The president оf Stаte University wаnts tо fоrecаst student enrollments for this academic year based on the following historical data: What is the forecast for this year using exponential smoothing with alpha = 0.5, if the forecast for two years ago was 16,000?
PREOPERATIVE DIAGNOSIS: Respirаtоry fаilure, intrаcranial hemоrrhage. POSTOPERATIVE DIAGNOSIS: Respiratоry failure, intracranial hemorrhage. PROCEDURE PERFORMED: Tracheostomy. ANESTHESIA TYPE: General. ESTIMATED BLOOD LOSS: 10 mL HISTORY: This is a 58-year-old female who presented to the trauma center several days ago with isolated head trauma. She has been on the ventilator and unable to support her ventilation without a mechanical ventilator. She is thus unable to be weaned from a ventilator and thus in need of a tracheostomy. She also is unable to swallow and thus will need a PEG placement. Due to the fact that there is no endoscope functioning at this time we have decided to do the PEG at a later time. The risks and benefits were explained to the family and they consented to the procedure. PROCEDURE: The patient was brought to the operating room and had SCDs placed prior to induction of anesthesia. She had preoperative antibiotics given prior to any incision. She had come down with the ET- tube and this was hooked up to the ventilator by the anesthesia staff. She was prepped and draped in normal sterile fashion and the anatomic landmarks of the thyroid cartilage and sternal notch were identified, as well as the cricothyroid membrane. About 1 fingerbreadth below the cricothyroid membrane, incision was made down to the level of the subcu tissue. Bovie electrocautery was used to dissect down through the platysma. Any venous bleeders were identified and tied off with silk suture. Right angles were used and a suture ligature was placed with silk suture around the end of the isthmus and this was transected in the midline. We then had good exposure of the trachea. We identified the third tracheal ring. We had the ICU staff deflate the balloon and we placed stay sutures laterally on both sides of the third tracheal ring. This was carried down from skin to the tracheal ring back up to the skin. We then reinflated the balloon and then when we were ready we deflate the balloon again and made a square incision around the third tracheal ring and removed this portion in a square fashion. We brought our ETtube out proximally just proximal to this and used a tracheal spreader to dilate the trachea. We then placed a #8 Shiley tracheostomy tube without any difficulty and the balloon was inflated. We then hooked our tracheostomy to the ventilator and received good end tidal C02. The patient was oxygenating at 100% and her tidal volumes were equivalent to what they were preop with the ET-tube. There were no signs of bleeding and good, hemostasis was, achieved. The skin around the tracheostomy incision was closed in running fashion and the tracheostomy was secured in four places with nylon suture. The Vicryl stay sutures were secured to the chest wall with Steri-Strips. The patient tolerated the procedure well and was taken to ICU in stable condition. ICD-10-PCS code(s):
PREOPERATIVE DIAGNOSIS: Lаrge right subdurаl hemаtоma. POSTOPERATIVE DIAGNOSIS: Large right subdural hematоma. PROCEDURE PERFORMED: Right craniоtomy with evacuation of subdural hematoma. HISTORY: This 58-year-old patient was transferred from an outside hospital after she was found unresponsive. She was on Coumadin, and she was found to have a large right-sided subdural hematoma with significant midline shift. On exam, she is noted to have anisocoria and large right pupil, decerebrating, to pain. The patient had received FFP as well as factor VII and was emergently rushed to the operating room. PROCEDURE: The patient was brought into the general operating theater. Following the induction of general anesthesia, the patient was supine. The scalp was clipped, prepped, and draped. We made a hairline incision frontal temporal parietal, reflecting it and incised down through the temporalis muscle. Fascia reflected with the skin flap. Bone flap was elevated without dural violation, tacked up to the bone edges with 4-0 Nurolon. As the dura was tacked up, the dura was opened. We encountered a very large subdural membrane. We circumferentially evacuated it. We did find a cortical arterial bleeder. Once it started bleeding, we removed the clot. This was coagulated, and the bleeding was stopped. We copiously irrigated, circumferentially inspecting the edges to make sure there was no venous bleeding. All seemed dry. We next reapproximated the dura. We did place a red rubber catheter in the subdural space. The dura was approximated with 4-0 Nurolon. Bone was placed back in place. Temporalis muscle and fascia were approximated with 2-0 Vicryl, the galea with inverted interrupted 2-0 Vicryl and the skin with staples. Following this procedure, all instrument, sponge, needle and padding counts were correct. ICD-10-PCS code(s):