DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Postoperative bleeding.
2. Status post emergency coronary artery bypass grafting x4.
3. Status post acute myocardial infarction.
4. Mild coagulopathy.
POSTOPERATIVE DIAGNOSES:
1. Postoperative bleeding.
2. Status post emergency coronary artery bypass grafting x4.
3. Status post acute myocardial infarction.
4. Mild coagulopathy.
OPERATIONS PERFORMED:
1. Emergency exploration of the mediastinum.
2. Evacuation of hemopericardium.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, PA-C
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 250 mL.
FINDINGS: The patient had diffuse oozing from all the raw surface areas. There was a small arterial bleeder from the lower aspect of the right side of the sternum. There was some oozing at the distal anastomosis to the right coronary artery.
DESCRIPTION OF OPERATION: The patient was taken from the intensive care unit to the operating room and placed on the operating room table in the supine position. General anesthesia was given via endotracheal tube previously placed. After this was performed, the chest, abdomen, and lower extremities were prepped and draped in the usual sterile fashion. Sutures from the previous procedure were removed as well as the sternal wires.
After this was performed, a sternal retractor was placed. Evacuation of hemopericardium was performed. All the clots in the pericardium and chest cavity were then removed. The chest cavity was then irrigated with antibiotic solution. Careful examination of all the suture lines was performed. Just some oozing was noticed at the distal anastomosis of the right coronary artery and then this was secured with a 7-0 Prolene suture.
Following this, we checked the other suture lines and neither one showed any bleeders. After the sternal retractor was removed, we noticed an arterial bleeder from the sternum. It was then controlled with a Bovie cautery. Meanwhile, the coagulopathy was corrected with blood products.
After adequate hemostasis was obtained, the chest tubes were placed back to their original position. The sternum was then approximated with #6 stainless steel wires. The chest wall was closed in layers. The patient tolerated the procedure and was transferred to the cardiovascular recovery unit in stable condition.
