Cardiothoracic surgery discharge summary

Discharge summary Cardiothoracic Surgery

1. DISCHARGE SUMMARY CARDIOTHORACIC SURGERY DIVISION, UATH Dr Paul Andrew 9th August, 2024

2. S/N NAME AGE ( yr ) SEX DIAGNOSIS OPERATION DOA 1 H. A 49 F Intravascular m igration of guide wire following right subclavian central venous catheter insertion Right groin exploration and retrieval of migrated guide wire under fluoroscopic guidance 2 2 E. O 50 M Penetrating chest injury with bilateral pneumothorax 2° assault Bilateral CTTD 9

3. Case 1 H. A. 49yr, F Admitted: 1/8/2024 Discharged: 3 /8/2024

4. History A 49yr old SCD patient admitted by the orthopaedic surgery team and being worked up for left total hip replacement for avascular necrosis of the left femoral neck Had central line inserted via the right subclavian vein approach as part of work up for surgery during which the guide wire inadvertently migrated completely into the intravascular space No associated chest pain, difficulty in breathing or haemoptysis This necessitated cardiothoracic surgery team review She had no other co-morbidity

5. Examination A middle aged woman, pale, afebrile CVS: Haemodynamically stable ( PR-86bpm BP-120/88mmHg) HS: S1 and S2 CHEST: Right subclavian central venous catheter insitu Adequate air entry bilaterally Vesicular breath sounds Other systems : Not remarkable Assessment: Inadvertent intravascular migration of guide wire in a haemodynamically stable patient

6. Management FBC- WBC-8.5, PCV-19%, PLT-347 EUCr : Essentially normal Chest and abdominal x-rays: Demonstrated a guide wire within the intravascular space extending from the right subclavian vein through SVC, right atrium enroute the IVC to the proximal right femoral vein

7. Management Counselled and prepared for right groin exploration and retrieval of guide wire under fluoroscopic guidance Intra-op findings: G uide wire tip within the r ight femoral vein just below the inguinal ligament with thrombus around it

8. Management cont … Giude wire retrieved via a transverse venotomy after heparinization and vascular control Venotomy repaired with prolene 5/0 Postoperative period: uneventful Discharged from CTS point of view on post-op day 2

9. Case 2 E.O 50yr, M Admitted: 25/7/2024 Discharged: 3/8/2024

10. History PC: Shortness of breath following a stab injury to the chest x 1/7 A police officer who was said to have been attacked by armed assailants trying to dispossess him of his belongings He was s tabbed on the left anterior side of his chest. Bled profusely with associated dizziness and fainting. Bleeding was temporarily arrested by application of pressure dressing Associated chest pain and difficulty in breathing but no haemoptysis No injury to any other part of the body and no other co-morbidity Received initial care at a peripheral facility before referral here for expert management

11. Examination O/E: Middle aged man, in painful and respiratory distress, afebrile, pale, anicteric, dehydrated CVS: PR-100bpm Bp-130/100mmHg HS: S1 & S2

12. Examination cont … CHEST : SPO2-99% on INO2 RR-28cpm Pressure dressing over the wound on the anterior chest wall 5cm transverse wound over the left 3 rd ICS just lateral to the sternal border, not actively bleeding and not sucking Trachea central Extensive subcutaneous emphysema extending from the chest wall to the neck and face Decreased chest wall excursion bilaterally ( worse on the left) Reduced air entry both lower lung zones bilaterally Other systems were grossly normal

13. Management Diagnosis : Penetrating chest injury with anaemia and bilateral pneumothorax with extensive subcutaneous emphysema secondary to assault Urgent PCV/FBC, EUCr , GXM 2units, CXR IVF resuscitation INO2, Antibiotics, TT, Analgesics Had bilaterally CTTD + closure of the stab wound

14. CXR following bilateral CTTD

15. Management FBC- PCV-23%, WBC-7.5, PLT-117 EUCr -Essentially normal Had 3 units of blood transfused, post-transfusion PCV-31% Commenced on incentive spirometry and chest physiotherapy Chest tubes were removed 1week later Discharged home for follow-up in clinic