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Q: Placement of a temporary pacemaker. The right subclavian area was prepped and draped in the usual fashion. Local anesthetic was infiltrated. The subclavian vein was entered via Seldinger technique
with a Cook needle. A guidewire was passed to the right heart. A 6-French dilator sheath was placed. The dilator and wire were then removed. The sheath was sutured into place. A 5-French bipolar pacemaker wire was placed near the apex of the right ventricle. Temporary pacing was instituted. Threshold was less than 0.5 mV. Pacer settings were 60 per minute demand and 5 MA. Patient returned to their room in good condition
A: DESCRIPTION OF OPERATION: The patient was brought to the electrophysiology laboratory in the fasting state after signing informed consent. The left subclavian area was prepped and draped in the usual sterile fashion. [ Local anesthesia was achieved along the left deltopectoral groove using a combination of 1% lidocaine and 0.5% Marcaine. An incision was extended along the groove, and using a
combination of blunt and Bovie dissection, the incision was extended to the level of the prepectoral fascia. A pulse generator pocket was fashioned inferomedial to the incision using blunt dissection in the prepectoral space. The left axillary vein was visualized with a Site-Rite II ultrasound device, and under direct ultrasound visualization, the vein was punctured with a Cook needle and a guidewire was placed. Using a similar ultrasound-guided technique, another guidewire was placed in the left axillary vein using a separate needle stick. Over one guidewire, a 7 French introducer sheath was advanced. Through this sheath, an active fixation pacing lead was advanced using straight and curved stylets. The lead was positioned in the right ventricular septal area at a site with favorable sensing and pacing characteristics, where the lead was actively fixed in the location and securely sutured to the underlying pectoral muscle. Final lead measurements were favorable, and there was no diaphragmatic stimulation at high output pacing. Over the second guidewire, another 7 French introducer sheath was advanced, and through this sheath, another active fixation pacing lead was advanced into the right atrium with the aid of a J-tipped stylet. The lead was positioned in the right atrial appendage at a site with favorable sensing and pacing characteristics, where the lead was actively fixed in the location and securely sutured to the underlying pectoral muscle. It should be noted that this original pacing lead did dislodge not long after closure of the wound. ]
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User: Placement of a temporary pacemaker. The right subclavian area was prepped and draped in the usual fashion. Local anesthetic was infiltrated. The subclavian vein was entered via Seldinger technique with a Cook needle. A guidewire was passed to the right heart. A 6-French dilator sheath was placed. The dilator and wire were then removed. The sheath was sutured into place. A 5-French bipolar pacemaker wire was placed near the apex of the right ventricle. Temporary pacing was instituted. Threshold was less than 0.5 mV. Pacer settings were 60 per minute demand and 5 MA. Patient returned to their room in good condition

Weegy: DESCRIPTION OF OPERATION: The patient was brought to the electrophysiology laboratory in the fasting state after signing informed consent. The left subclavian area was prepped and draped in the usual sterile fashion. [ Local anesthesia was achieved along the left deltopectoral groove using a combination of 1% lidocaine and 0.5% Marcaine. An incision was extended along the groove, and using a combination of blunt and Bovie dissection, the incision was extended to the level of the prepectoral fascia. A pulse generator pocket was fashioned inferomedial to the incision using blunt dissection in the prepectoral space. The left axillary vein was visualized with a Site-Rite II ultrasound device, and under direct ultrasound visualization, the vein was punctured with a Cook needle and a guidewire was placed. Using a similar ultrasound-guided technique, another guidewire was placed in the left axillary vein using a separate needle stick. Over one guidewire, a 7 French introducer sheath was advanced. Through this sheath, an active fixation pacing lead was advanced using straight and curved stylets. The lead was positioned in the right ventricular septal area at a site with favorable sensing and pacing characteristics, where the lead was actively fixed in the location and securely sutured to the underlying pectoral muscle. Final lead measurements were favorable, and there was no diaphragmatic stimulation at high output pacing. Over the second guidewire, another 7 French introducer sheath was advanced, and through this sheath, another active fixation pacing lead was advanced into the right atrium with the aid of a J-tipped stylet. The lead was positioned in the right atrial appendage at a site with favorable sensing and pacing characteristics, where the lead was actively fixed in the location and securely sutured to the underlying pectoral muscle. It should be noted that this original pacing lead did dislodge not long after closure of the wound. ]
newbre|Points 50|

User: The physician views the trachea using a bronchoscope placed through an established tracheostomy. The physician examines the conducting airways. The bronchoscope is removed.

Weegy: A diagnostic bronchoscopy is performed to locate the foreign body, and a surgical bronchoscopy is performed to remove the foreign body. Report code 31635.
jeifunk|Points 8380|

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Asked 1/13/2013 8:26:25 PM
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