[Expert Solution]: Case 3: BronchoscopyPreoperative…

Case 3: BronchoscopyPreoperative diagnoses:Left lower lobe opacity; possible pneumonia; with leukocytosis, on ventilator, ischemic strokePostoperative diagnoses:Left lower lobe opacity; pneumonia; with leukocytosis, AR F on ventilator, ischemic stroke due to cerebral artery embolismConsent:I have explained the following procedure (flexible bronchoscopy) to the patient/family and I have answered their questions. I have given the patient/family information about potential benefits, risks, and side effects of the proposed procedure (for bronchoscopy: bleeding, infection, pulmonary aspiration, low oxygenation, irregular heartbeats, vocal cord injury, airway injury/ perforation/collapses of lung (pneumothorax), bronchospasm, reaction to medication, and rarely, death); the likelihood of the patient achieving their goals; and potential problems that might occur during recuperation. I also discussed reasonable alternatives to the procedure and the risks, benefits, and side effects related to the alternatives and the risks related to not receiving the proposed procedure.Sedation:General Endotracheal Anesthetic (GETA) per anesthesia teamProcedure:Flcxible bronchoscopy Findings:Atelectasis to the left lower lobe on flexible bronchoscopy findings; apparent atelectasis and pneumonia on radiographic studies; low riding endotracheal tube, with distal tip 3cm above carina (instructed bedside respiratory therapist to retract endotracheal tube back by 2cm).Technique:Patient was placed in a semi-fowler position. Patient is on the ventilator. Hemodynamic and pulse oximetry monitoring provided throughout the entire procedure. Anesthesia service provider administered anesthesia for the entire procedure. Pre-oxygenation with supplemental oxygen given prior, during, and until completion of the procedure. A time out was held and the above information confirmed just prior to the procedure. No suspicion/risk for any potential presence of mycobacterial organisms for this procedure. A fiberoptic flexible bronchoscope was used for entry into the airways in the usual fashion. All airways were sequentially and carefully inspected with findings as noted below. Aliquots of 1% Lidocaine solution were instilled to anesthetize the airways during the procedure. Aliquots of saline for bronchial washing and lavage of LLL were used as noted.Specimens:Bronchial Washing, LLL, for routine aerobic cultureICD-10-CM code(s): 4 codes ICD-10-PCS code(s): 1 code