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May 12 17:11
• He is trying to reach and pull out his s/l pout socks. TIA!
+ hosp?
Sat Jul 30 22:04:09 2016 hosp?
Patient hallucinating and in withdrawal.

Patient is reaching states there is an insect on his finger and is asking me to remove the insect. He is trying to reach and pull out his _______ socks.

• pt with thrombocytopenia...on lab value S/L Ple-is-sol? 139,000..double stranded sm
+ ne
Sat Jul 30 16:07:02 2016 ne
On laboratory data, the (Ple-is-sol..or Glyizol?) is 139,000, double stranded DNA was positive. He is being seen by rheumatology
** • platelet (count)? - billybob
Sat Jul 30 16:26:39 2016 billybob


• skull fracture - s/l antero phalanx ?
+ kitty
Sat Jul 30 11:13:47 2016 kitty
IMPRESSION/PLAN:
1. Fall with subsequent hemorrhage noted within the subarachnoid space in the right posterior temple region as well as a tiny focus of increased attenuation along the ______ left of midline. This problem is being managed by the primary service, Dr.

** • may be anterior falx ? - kitty
Sat Jul 30 11:20:21 2016 kitty


• The patient was then prepped and draped in normal sterile fashion for ...
+ wav
Sat Jul 30 03:31:15 2016 wav
The patient was then prepped and draped in normal sterile fashion for cataract surgery. The main surgeon was sitting temporally during the case and made _____ at 12 oclock and 6 oclock using the MVR blade and a 0.12 pickup
** • paracenteses (shortening to paras?)? - nm
Sat Jul 30 05:57:23 2016 nm

** • is it parous? - guy
Sat Jul 30 03:46:02 2016 guy

**** • ...surgeon was sitting temporally (the position), and agree with "paras" as he says it - ter
Sat Jul 30 08:04:26 2016 ter


• On this day, the patient was brought to the operating room and placed ...
+ wav
Sat Jul 30 01:26:23 2016 wav
On this day, the patient was brought to the operating room and placed in the right lateral decubitus position. Anesthesia was induced and the airway was secured. All bony prominences were _____ padded. Before the start of the operation, a time-out was performed confirming
** • I think I hear "securely padded." I do find google hits for + Questyr
Sat Jul 30 01:56:02 2016 Questyr
pressure points being securely padded. (see link)
** • not sure there is anything there...sounds more like background noise - imo-poi
Sat Jul 30 01:32:47 2016 imo-poi

**** • Thanks a lot. - guy
Sat Jul 30 01:33:16 2016 guy


• He still reported drainage from the seton site as well as anal pruritu ...
+ wav
Sat Jul 30 00:53:59 2016 wav
He still reported drainage from the seton site as well as anal pruritus. The patient was then scheduled for exam under anesthesia ____ any further fistula *in/and* seton placement. Informed consent was obtained prior to the procedure.
** • to evaluate for any ...fistulae - poi
Sat Jul 30 01:06:03 2016 poi

**** • and - poi
Sat Jul 30 01:07:14 2016 poi

****** • Thanks a lot. - guy
Sat Jul 30 01:21:24 2016 guy


• This is a 43-year-old male with a history of Crohns disease, on Humir ...
+ wav
Sat Jul 30 00:13:41 2016 wav
This is a 43-year-old male with a history of Crohns disease, on Humira, who recently underwent a colonoscopy with GI in June 2016, was found to have an area of granular mucosa about 5 cm from the anus and another concerning area of raised mucosa about 20 cm from the anal mucosa. Flexible sigmoidoscopy in the _____ was indicated for further examination of the two lesions.
** • in EUA - poi
Sat Jul 30 00:18:48 2016 poi

**** • Thanks a lot. - guy
Sat Jul 30 00:23:00 2016 guy


• On exam in the office, a left perianal mass was noted and anoscopy ___ ...
+ wav
Fri Jul 29 22:53:36 2016 wav
On exam in the office, a left perianal mass was noted and anoscopy _____ secondary to pain. The patient was then scheduled for exam under anesthesia and excision of the perianal mass.
** • was deferred - nm
Fri Jul 29 22:59:09 2016 nm

** • but anoscopy was declined? - wag-poi
Fri Jul 29 22:59:00 2016 wag-poi

**** • Thanks a lot everybody - guy
Fri Jul 29 23:00:22 2016 guy

**** • ignore me, agree with nm. deferred - poi
Fri Jul 29 23:00:21 2016 poi


• The external oblique aponeurosis was opened in the direction of its fi ...
+ wav
Fri Jul 29 22:07:04 2016 wav
The external oblique aponeurosis was opened in the direction of its fibers through the external ring using first _____ with a scalpel and then Metzenbaum scissors
** • a nick with a - poi
Fri Jul 29 22:15:05 2016 poi

**** • yeah, what nm said :) - poi
Fri Jul 29 22:15:32 2016 poi

** • a nick - nm
Fri Jul 29 22:14:51 2016 nm

**** • Thanks a lot everybody - guy
Fri Jul 29 22:22:48 2016 guy


• After we placed the patient in a beach chair position to confirm the u ...
+ mp3
Fri Jul 29 20:39:31 2016 mp3
After we placed the patient in a beach chair position to confirm the upper markings, we realized that our initial markings were slightly too high and we would not be able to resect that _____ abdominal pannus. After reestablishing the upper incision, the incision was made sharply with a knife.
** • I think I hear "extent of" - Questyr
Fri Jul 29 20:43:26 2016 Questyr

**** • Thanks a lot. - guy
Fri Jul 29 20:44:06 2016 guy


• Surgical markings had been made prior to the patient being brought to ...
+ mp3
Fri Jul 29 20:16:47 2016 mp3
Surgical markings had been made prior to the patient being brought to the operating room. An inferior incision was made in the entirety with a knife, **after which Bovie cautery, the fascia was dissected down too.**

Dissection was then proceeded along the fascia superiorly moving more medially and dissection continued superiorly.

** • I think "knife, after which Bovie cautery. The fascia was dissected down to." (not too) - Questyr
Fri Jul 29 20:33:10 2016 Questyr

**** • Thanks a lot. was hearing "fascia was dissected down superior." - guy
Fri Jul 29 20:38:33 2016 guy


• After the bypass operation, she experienced massive weight loss with a ...
+ wav
Fri Jul 29 20:06:42 2016 wav
After the bypass operation, she experienced massive weight loss with a total weight loss of 140 pounds. She has had symptomatic abdominal _____ weight loss. She complains of poor fitting clothing, skin changes in intertriginous areas and occasional skin breakdown.
** • "__________ after massive" - Questyr
Fri Jul 29 20:29:27 2016 Questyr

**** • Thanks a lot. - guy
Fri Jul 29 20:29:44 2016 guy


• The brachial artery was clamped proximally and distally. The anterior ...
+ wav
Fri Jul 29 19:05:33 2016 wav
The brachial artery was clamped proximally and distally. The anterior wall of the artery was opened with a #11 blade in a longitudinal fashion. The incision at the arteriotomy was extended to approximately 5 mm using Potts scissors. At this point, we proceeded to create an anastomosis. The _____ was sewn with 7-0 Prolene sutures in a parachute fashion.
** • heel? - poi
Fri Jul 29 19:12:14 2016 poi

**** • appears to be some usage + link-poi
Fri Jul 29 19:13:15 2016 link-poi
link
****** • Thanks a lot. - guy
Fri Jul 29 19:14:04 2016 guy


• Palpitations
+ ESL
Fri Jul 29 18:26:39 2016 ESL
The patient was admitted for "reversal" palpitation and epigastric and chest pain.

• which may have **??pet-er-arie* risk...Sounds like something is cut off on voice file
+ sm
Fri Jul 29 16:34:20 2016 sm
I then spent considerable time drying things up. It did appear that she had an abnormal collection of epidural veins, and in fact, some tiny arterials over the surface of the dura, which may have **??pet-er-arie* risk for this given the procedure that was done. I was able to control this bleeding with low-power bipolar cautery, bone wax, and Surgifoam.
** • Put her at risk? - CO MT
Fri Jul 29 18:03:49 2016 CO MT


• Double Checking--there was a tremendous amount of *taut?* blood underneath the lamina
+ SM
Fri Jul 29 16:18:08 2016 SM
I then gently elevated the lamina along all the segments, and there was a tremendous amount of taut blood underneath the lamina. After traversing the ligament, I was able to remove the epidural hematoma with suction and irrigation.
** • Are you sure it is not "clot and blood" or "clotted blood" ? + taco
Fri Jul 29 16:30:18 2016 taco
Taut means tightly stretched, so I don't think it fits with "blood"

• A **block or blocked?** discectomy was then carried out.
+ SM
Fri Jul 29 15:59:44 2016 SM
Thereafter, distraction pins were placed in 5 and 6, the interspace was opened. A block discectomy was then carried out. This was done utilizing angled curettes and interspace rongeurs.
** • Google-off shows 347 hits for "block" and zero for "blocked" so I'd say "block" - taco
Fri Jul 29 16:07:21 2016 taco

**** • What is Google-off? Thank you! - OP
Fri Jul 29 16:09:43 2016 OP

****** • You search your phrase on Google both ways using quotation marks... + taco
Fri Jul 29 16:29:11 2016 taco
so you search "block discectomy" versus "blocked discectomy" and see which one gets more search results. You have to be sure to use the quotation marks to narrow your search.
******** • I never knew that...thank you so much!! - OP
Fri Jul 29 16:34:52 2016 OP


• less than 1 mm in size with *popcorn* settings.
+ sm
Fri Jul 29 13:54:19 2016 sm
It was through this ureteral sheath that the flexible ureteroscope was passed. The ureteral stone was seen and easily moved into the kidney, where it was able to be treated. Using a 200-micron laser, the ureteral stone was fragmented into piece of less than 1 mm in size with *popcorn* settings.
** • yes - it's popcorn (google "popcorn" with "lithotripsy" for more info) - taco
Fri Jul 29 14:00:12 2016 taco

**** • thank you - -
Fri Jul 29 14:43:21 2016 -


• was induced without difficulty *dual lumen Carlin* tube.
+ sm
Fri Jul 29 13:03:02 2016 sm
PROCEDURE: The patient was taken to the operating room and placed on the operating table in supine position. General endotracheal anesthesia was induced without difficulty *dual lumen Carlin* tube. Fiberoptic bronchoscopy was performed. The distal trachea, left and right main stem bronchi, and segmental bronchi were found to be normal. Advancement into the area of the left upper and lower lobes identified no evidence of bronchial pleural fistula.
** • Fwiw Google and our Archives show there is a Carlens double-lumen tube - Questyr
Fri Jul 29 14:09:22 2016 Questyr

**** • p.s. Also found it listed in Tessier's Surgical Word Book - Q
Fri Jul 29 14:13:12 2016 Q

** • flagged - -
Fri Jul 29 13:33:32 2016 -


• Neck is supple but she does have some s/l ropiness to palpation.
+ cee
Fri Jul 29 11:50:55 2016 cee
s/l ropey-ness
** • ropiness is a word - the neck is ropy (or ropey) - like cords or ropes in the neck. - makes sense to me
Fri Jul 29 11:58:17 2016 makes sense to me

** • lumpiness? - wag
Fri Jul 29 11:56:49 2016 wag

**** • Thanks. I know it's a word, but that's the first time I've heard it referred to neck! - cee
Fri Jul 29 12:16:09 2016 cee


• the psoas muscle ______ with the indirect
+ wav
Fri Jul 29 11:00:20 2016 wav
The entire left myopectineal orifice of Fruchaud was completely dissected free and cleared. The patient was noted to have an indirect left inguinal hernia. The round ligament was divided and reduced off of the psoas muscle ______ with the indirect hernia sac back to the level of the umbilicus. A 15 x 10 anatomical Parietex left-sided ProGrip mesh was placed on the operative field.
** • used below - -
Fri Jul 29 11:22:14 2016 -


• off of the psoas muscle *in continuity* with the indirect hernia sac back
+ sm
Fri Jul 29 10:32:33 2016 sm
The patient was noted to have an indirect left inguinal hernia. The round ligament was divided and reduced off of the psoas muscle *in continuity* with the indirect hernia sac back to the level of the umbilicus. A 15 x 10 anatomical Parietex left-sided ProGrip mesh was placed on the operative field. The mesh was soaked in antibiotic solution.
** • sure, makes sense to me. - b k l o l i
Fri Jul 29 10:59:27 2016 b k l o l i

**** • thanks - -
Fri Jul 29 11:00:50 2016 -


• knee MRI s/l APL
+ sm
Fri Jul 29 10:26:58 2016 sm
radiologist describes this as a 5 mm long by 1 mm transverse and a 2 mm s/l APL linear interstitial tear.
** • I think it might be ACL (as in anterior cruciate ligament)[see Google hits link] + Questyr
Fri Jul 29 12:40:34 2016 Questyr
One example of the hits: The distinction between full-thickness and partial-thickness ACL tears can be more .... of the PCL (arrows), representing a linear longitudinal intrasubstance tear. (from NCBI article)
** • guessing AP - not 100%
Fri Jul 29 10:35:02 2016 not 100%


• searching but might be missing it-female name s/l Sa tor is
- ty
Fri Jul 29 08:30:55 2016 ty

** • nevermind - p
Fri Jul 29 08:42:49 2016 p


• % FIO2, assist control ____ 500, PEEP of 0 and assist control of 15.
+ mp3
Fri Jul 29 08:06:37 2016 mp3
On physical examination, he is a thin, frail figuring male, appearing older than his age. Temperature is 98.8, blood pressure 92/60, pulse 99, respiratory rate 15, O2 saturation 100% on 40% FIO2, assist control ____ 500, PEEP of 0 and assist control of 15. HEENT examination unremarkable, except for alopecia.
** • I hear tidal volume - ter
Fri Jul 29 08:20:08 2016 ter

**** • thank you - -
Fri Jul 29 08:44:26 2016 -


• assembled to the back of the large __________ glenoid on the back table
+ wav
Fri Jul 29 07:32:37 2016 wav
The guide was used to place the guidewire in the glenoid. The guidewire was placed to correct approximately five degrees of posterior eversion. With the guidewire placed, the reamer was then advanced and the preparation of the glenoid was performed in the standard fashion. The Regenerex post was assembled to the back of the large __________ glenoid on the back table. The wound was copiously irrigated. It was determined that the two inferior holes did have complete bone tunnels. The superior peg did not have a complete bone tunnel and therefore, no cement was placed in the peg superiorly.
** • polyethylene - tqaco
Fri Jul 29 07:57:32 2016 tqaco

**** • thanks - -
Fri Jul 29 08:11:27 2016 -


• s/l sada-light (distension medium for biopsy?)
+ kitty
Fri Jul 29 06:09:07 2016 kitty
This was passed in and out of the nodule until bloody aspirate was obtained. This was injected into _____ using sterile saline. Two additional specimens were obtained in identical fashion. Using the same skin entry site, a 25 gauge needle was guided into the left lobe nodule using realtime ultrasound guidance as well. An aspirate was obtained and was placed in _____. Two additional aspirates were obtained in identical fashion
** • found it... CytoLyt Solution vials are used by the clinician to collect the sample - kitty
Fri Jul 29 06:15:24 2016 kitty


• sm
+ :) wav
Fri Jul 29 04:14:24 2016 :) wav
PAST SURGICAL HISTORY:
1. Tubal ligation.
2. Hysterectomy.
3. Exploratory laparotomy.
4. Lumbar surgeries.
5. Right rotator cuff repair.
6. Bladder prolapse recurrence __________ .


** • is still apparent - b k l o l i
Fri Jul 29 04:41:07 2016 b k l o l i


• sustaining a twisting injury and a bimalleolar ankle fracture. She was seen ______sm
+ wav :)
Fri Jul 29 02:32:26 2016 wav :)
at the emergency room where x-rays confirmed the ankle injury.
** • at an outside emergency room? - isgal
Fri Jul 29 03:22:07 2016 isgal


• Intraoperative findings, we noted a rather large intraoperative orbita ...
+ wav
Fri Jul 29 01:47:38 2016 wav
Intraoperative findings, we noted a rather large intraoperative orbital floor fracture with herniation of the orbital contents inferiorly to maxillary sinus. This was repaired with a titanium _____ plate and the _____ plate was secured with one 4-mm self-tapping and self-drilling screw _____ orbital rim. Of note, the orbital rim was noted to be intact _____ performed at the completion of the case.
** • custom-made plate... - billybob
Fri Jul 29 02:13:15 2016 billybob

**** • Thanks a lot. - guy
Fri Jul 29 03:36:38 2016 guy


• He is a __________ physician and he was giving an order to his assistant and he sm
+ wav :)
Fri Jul 29 01:19:09 2016 wav :)
could not get it right and the aphasia lasted about 20 seconds and then he was back to normal, but had another episode of that.
** • I have no idea, sorry - poi
Fri Jul 29 01:26:49 2016 poi

**** • Thanks. I could not find a thing on it. - :)
Fri Jul 29 01:29:26 2016 :)

****** • sorry. i tried but not get. pls post your wav again - guy
Fri Jul 29 01:52:25 2016 guy

******** • I don't think I need to post the wav again. I am just going to leave that one blank. - Thanks though. :)
Fri Jul 29 01:56:52 2016 Thanks though. :)

********** • wanted to come back and let you know I found this. PM&R physician. sm + :)
Fri Jul 29 02:25:38 2016 :)
Physical medicine and rehabilitation (PM&R). She later referred to him as an occupational therapy physician and that helped me narrow it down and locate this.
************ • Thanks for the info. - guy
Fri Jul 29 03:36:07 2016 guy


• Attention was again turned into the abdominal cavity. The appendix wa ...
+ wav
Fri Jul 29 01:12:28 2016 wav
Attention was again turned into the abdominal cavity. The appendix was located and appeared to be _____. Upper abdominal survey normal as defined above.
** • abnormal. - poi.
Fri Jul 29 01:14:46 2016 poi.

**** • Thanks a lot. dictated normal appendix previously in report, so was confused. - guy
Fri Jul 29 01:16:58 2016 guy

****** • see my message below - poi
Fri Jul 29 01:18:51 2016 poi


• pls hear further after 2 cm. she is making correction after 2 cm
+ wav
Fri Jul 29 00:55:44 2016 wav
FINDINGS: Exam under anesthesia, 5 cm mass palpated in the posterior cul-de-sac. Small mobile uterus intraop. Normal appearing uterus. Left fallopian tube and ovary, 5 cm right simple paratubal cyst with clear fluid _____ 2 cm left ovarian mass shelled out in full. Left ovarian bed with good hemostasis noted. Normal appearing appendix in upper abdominal survey.
** • are you sure about this line?: Normal appearing appendix in upper abdominal survey. - poi
Fri Jul 29 01:14:15 2016 poi

** • contents resected. Two centimeter + imo-poi
Fri Jul 29 01:07:38 2016 imo-poi
she just corrected out the word *intact*
**** • Thanks a lot. Thanks for the correction. - guy
Fri Jul 29 01:10:58 2016 guy


• The reconstruction plate was noted to have extensive bony overgrowth a ...
+ wav
Fri Jul 29 00:01:25 2016 wav
The reconstruction plate was noted to have extensive bony overgrowth and was removed using _____ fissure bur and Stryker Core and osteotome in increasing sequential size. The mandible was noted to be intact in the proximal and distal segments _____ once the reconstruction plate was removed.
** • 1. 701 2. without fracture - poi
Fri Jul 29 00:05:27 2016 poi

** • Old WAV still there. - Questyr
Fri Jul 29 00:03:48 2016 Questyr

**** • Thanks a lot everybody - guy
Fri Jul 29 00:08:27 2016 guy


• Using a marking pen, a planned surgical incision was made **approximat ...
+ mp3
Thu Jul 28 23:39:01 2016 mp3
Using a marking pen, a planned surgical incision was made **approximately from the right cervical neck to centimeters** below the right earlobe extending anteriorly through her existing cervical scar crossing the midline and ending in the region of the left submandibular region.
** • cervical neck, 2 cm below the - poi
Thu Jul 28 23:49:02 2016 poi

**** • Thanks a lot. - guy
Thu Jul 28 23:50:11 2016 guy


• The patient states for several weeks he has been having abdominal pain. This sm
+ wav :)
Thu Jul 28 23:13:01 2016 wav :)
happens about every 2 hours or so without a lot of __________ aggravating or alleviating factors, it is just pains in various areas of his abdomen not consistent, lasts a few minutes and will resolve spontaneously.
** • Thanks poi. I already sent it in. - :)
Fri Jul 29 01:18:07 2016 :)

** • viable? - poi
Thu Jul 28 23:50:40 2016 poi


• The next loop of bowel was measured to be 14 cm before the next circum ...
+ wav
Thu Jul 28 22:49:15 2016 wav
The next loop of bowel was measured to be 14 cm before the next circumferential area of necrosis. The distal end of this loop was left open for _____ and a small area of ileum was resected and sent as specimen.
** • ostomy placement - MTmom
Thu Jul 28 22:54:18 2016 MTmom

**** • Thanks a lot. - guy
Thu Jul 28 22:55:25 2016 guy


• The lens was centered and bimanual irrigation and aspiration was used ...
+ wav
Thu Jul 28 22:08:16 2016 wav
The lens was centered and bimanual irrigation and aspiration was used to remove any residual viscoelastic material. _____ Miochol was injected into the anterior chamber and all wounds were inspected and found to be watertight.
** • Prefiltered - MTmom
Thu Jul 28 22:26:47 2016 MTmom

**** • Thanks a lot. - guy
Thu Jul 28 22:29:42 2016 guy


• In addition to those risks there is also the risk that this wound may ...
+ wav
Thu Jul 28 21:34:15 2016 wav
In addition to those risks there is also the risk that this wound may again break down and for this reason, we opted for full-thickness skin grafting with the possible backup of a cross-finger flap. However, the concern with the cross-finger flap is that this is almost a _____ effort to provide coverage for _____ skin.
** • #1 last ditch #2 volar ("last ditch effort" is an idiom) - taco
Thu Jul 28 21:36:53 2016 taco

**** • correction: last-ditch effort (should be hyphenated) - t
Thu Jul 28 21:37:46 2016 t

****** • Actually, no hyphen is required (at least not now I think) since + Questyr
Thu Jul 28 21:42:46 2016 Questyr
Merriam Webster lists "last ditch" as a noun. So "last ditch effort" makes "last ditch" a noun modifier. It would fall into the same category as "high school band".
******** • my Webster's New World (3rd College Edition) has "last-ditch" with a hyphen. + but whatever...t
Fri Jul 29 09:09:50 2016 but whatever...t
Don't want to argue about it, but I think it is a little bit strong to say "no hyphen is required." It looks to me like the hyphen is pretty commonly used and acceptable. In any case, it has absolutely no effect on patient care, so I'm not sure why you felt like my answer needed correcting.
********** • Sorry, I wasn't trying to correct you. I thought I was just + Q
Fri Jul 29 12:33:09 2016 Q
adding support to your "first instinct" when you typed it without a hyphen. And I'm sorry if my message came across as "a little bit strong." It was not intentional.
************ • Well, I corrected myself because I thought my first instinct was wrong. + t
Fri Jul 29 13:02:40 2016 t
So I saw it more like you were contradicting my final/revised answer rather than "adding support" to the answer I changed my mind about... and it didn't really matter one way or the other. I'm probably just being a little oversensitive. I shouldn't have mentioned it at all. I know you were just trying to be helpful and meant no offense. Have a good day, Q.
************** • Thanks. m glad we're OK. - Q
Fri Jul 29 14:10:25 2016 Q

******** • Thanks. :-) - guy
Thu Jul 28 21:48:16 2016 guy

****** • Thanks a lot. - guy
Thu Jul 28 21:40:51 2016 guy


• Should 'foot' be edited to 'feet'?
+ l g n k n g
Thu Jul 28 20:41:39 2016 l g n k n g
longstanding history of left knee pain dating from a fall off a 60-foot wall
** • sounds awful tall to me. - billybob
Thu Jul 28 20:57:32 2016 billybob

**** • Not too tall for Trump to build it along the border and make Mexico pay for it! - hahahaha
Thu Jul 28 21:39:12 2016 hahahaha

** • foot wins a google-off 9700 to 3200. I would not change it + imo-poi
Thu Jul 28 20:54:09 2016 imo-poi
though I am sure Q can come up with a better *why* than my goggle-off :)
**** • yep (just like we say 10-year-old not 10-years-old) but I don't know the reason why either - fwiw-taco
Thu Jul 28 21:35:33 2016 fwiw-taco


• The patient is a 15-month-old ex-30-week male twin, seen at pediatric ...
+ wav
Thu Jul 28 20:13:41 2016 wav
The patient is a 15-month-old ex-30-week male twin, seen at pediatric surgery clinic for elective circumcision. The patient _____ born as a stat C-section for maternal abruption and remained in the NICU for a total of 30 days for respiratory distress and hyperbilirubinemia.
** • was initially - Questyr
Thu Jul 28 20:18:53 2016 Questyr

**** • Thanks a lot. - guy
Thu Jul 28 20:19:12 2016 guy


• We irrigated and once we had removed all the necrotic tissue, we then ...
+ wav
Thu Jul 28 19:58:37 2016 wav
We irrigated and once we had removed all the necrotic tissue, we then placed a VAC. A small VAC _____ placed in its entirety and hooked to suction.
** • line. - billybob
Thu Jul 28 20:03:25 2016 billybob

**** • Thanks a lot. - guy
Thu Jul 28 20:13:18 2016 guy


• Deep ______ were made into the left base of tongue
+ mp3 posted
Thu Jul 28 19:48:36 2016 mp3 posted
Using large upbiting cupped forceps, multiple areas on the left base of tongue were biopsied. Deep ________ were made into the left base of tongue to get deep tissue, all submitted fresh, immediately to be taken to the pathologist.
** • cores - poi
Thu Jul 28 19:49:55 2016 poi

**** • Thanks, poi! - mp3 posted
Thu Jul 28 20:11:29 2016 mp3 posted


• She has since gone out to a nursing home and has done well, but return ...
+ wav
Thu Jul 28 19:47:48 2016 wav
She has since gone out to a nursing home and has done well, but returns now with a new third nerve palsy. Her _____ CT scan of the chest which demonstrated some residual necrotic tissue in the wound and therefore she presents for debridement.
** • As part of her workup here, she also got a - poi
Thu Jul 28 19:49:22 2016 poi

**** • Thanks a lot. - guy
Thu Jul 28 19:51:35 2016 guy


• doctor is spelling medication - tiricay or diricay. Cannot verify.
+ tia
Thu Jul 28 18:40:02 2016 tia
PMH: hypertension, PVCs, HIV, gout, depression
** • Tivicay? - Oasis
Thu Jul 28 18:57:08 2016 Oasis

**** • Thanks Oasis! - OP
Thu Jul 28 19:10:07 2016 OP


• Dental fluid collection
+ b o h b c p
Thu Jul 28 15:46:12 2016 b o h b c p
Radiographic examination showed a rim-enhancing fluid collection of the right lateral pharyngeal "mentegra," mandibular, and submandibular spaces
** • pterygomandibular - Got it
Thu Jul 28 15:55:13 2016 Got it


• Pantoprazole, __________, Cymbalta, vitamin D.
- mp3 posted
Thu Jul 28 15:38:56 2016 mp3 posted

** • colace, ____ - isgal
Thu Jul 28 15:41:25 2016 isgal

**** • thanks for trying isgal. I *think* I am hearing cholesterol medicine?? - OP
Thu Jul 28 15:45:50 2016 OP

****** • I hear "cholest... " could be "cholesterol medicine" or maybe CholestOff? or... + t
Thu Jul 28 15:48:57 2016 t
there's another one that sounds similar to that but I can't remember it and can't find it in archives, sorry.
******** • thanks taco. Going to use CholestOff and slap a Post-it on it - OP
Thu Jul 28 16:18:31 2016 OP


• each of these areas was *lesioned* for minute and a half at 80-degree centigrade
+ ok?
Thu Jul 28 14:31:39 2016 ok?
Oblique and lateral views of fluoroscope were further utilized. Subsequently, each of these areas was *lesioned* for minute and a half at 80-degree centigrade after the instillation of 1 cc of 0.5% Marcaine and 20 mg of Kenalog. The needle was withdrawn, flushed with lidocaine and removed. The patient tolerated the procedure very well. There were no complications.
** • I'd let 'em have it - the meaning is clear (created a lesion=lesioned) - t
Thu Jul 28 14:35:42 2016 t

**** • ok thanks - -
Thu Jul 28 14:42:36 2016 -


• 10 mm active curve *rit* needle
+ ?
Thu Jul 28 14:28:21 2016 ?
After obtaining consent and explaining the risks and benefits of the procedure with the patient lying in the prone position, the L3-L4 facet joint on the right as well as the left L4-L5 on the right as well as the left, L5-S1 sacra ala on the right as well as left were visualized with the use of fluoroscope. Subsequently, after adequate sterile prep and drape and adequate local anesthesia, a 20-gauge 10-cm 10 mm active curve *rit* needle was advanced to make bony contact at the junction of superior articulating process of the transverse process. Subsequently, motor and sensory testing was performed at each of these levels.
** • curved tip? - wag
Thu Jul 28 14:38:47 2016 wag

**** • will try - thx
Thu Jul 28 14:42:25 2016 thx


• Is she saying every 2-4 hours or every 3-4 hours?
- mp3
Thu Jul 28 14:27:18 2016 mp3

** • I hear 2 to 4 - fwiw-poi
Thu Jul 28 14:35:10 2016 fwiw-poi




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