The оwner оf Crаckers, Inc. prоduces two kinds of crаckers: Deluxe (D) аnd Classic (C). She has a limited amount of the three ingredients used to produce these crackers available for her next production run: 4,800 ounces of sugar; 9,600 ounces of flour, and 2,000 ounces of salt. A box of Deluxe crackers requires 2 ounces of sugar, 6 ounces of flour, and 1 ounce of salt to produce; while a box of Classic crackers requires 3 ounces of sugar, 8 ounces of flour, and 2 ounces of salt. Profits for a box of Deluxe crackers are $0.40; and for a box of Classic crackers, $0.50. What is the constraint for sugar?
Assign оnly the Medicаl аnd Surgicаl sectiоn cоdes Procedure: Open reduction and internal fixation of bilateral tibial plateau fractures. Indications: This 23-year-old was involved in a serious accident and sustained bilateral tibial plateau fractures Description of Operation: The patient was brought to the operating room and placed on the operating room table in the supine position. General anesthesia was induced, and after this both lower extremities were prepped and draped in the usual sterile fashion. Attention was first directed towards the left tibial plateau. A standard lateral procedure to reduce the lateral tibial plateau fracture was performed. After a submeniscal arthrotomy was performed, the joint was visualized via the lateral approach. The posterolateral fragments were reduced and the lateral tibial plateau was elevated, restoring the articular surface. K-wires were placed to provisionally hold this reduction. C-arm fluoroscopy was used to confirm good reduction of the joint surface. Next, a 6-hole lateral plateau locking plate from the Stryker sets was selected. This locking plate was advanced down the tibial shaft. Screws were placed to secure the plate to the bone. Four screws were placed in the distal shaft fragments and 4 locking screws in the proximal fragment. A kickstand screw was also placed in the locking mode. After all screws were placed, x-rays exhibited good reduction of the fracture, as well as good placement of all hardware. Next, the wound was thoroughly irrigated with normal saline. The meniscal arthrotomy was closed with the 0 PDS suture, including the capsule. Next, the IT band was closed with 0 Vicryl suture, followed by 2-0 Vicryl sutures for the skin and staples. Attention was then directed toward the right tibial plateau. A similar procedure was performed on the right side. Then, the lateral approach to the lateral tibial plateau was performed, exposing the fracture. The incision was approximately 4 cm on the right side. A 6-hole LISS plate was advanced down the tibial shaft. Four screws were placed in the distal fragments followed by four screws in the locking mode and proximal metaphysial fragment. Excellent fixation was obtained. The C-arm fluoroscopy was used to confirm excellent reduction of the fracture on both the AP and lateral fluoroscopic images. Next, the wound was thoroughly irrigated and closed in layers. Sterile dressings were applied All wounds were dressed with sterile dressing and the patient was placed into knee immobilizers. The patient was then awakened from anesthesia, and transferred to recovery. The patient will be nonweightbearing for approximately three months on bilateral lower extremities. The patient will receive DVT prophylaxis during this time. ICD-10-PCS code(s):
Dо nоt cоde the fluoroscopy or аngiogrаm for this cаse PREOPERATIVE DIAGNOSIS: High-grade asymptomatic right carotid artery stenosis. POSTOPERATIVE DIAGNOSIS: High-grade asymptomatic right carotid artery stenosis. PROCEDURE PERFORMED: Percutaneous transluminal angioplasty and stenting of the right internal carotid artery. (This was done under the Choice protocol.) ANESTHESIA: Local. INDICATION: The patient is a 72-year-old gentleman who is 10 years status post head and neck surgery for cancer, status post radiation, and has a tracheotomy in place. He has developed a high-grade asymptomatic right carotid artery stenosis. After reviewing the risks, benefits and alternatives of his options, he wished to proceed with carotid artery stenting, due to his high anatomical risk factors and high risk of nerve injury. He was enrolled under the Choice post market registry protocol. After the patient was correctly identified and consented, he was taken to the cardiac cath lab and placed in supine position. The right groin was prepped and draped in usual sterile fashion and anesthetized with 1% local. Using anatomical landmarks, the right common femoral artery was punctured with a micropuncture needle in a retrograde fashion. A 0.018-inch wire was then passed under fluoroscopy into the aorta. The needle was exchanged out for a 5-French coaxial dilator and subsequently for a 5-French sheath. Omni flush catheter was then taken into the arch in an LAO projection and aortogram was then performed. This demonstrates a mildly to moderately atherosclerotic aortic arch without any evidence of stenosis. The origins of the great vessels are identified, and these are widely patent without severe disease. The visualized portions of the right subclavian, vertebral, left subclavian, and left vertebral arteries are all widely patent without any evidence of severe disease. The left common carotid artery is patent proximally. The right common carotid artery arises from the innominate in a normal variant. The patient was then systemically heparinized, and his ACT was kept over 220 seconds throughout the entire case. The right common carotid artery was negotiated and then cannulated with a with a Bernstein catheter. With a catheter in the common carotid, angiogram was performed, which demonstrates a high-grade atherosclerotic lesion of the proximal right internal carotid artery MAC with 80–90% stenosis. Distal to this, the artery is widely patent. The external carotid artery is identified and is otherwise normal. An angled guide wire was then advanced deep into the external carotid artery branches and then the catheter was then tracked into this area. Using an exchange technique over an Amplatz wire, an 8-French JR guiding catheter was then advanced through sheath that had been exchanged into the groin and placed with its tip in the distal common carotid artery. With the catheter in this position, a Spider wire embolic protection filter wire was then advanced very carefully through internal carotid artery lesion and placed 5 cm distal to the area of treatment. The filter wire was deployed and a follow-up angiogram demonstrates excellent position without any evidence of embolism or vasospasm. After making appropriate measurements, an Abbott Xact 6 mm × 30 mm self-expanding stent was then deployed across the lesion under fluoroscopy with the filter in place. The stent opened and moved forward slightly but was otherwise in good position. With the stent completely deployed, a 6 × 20 mm balloon was then used to post dilate the stent to form full apposition. A follow-up angiogram was done, which demonstrates excellent treatment of the lesion with less than 20% residual stenosis. The filter wire is in place and does not appear to have a severe amount of debris within it. The filter was then retracted and removed and a cervical carotid angiogram demonstrated wide patency of the common internal and external carotid arteries. The AP and lateral views of the unilateral cerebral carotid demonstrated wide patency with excellent flow through the MCA distribution and cross filling without any evidence of embolism or vasospasm. The guiding catheter and sheath were then removed with direct manual compression held over the groin for 30 minutes. The patient was given protamine to reverse the heparin and then loaded with Plavix, given the placement of the stent. He maintained hemodynamic and neurological stability throughout the entire case. The wound was then cleaned, dried, and dressed using gauze and Tegaderm. The patient appeared to tolerate the procedure well. There were no immediate complications. The patient was taken to recovery room in stable condition. A total of 70 mL of contrast was used for the entire case. ICD-10-PCS code(s):