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clamp placed. A single 5 mm punch aortotomy was created, and the vein graph was anastomosed to the aorta with 6-0 Prolene running suture. The vein graft was de-aired as the partial occluding clamp was removed. The patient responded with the paced rhythm, as she was intermittently paced preoperatively and was slowly weened for bypass. Patient had a significant amount of reperfusion arrhythmias,which required time and patience to allow this massively hypertrophic ventricle to reperfuse. Again, with time and rewarming, patient did respond with a sinus paced rhythm, and she was slowly and easily weaned from bypass.TEE did confirm adequate deairing and good prosthetic valve function before coming off bypass.Once off bypass, protamine sulfate was given to reverse the effects of heparin. All cannulae were then removed, and pursestrings were secured down. One final inspection of all suture lines, all anastomoses, and all pursestrings revealed adequate hemostasis. Before closing, ventricular pacing wires x2 were placed as well as 2 mediastinal drainage tubes. Again, once hemostasis was assured, patient was then closed. The pericardium was reapproximated with 2-0 silk suture. The sternum was closed with #6 sternal wire. The lenia alba and pectoralis fascia were closed with #1 Vicryl running suture. The subcutaneous tissue and skin were closed with running Vicryl suture. Count correct x2. Antibiotic ointment and sterile dressings were placed on all incisions. DISPOSITION OF PATIENTPatient tolerated this procedure well, was hemodynamically stable throughout, and was transferred to the surgical intensive care unit, intubated, sedated, in fair condition, and on low doses of dopamine and nitroglycerin.___________________________________Emily Adkins, MD, Surgical Resident for Jeffrey Wolfe, MD, Cardiac SurgeryEA:adD: 08/14/----T: 08/15/----
Chapter 3; TE #4; Consultation: Wound InfectionForrest General Medical Center1038 Superior Street NWNashville, TN 37189Phone 651.555.5000INFECTIOUS DISEASES CONSULTPatient Name: Donald GardenerPCP: Anderson Phipps, MDPatient ID: 000128Sex/Age: M/69DOB: 17 September, ----Date of Admission:3 June, ----Date of Consultation: 4 June, ----HISTORY OF PRESENT ILLNESS: Briefly, the patient is 69-year-old white gentlemen, a practicing attorney. He was last hospitalized at Forrest General from 30 June to 3 July of last year. At that time, he presented with a chest discomfort and shortness of breath. The patient had a cardiac catherization on 1 July of last year that showed a severely diseased distal left anterior descending artery with total occlusion of the circumflex artery. The patient was discharged home on 3 July. Then, I am told, he was re-admitted in Memphis and had a quadruple coronary bypass surgery. I have requested a Discharge Summary from the hospitalization. From my understanding, the patient’s stay was complicated by sternal dehiscence and what sounds like a sternal wound infection. This was treated with a muscle flap closure. The patient told me that he had a PICC line placed at that time, but at the time of discharge he was not prescribed parenteral antibiotics. Having said that, the patient developed multiple draining sinuses on the