Assign appropriate CPT and ICD-10-CM codes and modifiers

3. PREOPERATIVE DIAGNOSIS: Left tibial tubercle avulsion fracture.

POSTOPERATIVE DIAGNOSIS: Comminuted left distal end of the tibia

PROCEDURE: Open reduction and internal fixation of left tibia.

ANESTHESIA: General. The patient received 10 ml of 0.5% Marcaine local anesthetic.

TOURNIQUET TIME: 80 minutes.

ESTIMATED BLOOD LOSS: Minimal.

DRAINS: One JP drain was placed.

COMPLICATIONS: No intraoperative complications or specimens. Hardware consisted of two 4-5 K-wires, One 6.5, 60 mm partially threaded cancellous screw and one 45, 60 mm partially threaded cortical screw and 2 washers.

HISTORY AND PHYSICAL: The patient is a 14-year-old male who reported having knee pain for 1 month. Apparently while he was playing basketball on 12/22/2007 when he had gone up for a jump, he felt a pop in his knee. The patient was seen at an outside facility where he was splinted and subsequently referred to Children's for definitive care. Radiographs confirmed comminuted tibial tubercle avulsion fracture with patella alta. Surgery is recommended to the grandmother and subsequently to the father by phone. Surgery would consist of open reduction and internal fixation with subsequent need for later hardware removal. Risks of surgery include the risks of anesthesia, infection, bleeding, changes on sensation in most of the extremity, hardware failure, need for later hardware removal, failure to restore extensor mechanism tension, and need for postoperative rehab. All questions were answered, and father and grandmother agreed to the above plan.

PROCEDURE: The patient was taken to the operating and placed supine on the operating table. General anesthesia was then administered. The patient was given Ancef preoperatively. A nonsterile tourniquet was placed on the upper aspect of the patient's left thigh. The patient's extremity was then prepped and draped in the standard surgical fashion. Midline incision was marked on the skin extending from the tibial tubercle proximally and extremities wrapped in Esmarch. Finally, the patient had tourniquet that turned in 75 mmHg. Esmarch was then removed. The incision was then made. The patient had significant tearing of the posterior retinaculum medially with proximal migration of the tibial tubercle which was located in the joint there was a significant comminution and intraarticular involvement. We were able to see the underside of the anterior horn of both medial and lateral meniscus. The intraarticular cartilage was restored using two 45 K-wires. Final position was checked via fluoroscopy and the corners were buried in the cartilage. There was a large free floating metaphyseal piece that included parts of proximal tibial physis. This was placed back in an anatomic location and fixed using a 45 cortical screw with a washer. The avulsed fragment with the patellar tendon was then fixed distally to this area using a 6.5, 60 mm cancellous screw with a washer. The cortical screw did not provide good compression and fixation at this distal fragment. Retinaculum was repaired using 0 Vicryl suture as best as possible. The hematoma was evacuated at the beginning of the case as well as the end. The knee was copiously irrigated with normal saline. The subcutaneous tissue was re-approximated using 2-0 Vicryl and the skin with 4-0 Monocryl. The wound was cleaned, dried, and dressed with Steri-Strips, Xeroform, and 4 x4s. Tourniquet was released at 80 minutes. JP drain was placed on the medium gutter. The extremity was then wrapped in Ace wrap from the proximal thigh down to the toes. The patient was then placed in a knee mobilizer. The patient tolerated the procedure well. Subsequently extubated and taken to the recovery in stable condition.

POSTOP PLAN: The patient hospitalized overnight to decrease swelling and as well as manage his pain. He may weightbear as tolerated using knee mobilizer. Postoperative findings relayed to the grandmother. The patient will need subsequent hardware removal. The patient also was given local anesthetic at the end of the case.

Antibiotics are one of the most highly utilized and important medication classes in medicine. Did you know that livestock animals such as cows, pigs, and chickens can receive antibiotics? Resistance to antibiotics is a growing concern, not only in humans but also in livestock animals. Antibiotic resistance occurs when bacteria change in such a way that the effectiveness of drugs is reduced.

For your initial post, research antibiotic resistance further and address the following:

• How does antibiotic resistance develop?
• What complications can occur from antibiotic resistance, both in humans and in livestock?
• Should we decrease the use of antibiotics in humans and livestock animals?

For your reply post, address the following question:

• After reading your classmate's initial discussion post, research and report on an opposing view. After reviewing both positions, what are your thoughts?

The American diet isn't as healthy as it could be. As it has become easier to obtain and prepare food, the amount of food we eat has increased. American adults eat more calories than they did 50 years ago primarily due to larger portion sizes, especially from fast foods, and an increase in the frequency of snacking and calories consumed from those snacks. As a result, over two-thirds of American adults weigh more than they should.

Think About This:
Americans are replacing more and more home cooked meals with meals from fast food restaurants. What is the cost of this convenience?

In Your Topic Post: In your own words;

• Why do you think Americans today rely more on prepackaged and restaurant meals than our grandparents did?
• Share what you see as the nutritional impacts of this trend?
• Share 1-2 obstacles you face when it comes to healthy food choices.

As part of a pathophysiology lecture in a fourth year course, you are informed that two different types of G-protein coupled receptors are expressed on a human organ system. The activation of receptor-1 (R-1) causes an elevation in cyclic adenosine monophosphate (cAMP) levels in the cells. While the activation of receptor-2 (R-2) causes an inhibition in the rise of cAMP levels in the same cells.

Q1. Which G-protein alpha subunit is most likely associated with R-1 and R-2? 2 points R-1 = Q2.

You are further informed that activation of R-1 causes relaxation of smooth muscles in the organ expressing these receptors.

What do you think could be the possible effect of R-2 activation? 1 point

Q3. If the pathophysiology (clinical problem) in patients is excessive muscle contraction and constriction of the tissue, how can you target these two receptors to correct the underlying disorder? Note: Think in terms of agonist/antagonist for receptors R-1 and R-2. 2 points

detail how Wolff’s Law can explain an in increase in bone density, and also, how it can explain decrease in bone density.

What is the RMP?

Depolarization: Which gates are open and which gates are closed?

Repolarization: Which gates close and which ones open?

How does the cell go back to RMP?

Write a 1,000-1,250 word paper in which you analyze a scenario using the Emergency Medical Treatment and Active Labor Act (EMTALA).

You are the administrator on call for Hospital A and are responsible for accepting and rejecting patients. You receive a call at 2:00am from Health Hosptial B regarding a patient with a severed ear.

The ED physician is calling to arrange an EMTALA-qualified transfer from his hospital to yours, but the ENT physician on call at your hospital is refusing to accept the transfer, stating that the patient does not need a higher level of care.

You call your ENT on call and he admits he has just had three glasses of wine and will not be available for about 6 hours. You electronically send him the record that Health Hospital B would send with the patient. The ENT physician advises that the ear looks salvageable and could easily be sutured in any ED. The ED physician at Health Hospital B is ver nervous about the possibility of an EMTALA violation.

1. If you decide to reject the patient, is this a violation of EMTALA? Explain.

2. What decision will you make as the administrator? Explain.

3. Based on this scenario, what could be implemented to prevent this type of situation from occurring in the future?

4. Under what scenario would the Hospital A physician be concerned about an EMTALA situation?

Scenario 2: You are informed that an endocrine organ in the body expresses four membrane receptors a) receptor-i which is Gs coupled b) receptor-ii which is Gi coupled c) receptor-iii which is Gq coupled d) receptor-iv is a receptor guanylyl cyclase You are further informed that an increase in Ca2+ concentration or an increase in the active PKA levels inside the organ both will result in release of hormone from this endocrine organ. On the other hand, PKG inhibits the release of hormone from this organ. What would be the expected outcome (increased blood concentration of hormone or decreased blood concentration of hormone) with the following drugs: Q4. Receptor 1 agonist? 1 point

Q5. Receptor 1 antagonist? 1 point

Q6. Receptor 2 agonist? 1 point

Q7. Receptor 2 antagonist? 1 point

Q8. Receptor 3 agonist? 1 point

Q9. Receptor 3 antagonist? 1 point

Q10. Receptor 4 agonist? 1 point

Q11. Receptor 4 antagonist? 1 point

CELLULAR RESPIRATION

1- Steps of Cellular Respiration: Anaerobic vs. Aerobic

a. Glycolysis

b. Citric acid cycle

c. Electron transport chain (ETC)

2- Carbohydrate storage.

Define What is health?

I'm calculating the equilibrium potentials of sodium ions and potassium ions using the Nernst equation. In the problem I just did, I calculated Ena= +69.9 mV and Ek=-92.0 mV.

The next part of the question asks, "If the conditions are the same as above, at which membrane potential would you expect the movement of the Na and K ions to cancel each other out and there be no net change in membrane potential?"

Do I average their equilibrium potentials or is it more complicated than that?