratory failure, intracranial hemorrhage. POSTOPERATIVE DIAGNOSIS: Respiratory failure, intracranial hemorrhage. PROCEDURE PERFORMED: Tracheostomy. ANESTHESIA TYPE: General. ESTIMATED BLOOD LOSS: 10 mL HISTORY: This is a 58-year-old female who presented to the trauma center several days ago with isolated head trauma. She has been on the ventilator and unable to support her ventilation without a mechanical ventilator. She is thus unable to be weaned from a ventilator and thus in need of a tracheostomy. She also is unable to swallow and thus will need a PEG placement. Due to the fact that there is no endoscope functioning at this time we have decided to do the PEG at a later time. The risks and benefits were explained to the family and they consented to the procedure. PROCEDURE: The patient was brought to the operating room and had SCDs placed prior to induction of anesthesia. She had preoperative antibiotics given prior to any incision. She had come down with the ET tube and this was hooked up to the ventilator by the anesthesia staff. She was prepped and draped in normal sterile fashion and the anatomic landmarks of the thyroid cartilage and sternal notch were identified, as well as the cricothyroid membrane. About 1 fingerbreadth below the cricothyroid membrane, incision was made down to the level of the subcu tissue. Bovie electrocautery was used to dissect down through the platysma. Any venous bleeders were identified and tied off with silk suture. Right angles were used and a suture ligature was placed with silk suture around the end of the isthmus and this was transected in the midline. We then had good exposure of the trachea. We identified the third tracheal ring. We had the ICU staff deflate the balloon and we placed stay sutures laterally on both sides of the third tracheal ring. This was carried down from skin to the tracheal ring back up to the skin. We then reinflated the balloon and then when we were ready we deflate the balloon again and made a square incision around the third tracheal ring and removed this portion in a square fashion. We brought our ETtube out proximally just proximal to this and used a tracheal spreader to dilate the trachea. We then placed a #8 Shiley tracheostomy tube without any difficulty and the balloon was inflated. We then hooked our tracheostomy to the ventilator and received good end tidal C02. The patient was oxygenating at 100% and her tidal volumes were equivalent to what they were preop with the ET-tube. There were no signs of bleeding and good, hemostasis was, achieved. The skin around the tracheostomy incision was closed in running fashion and the tracheostomy was secured in four places with nylon suture. The Vicryl stay sutures were secured to the chest wall with Steri-Strips. The patient tolerated the procedure well and was taken to ICU in stable condition. Using the ICD 10 PCS Codebook apply the appropriate code(s) to describe the above scenario.