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Feb 24 21:07
• : I am now recommending the application of a dry s/l ABD dressing dail ...
+ o g g i n f
Sun Feb 25 06:09:37 2018 o g g i n f
: I am now recommending the application of a dry s/l ABD dressing daily at the scrotum.
** • yep, a dressing using ABD pads. - vtv
Sun Feb 25 06:26:40 2018 vtv


• I am now recommending the application of a dry s/l ABD dressing daily ...
+ o g g i n f
Sun Feb 25 06:03:41 2018 o g g i n f
I am now recommending the application of a dry s/l ABD dressing daily at the scrotum.

• I did review the strips on telemetry as well as the serial EKGs and his ____ recorder
+ g j g m d p
Sat Feb 24 16:00:05 2018 g j g m d p
s/l link, definitely not saying loop
** • LINQ - taco
Sat Feb 24 16:08:47 2018 taco

**** • Thanks a bunch! - g j g m d p
Sat Feb 24 16:11:19 2018 g j g m d p


• CSS or CSF
+ b o c d l d
Sat Feb 24 13:16:17 2018 b o c d l d
At L3-4, there is a broad-based osteophyte disk ridge complex facing both anterior and posterior *s/l CSF or CSS* space with midline AP canal diameter of 1.1 cm.
** • Oh wow, thanks! - b o c d l d
Sat Feb 24 19:05:57 2018 b o c d l d

** • effacing (not facing) and CSF (cerebrospinal fluid) space - poi
Sat Feb 24 14:42:21 2018 poi


• a fib arising from the left superior pulmonary vein s/l which with a fib TIA!
+ card?
Sat Feb 24 07:47:37 2018 card?
The patient had atrial fibrillation arising from the left superior pulmonary vein ________ with atrial fibrillation terminated after ablating in the left superior pulmonary vein ________ area.
** • Could it be ridge? - hmm
Sat Feb 24 20:33:54 2018 hmm

** • Doesn't make sense to me. I'd have to hear it. - Questyr
Sat Feb 24 12:18:37 2018 Questyr


• born post dates and developed some s/l poor-toe and had hypoglycemia TIA!
+ peds?
Fri Feb 23 19:27:39 2018 peds?
BIRTH HISTORY: Patient was born post dates and developed some s/l poor-toe________ and had hypoglycemia after birth and was kept in the hospital for several days for sepsis rule out, which was negative.
** • poor tone? google:Other symptoms of sepsis in newborns and infants include:decreased tone + poi
Fri Feb 23 20:02:24 2018 poi
(floppiness)

• Focal **lateral** right eye and Focal s/l*PMP or P and P** right eye.
+ SM
Fri Feb 23 16:42:06 2018 SM
I don't have much to go on as he is doing medical records review...

Focal **lateral** right eye. Treatment plan: Focal PMP right eye.
** • Do you have a diagnosis? - nm
Fri Feb 23 17:45:35 2018 nm


• After this, the remaining attachments to the uterus were taken down wi ...
+ mp3
Fri Feb 23 16:07:15 2018 mp3
After this, the remaining attachments to the uterus were taken down with the LigaSure until the uterus was safely removed and passed off the field. Attention was then turned to the salpingectomy. The patient was placed in Trendelenburg and the bowel was packed away. The ovaries were not well visualized, so the fallopian tubes were grasped with Babcock and _____ with the LigaSure device and sent off as separate specimen. There was no bowel injury noted.
** • never mind. Thanks to anyone who tried. - a e c m k o
Fri Feb 23 16:36:58 2018 a e c m k o


• Preoperative Diagnosis: PELVIC ORGAN PROLAPSE. Procedure: ...
+ wav
Fri Feb 23 15:48:44 2018 wav
Preoperative Diagnosis:
PELVIC ORGAN PROLAPSE.

Procedure:
TRANSVAGINAL HYSTERECTOMY, BILATERAL SALPINGO-OOPHORECTOMY, _____, MIDURETHRAL SLING PLACEMENT, AND CYSTOSCOPY.

Postoperative Diagnosis:
PELVIC ORGAN PROLAPSE.

ANESTHESIA: General.

SURGERY START TIME: 1313

SURGERY END TIME: 1506

FINDINGS: Postmenopausal uterus. _____ at conclusion of case.

SPECIMENS: Uterus, bilateral fallopian tubes.

IMPLANTS: _____ sling.

IS AND OS: 1500 IV fluids. Urine output, not recorded.

** • never mind. Thanks to anyone who tried. - a e c m k o
Fri Feb 23 16:36:52 2018 a e c m k o


• The dragon boat "coccyn" had given her a Kleenex (during a dragon boat race)
+ tia
Fri Feb 23 13:50:28 2018 tia
He spells this but having trouble verifying. Any ideas what he means?
** • found it I think - coxswain - op
Fri Feb 23 13:51:21 2018 op


• Dislocated posterior chamber intraocular lens in the bag, in the right eye
+ p g d e l l
Fri Feb 23 11:45:16 2018 p g d e l l
Patient is status post "DMICK"

** • DMEK - p g d e l l
Fri Feb 23 11:55:40 2018 p g d e l l


• but got side effects of dry mouth and __ without restless leg
+ WAV
Fri Feb 23 11:34:26 2018 WAV
She did try some amitriptyline just to help with sleep and some aspects of pain but got side effects of dry mouth and __ without restless leg
** • anyone have a guess? - help please??
Fri Feb 23 11:55:10 2018 help please??


• Preoperative Diagnosis: CHOLELITHIASIS, HISTORY OF MARGINAL ULCERS. ...
+ wav
Fri Feb 23 00:58:14 2018 wav
Preoperative Diagnosis:
CHOLELITHIASIS, HISTORY OF MARGINAL ULCERS.

Procedure:
LAPAROSCOPIC CHOLECYSTECTOMY, INTRAOPERATIVE CHOLANGIOGRAM, AND ESOPHAGOGASTRODUODENOSCOPY (EGD).

FINDINGS: Non-inflamed gallbladder, critical view of safety was obtained. IOC showed normal filling of CBD and duodenum, and proximal hepatic biliary radicals bilaterally. EGD showed no definitive ulcers. The _____ and gastric pouch mucosa were normal. There was questionable outpouching in the proximal Roux limb, but it was unclear if this represented a clean-based ulcer.
** • Just a guess, can't really document: PJ (pyloric junction)? - mn
Fri Feb 23 08:26:02 2018 mn

**** • Thanks a lot. - guy
Fri Feb 23 15:49:31 2018 guy


• Preoperative Diagnosis: CATARACT, RIGHT EYE. Procedure: C ...
+ wav
Thu Feb 22 21:22:42 2018 wav
Preoperative Diagnosis:
CATARACT, RIGHT EYE.

Procedure:
CATARACT EXTRACTION WITH INTRAOCULAR LENS PLACEMENT, RIGHT EYE.

After obtaining informed consent from the patient, a drop of tetracaine was instilled in the right eye and the 90 and 180 degrees _____ were marked in the holding. The patient was then brought into the operating room and a surgical time-out was performed.
** • haptics? - mn
Thu Feb 22 21:51:06 2018 mn

**** • Thanks a lot. - guy
Fri Feb 23 00:57:53 2018 guy


• Phosphorus is high. s/l in-fuh-gel will be prescribed. TIA!
+ med?
Thu Feb 22 20:34:15 2018 med?
Phosphorus is high. s/l in-fuh-gel will be prescribed. Additional supplementation will be evaluated.
** • Amphogel. - mn
Thu Feb 22 21:14:11 2018 mn

**** • Thanks! - OP
Thu Feb 22 21:54:47 2018 OP


• The IMA was also identified and preserved. We then again surveyed our ...
+ mp4
Thu Feb 22 17:55:10 2018 mp4
The IMA was also identified and preserved. We then again surveyed our resection bed having completed our bilateral template to assess for hemostasis and lymphatic control to avoid _____. One area of lymphatic drainage was clipped in addition. Once hemostasis was confirmed,
** • never mind. Thanks to anyone who tried. - guy
Thu Feb 22 18:23:54 2018 guy


• The procedure then began with entry into the abdomen. We first attemp ...
+ mp3
Thu Feb 22 17:37:11 2018 mp3
The procedure then began with entry into the abdomen. We first attempted a Veress needle entry lateral and inferior to the umbilicus. However, with adequate insufflation, we were unable to pass the robotic trocar due to the patient _____. We then made our incision for our assistant port in the right lower quadrant and using the Hasson technique, entered into the peritoneal cavity.
** • due to the patient's ___ pressure? - billybob
Thu Feb 22 18:50:33 2018 billybob

** • all I can get is "due to the patient's ______" - Questyr
Thu Feb 22 17:44:49 2018 Questyr

**** • Thanks for the effort. - guy
Thu Feb 22 17:45:56 2018 guy

****** • I hear: ...due to the patient's very strong pressure. - mn
Thu Feb 22 19:45:44 2018 mn


• The patient is a 20-year-old, found to have stage 2A nonseminoma germ ...
+ wav
Thu Feb 22 17:21:30 2018 wav
The patient is a 20-year-old, found to have stage 2A nonseminoma germ cell tumor after a right radical orchiectomy in December 2017. The patient was found to have equivocal nodes, less than 1 cm, on post orchiectomy imaging with normalization of tumor margins. After discussion at tumor board, decision was made to proceed with primary RPLND for surgical management of disease. Risks and benefits including a lack of _____ and callus ascites were discussed with the patient who expressed understanding and wished to proceed.
** • never mind. Thanks to anyone who tried. - guy
Thu Feb 22 18:23:45 2018 guy


• SPECIMENS: Right common iliac nodes, right paracaval nodes, right gon ...
+ mp3
Thu Feb 22 17:13:49 2018 mp3
SPECIMENS: Right common iliac nodes, right paracaval nodes, right gonadal nodes, right perihilar nodes, intraaortic caval nodes, _____ ureteral perihilar left nodes, left iliac nodes, and aortocaval #2 nodes and right spermatic cords, sent as seven specimens.

should i number them?
** • Could she be saying ? paraaortic plaque??? And I wouldn't number them since she didn't - Questyr
Thu Feb 22 17:32:36 2018 Questyr

**** • Thanks a lot. - guy
Thu Feb 22 17:35:51 2018 guy


• Preoperative Diagnosis: TESTICULAR CANCER. Procedure: ROB ...
+ wav
Thu Feb 22 17:09:23 2018 wav
Preoperative Diagnosis:
TESTICULAR CANCER.

Procedure:
ROBOTIC RETROPERITONEAL LYMPH NODE DISSECTION BILATERAL.

SURGERY START TIME: _____

SURGERY END TIME: 1800

FINDINGS: _____

SPECIMENS:
** • FINDINGS: No grossly positive nodes. - taco
Thu Feb 22 17:11:24 2018 taco

**** • Thanks a lot. - guy
Thu Feb 22 17:14:07 2018 guy


• Injection
+ p g d e l l
Thu Feb 22 12:06:02 2018 p g d e l l
Erythropoietin alfa 10,000 units IV "OCD"
** • Doctor has misspoken...the injectible is Epoetin Alfa .erythropoietin is the protein in + Questyr
Thu Feb 22 17:42:45 2018 Questyr
the body (see link)
**** • but check whether it needs to be capped or not - Q
Thu Feb 22 17:46:21 2018 Q


• both polypectomy sites were bleeding and we provided ___with clipping to stop it.
+ WAV
Thu Feb 22 11:28:44 2018 WAV
At that site both polypectomy sites were bleeding and we provided ___with clipping to stop it.
** • sclerotherapy? - taco
Thu Feb 22 12:36:04 2018 taco

** • I hear something like "scrub___ therapeutic clipping" - nm
Thu Feb 22 11:41:35 2018 nm

**** • thanks for trying nm! - .
Thu Feb 22 11:56:30 2018 .

** • anyone help please!!!!???? - ???
Thu Feb 22 11:39:18 2018 ???


• level 1 Delta VP shunt or level I Delta VP shunt?
- shunt
Thu Feb 22 11:06:18 2018 shunt

** • level 1 - nm
Thu Feb 22 14:10:13 2018 nm

**** • ... - thanks
Thu Feb 22 17:29:58 2018 thanks


• vagovagal syncope. Is this okay? Or should I change it to vasovagal? There are a few
+ tia
Thu Feb 22 10:51:25 2018 tia
hits on Google but not sure how reliable.
** • You need to look at the context + sm
Thu Feb 22 14:17:47 2018 sm
It's most likely vasovagal syncope. Vagovagal is quite rare; I have never encountered it in 25 years. Is there esophageal spasm or syncope after swallowing?
**** • no idea--this was mentioned in the PMH. thanks - op
Thu Feb 22 17:30:28 2018 op

****** • And what else was in the PMH? What is pt being seen for and by whom? + sm
Fri Feb 23 08:21:21 2018 sm
There's always context to draw from. In the absence of meaningful info, vasovagal is most likely.

• Ortho help please: bone contusion to the acromion versus ??
+ cmd
Thu Feb 22 09:31:48 2018 cmd
MRI of the left shoulder showed subacromial and subdeltoid bursitis, supraspinatus tendinosis, and a bone contusion to the acromion versus ??osseocrominel?? Thanks in advance for any help.
** • os acromiale? - this?
Thu Feb 22 09:46:22 2018 this?

**** • Yes! Thank you. I am new to ortho. :) - CMD
Thu Feb 22 09:55:40 2018 CMD


• FINDINGS: Exam under anesthesia: Mobile, 16-week size anteverted ute ...
+ wav
Wed Feb 21 22:33:23 2018 wav
FINDINGS: Exam under anesthesia: Mobile, 16-week size anteverted uterus. Intraop: Enlarged adenomyotic uterus, otherwise normal appearing anatomy including bilateral fallopian tubes, ovaries, _____. Cystoscopy: Bilateral jets seen from ureteral orifices.
** • never mind. Thanks to anyone who tried. - guy
Thu Feb 22 00:01:28 2018 guy

**** • i need to stop reading so fast. I saw "anyone who lied" I'm going back to bed. - b o l b o m
Thu Feb 22 04:41:44 2018 b o l b o m


• schedule this upon receipt of his ascent. Def. does not match meaning. How do I
+ spell?
Wed Feb 21 19:35:27 2018 spell?
. He is going to think about it for a day or two, but he drinks he wishes to proceed. We will schedule this upon receipt of his ascent.
** • He drinks he wishes to proceed? I think you have a typo there. - isgal
Thu Feb 22 11:01:10 2018 isgal

** • It's assent! Should have known - spell?
Wed Feb 21 19:39:23 2018 spell?


• Procedures: 1. TOTAL THYROIDECTOMY. 2. AUTOTRANSPLANTATION LEF ...
+ wav
Wed Feb 21 18:21:57 2018 wav
Procedures:
1. TOTAL THYROIDECTOMY.
2. AUTOTRANSPLANTATION LEFT SUPERIOR PARATHYROID.

Next, the middle thyroid vein was divided and the recurrent laryngeal nerve was identified. The remainder of the right thyroid lobe was then fully mobilized after the inferior pole vessels were divided and Berrys ligaments were _____.
** • ???separated??? - Questyr
Wed Feb 21 18:24:35 2018 Questyr

**** • Thanks a lot. - guy
Wed Feb 21 18:26:06 2018 guy


• Procedure: REMOVAL OF LEFT DISTAL INTERLOCKING SCREW. A smal ...
+ mp3
Wed Feb 21 17:44:17 2018 mp3
Procedure:
REMOVAL OF LEFT DISTAL INTERLOCKING SCREW.

A small incision was made with a #15 blade. The fibers of the IT band were incised longitudinally. Hemostasis was achieved with Bovie electrocautery. The screw was easily palpated through the wound and the screwdriver was easily removed from the distal aspect of the _____ was removed easily. Final fluoros demonstrated that it was removed without complication.
** • of the wound. The ____ of the screw was removed - billybob
Wed Feb 21 17:59:49 2018 billybob

**** • Thanks a lot. Thanks for the correction. - guy
Wed Feb 21 18:21:40 2018 guy


• The retina was flat _____ for 360 degrees.
+ wav
Wed Feb 21 17:36:03 2018 wav
Peripheral retinal inspection was performed. 360 degrees of corneoretinal scarring was noted secondary to his previous trauma. No retinal breaks were identified. The retina was flat _____ for 360 degrees. A partial air/fluid exchange was performed.
** • ... - wav deleted
Wed Feb 21 17:49:35 2018 wav deleted


• plastic surgery s/l quad left or lift ?
+ sm
Wed Feb 21 15:19:18 2018 sm
mini brachioplasty 2014, s/l quad left with revision rhinoplasty
** • Looks like it might be quad lift ....see link + Questyr
Wed Feb 21 18:29:34 2018 Questyr
link

• echo results
+ sm
Wed Feb 21 14:04:34 2018 sm
His echogram shows the previously noted severe aortic incompetence and the MRI indicates that his left ventricular and systolic dimensions are increasing slightly and is now just 2/4 s/l shond beats.
** • It's echocardiogram. It's left ventricular end-systolic dimensions + sm
Thu Feb 22 14:38:41 2018 sm
What's 2/4? Are they saying "two four?" "Two slash four?"

I have a feeling that "shond beats" might be centimeters (often pronounced "sontimeters."

If the dimension is increasing slightly, "now just" doesn't make sense. Listen for "now measures."

• Hypotony in the right eye.
+ ESL, yes
Wed Feb 21 13:39:45 2018 ESL, yes
Lid speculum was then placed to provide good exposure. Lidocaine gel was then given "Nvia blade," the lid speculum was then placed. "Nvia blade" was then used to create a paracenteses.
** • You might be hearing "MVR blade" (see link) + Questyr
Wed Feb 21 18:36:01 2018 Questyr
link

• Thank you.
+ wav posted
Wed Feb 21 13:16:00 2018 wav posted
We followed down the distal forearm fascia ________ The longus tendon was distracted radially out of the field. We incised the distal forearm fascia, identifying the flexor tendons and the median nerve below. The elevator instrument was used to free ________ transverse carpal ligament.
** • ... - wav deleted
Wed Feb 21 15:37:48 2018 wav deleted


• ...persistent symptoms noted on the right side as her ______ are _______. ..
+ mp3 posted
Wed Feb 21 13:10:19 2018 mp3 posted
have bilateral carpal tunnel syndrome, confirmed again on EMG, with persistent symptoms noted on the right side as her ______ are _______.
** • Hi. Still waiting if anyone can help. Thanks - mp3 posted
Wed Feb 21 14:55:28 2018 mp3 posted

**** • ... - mp3 deleted
Wed Feb 21 15:37:33 2018 mp3 deleted


• **Q and 3** sinus rhythm
+ ?
Wed Feb 21 12:30:56 2018 ?
Exam per hospitalist was essentially unremarkable.

EKG probable old inferior infarct with Q and 3 sinus rhythm.
** • Q in 3 (Q wave in lead 3) - taco
Wed Feb 21 12:48:18 2018 taco

** • flagging - -
Wed Feb 21 12:40:20 2018 -


• Thank you for referring ** to the __ Clinic today
+ WAV
Wed Feb 21 11:43:52 2018 WAV
Thank you for referring ** to the __ Clinic today
** • HPB Clinic - dt
Wed Feb 21 11:45:28 2018 dt


• gastroscopy in October 2017 ____ showed severe erosive esophagitis.
+ WAV
Wed Feb 21 11:31:22 2018 WAV
His most recent gastroscopy in October 2017 ____ showed severe erosive esophagitis.

• AICD implantation, *mem* insertion monitoring
+ ?
Wed Feb 21 08:13:43 2018 ?
REASON FOR CONSULTATION: Renal insufficiency and hyperkalemia.

The patient is a 73-year-old white male with a history of diabetes, hypertension, coronary artery disease, congestive heart failure, prior angioplasty and stent, AICD implantation, _____ insertion monitoring, history of BPH with prior urinary tract infections, status post bilateral cataract resection, epistaxis in the past, hyperlipidemia, peripheral vascular disease, chronic kidney disease followed by us office, who was admitted to the hospital with apparent change in mental status and fever, chills, and sweats with nausea since yesterday. It appears as if he has a urinary tract infection. He had cardiac cath in the past in 2004, had a 100% mid LAD lesion and circ and right coronary artery collaterals and right PDA to LAD collateral. Left main was 45%. He has had cholecystectomy in the past. Rib removal in the past, left knee surgery with a plate, and a peripheral artery stent graft. The patient is a former s
** • flagging - -
Wed Feb 21 09:05:05 2018 -


• composite mesh implant _____ FT
- wav :)
Wed Feb 21 03:00:44 2018 wav :)


• The patient is a 69-year-old patient with rheumatoid arthritis. The p ...
+ mp3
Wed Feb 21 01:33:00 2018 mp3
The patient is a 69-year-old patient with rheumatoid arthritis. The patient was seen in clinic and examined. The patient complained of pain and clicking in her right long and ring fingers. The pain was increased with finger flexion and the patient complained also of being unable to fully close her fingers. The patient was already seen in _____ clinic and received a Kenalog injection for the trigger finger, however no improvement in the symptoms was seen. Upon examination, the patient had triggering at the level of the A1 pulley. No skin changes were seen at this point. The patient was consented for the tenosynovectomy of the right long and ring fingers with preservation of the A1 pulleys to avoid an ulnar drift.
** • never mind. Thanks to anyone who tried. - guy
Wed Feb 21 01:48:20 2018 guy


• I exposed the fracture. I _____ debrided with a ronguer _____ bone. sm
+ wav :) sm blank
Wed Feb 21 00:51:46 2018 wav :) sm blank
The skin was somewhat macerated. However, _____ appeared to be _____ viable.
** • I m hearing + guy
Wed Feb 21 01:02:36 2018 guy
I debrided with a rongeur glottic bone....the areas appeared to be____
**** • Thanks. He sounds so muffled. - :)
Wed Feb 21 01:18:35 2018 :)


• Preoperative Diagnosis: RIGHT LONG AND RING TRIGGER FINGERS. ...
+ wav
Wed Feb 21 00:46:58 2018 wav
Preoperative Diagnosis:
RIGHT LONG AND RING TRIGGER FINGERS.

Procedure:
TENOSYNOVECTOMY, RIGHT LONG AND RING FINGERS.

ANESTHESIA: Infraclavicular block.

ESTIMATED BLOOD LOSS: Minimal.

SPECIMENS: None.

ANTIBIOTICS: _____ IV.

DVT PROPHYLAXIS: None.

** • Clindamycin - :)
Wed Feb 21 00:49:16 2018 :)

**** • Thanks a lot. - guy
Wed Feb 21 01:00:26 2018 guy


• anti modules antibodies, anticoagulant antibodies ...
+ b g c n p g
Tue Feb 20 20:47:10 2018 b g c n p g
anti modules antibodies, anticoagulant antibodies
** • can you hear "antinuclear antibodies?" + sm
Tue Feb 20 21:23:23 2018 sm
Diagnosis and/or surrounding sentences would help.

• placed in the supine position. s/l SUG devices were placed.
- tx
Tue Feb 20 19:50:29 2018 tx

** • SCD - mn
Tue Feb 20 20:27:46 2018 mn

**** • sequential compression device - mn
Tue Feb 20 20:28:59 2018 mn


• Preoperative Diagnosis: LEFT CHEEK CYST. Procedure: EXCIS ...
+ wav
Tue Feb 20 17:02:37 2018 wav
Preoperative Diagnosis:
LEFT CHEEK CYST.

Procedure:
EXCISION OF LEFT CHEEK CYST.

INDICATIONS: This is a 54-year-old female with no past medical history who presents for _____ requesting left cheek cyst removal. The patient states
** • presents to ____ derm clinic (name of the clinic?) - taco
Tue Feb 20 17:09:51 2018 taco

**** • maybe Fordham Derm(atology) Clinic? - t
Tue Feb 20 17:11:23 2018 t

****** • or maybe he is saying "referred from" or "on referral from" derm clinic? - t
Tue Feb 20 17:12:19 2018 t

****** • Thanks a lot. - guy
Tue Feb 20 17:11:54 2018 guy


• ..with radiculopathy with ______ stenosis at L3-4..
+ mp3 posted
Tue Feb 20 14:56:09 2018 mp3 posted
The patient had a previous L4-5 fusion, now presents with radiculopathy with ______ stenosis at L3-4, brought to the procedure room for epidural steroid injection.
** • I hear: referable to stenosis at L3-4 - mn
Tue Feb 20 15:25:52 2018 mn

**** • ...now presents with radiculopathy referable to stenosis.... - mn
Tue Feb 20 15:34:46 2018 mn

****** • I agree - I take back my previous answer. mn is correct. - taco
Tue Feb 20 15:36:55 2018 taco

******** • Thanks so much, both of you. I thought it was foraminal. - mp3 posted
Tue Feb 20 17:10:11 2018 mp3 posted

** • foraminal ? - taco
Tue Feb 20 15:09:58 2018 taco


• question about hip component, pls sm
+ nt
Tue Feb 20 14:39:27 2018 nt
Stryker Secur-Fit standard offset stem size 8, standard offset with a 36 +5 head.

My question: Does "standard offset" refer to both the stem and the head, or is doc repeating himself on the standard offset referring to the stem here?
** • This article (page 4, column 2, 2nd paragraph) makes use of the + Questyr
Wed Feb 21 00:11:52 2018 Questyr
term offset talking both about the neck and further down the paragraph talking about the head

• can versus cannot...sm
+ sm
Tue Feb 20 13:47:14 2018 sm
If they want to start another biologic, we would need to discuss as we s/l can't give 2 biologics together in combination.

not sure if saying can or can't give 2 biologics together
** • agree with "can't" + sm
Tue Feb 20 15:53:21 2018 sm
link
** • Just from context would guess "can't," but we're not hearing what you can hear - CO MT
Tue Feb 20 14:00:48 2018 CO MT


• help with commas, plse sm for sentence.
+ nt
Tue Feb 20 13:38:21 2018 nt
Not sure if I am overdoing it here or not:

He was accompanied by his wife, Ann and John, his son, for further collateral history.

(Not allowed to put comma before "and" on this account).
** • See link...apparently you can get away without the + Questyr
Wed Feb 21 00:22:47 2018 Questyr
comma following the word "wife"....but you do need the one following the word "John". See link, item 4, paragraph which starts with the word "Sometime"
**** • My typo...See link, item 4, in the paragraph starting with the word "Sometimes" - Q
Wed Feb 21 00:23:52 2018 Q

** • I would think this is an exception to the rule... + sm
Tue Feb 20 13:56:54 2018 sm
but if you are really worried about being dinged for using a comma between "Ann" and "and" I would omit the comma also between "wife" and "Ann" - as the commas would be for the purpose of setting of "Ann" and if you can't use the closing comma, you shouldn't use the opening comma.
**** • Okay, thanks for your great input. Have a good day. - nt
Tue Feb 20 14:05:58 2018 nt


• her mother reported that ___ had been complaining about regularly had essentially dis
+ WAV
Tue Feb 20 12:39:22 2018 WAV
On her second review, her mother reported that ___ had been complaining about regularly had essentially disappeared
** • her stomach pains that she - taco
Tue Feb 20 12:45:12 2018 taco

**** • taco, you rock! Thank you!!!! - :)
Tue Feb 20 12:51:34 2018 :)


• allbladder was grasped with the fundus at the *D & D* from the lateral port
+ ?
Tue Feb 20 12:07:17 2018 ?
The patient was placed in Trendelenburg with the right side up and the gallbladder was grasped with the fundus at the D&D from the lateral port and at the infundibulum from the lateral port and retracted laterally to obtain the critical view.
** • flagged - -
Tue Feb 20 13:32:38 2018 -


• he will get along better with a male practitioner, so I have suggested ___ at ___psyc
+ WAV
Tue Feb 20 12:00:01 2018 WAV
They could also do further educational testing that is required. His mother reports that she thinks he will get along better with a male practitioner, so I have suggested ___ at ___psychology.

Location is VIC Australia
** • flagged - .
Tue Feb 20 12:03:04 2018 .


• Based on these she recommended continued IEP, _____ his communication, speech issues.
- wav :)
Tue Feb 20 00:51:02 2018 wav :)

** • for students with communication... - billybob
Tue Feb 20 01:10:35 2018 billybob

** • I still get old WAV. - nm
Tue Feb 20 01:02:11 2018 nm

**** • It's there now. I had to refresh my page to get it. - :)
Tue Feb 20 01:08:34 2018 :)


• Lack of recognition of social boundaries, being _____ , decreased food sm
+ wav :)
Tue Feb 20 00:31:58 2018 wav :)
variety, ....
** • being very literal. - billybob
Tue Feb 20 00:40:57 2018 billybob

**** • Thanks billybob - :)
Tue Feb 20 00:43:27 2018 :)


• s/l slu tear sm
+ dd
Mon Feb 19 16:55:40 2018 dd
5-yo boy comes in for clavicle fracture and runny nose. Had allergy testing. Positive results for A. alternate. Negative for guinea pig.

In physical exam, doc says "No allergic s/l slu tear. No cough."

Any idea what the slu tear could be.
** • allergic salute? - billybob
Mon Feb 19 17:03:49 2018 billybob

**** • Ah, yes! Thanks for being my second set of ears! nm + dd
Mon Feb 19 17:07:07 2018 dd
d

• The reduction was confirmed and the guidewire was then pushed from the ...
+ mp4
Mon Feb 19 16:17:15 2018 mp4
The reduction was confirmed and the guidewire was then pushed from the proximal fragment into the distal fragment. The opening reamer was then placed with soft tissue guide over the _____ and the proximal fragment was opened with the _____ 5 opening reamer and a 11 x 170 Stryker Gamma 3 short cephalomedullary nail with 125-degree angle was placed over the guidewire and confirmed in the canal in both the proximal and distal fracture fragments on multiple views.
** • never mind. Thanks to anyone who tried. - guy
Mon Feb 19 16:21:27 2018 guy


• At this point, the patient was prepped and draped in the usual sterile ...
+ wav
Mon Feb 19 16:07:56 2018 wav
At this point, the patient was prepped and draped in the usual sterile fashion and an incision was made proximal to the greater troch allowing access to the medial aspect of the greater troch _____ cephalomedullary nail. **Using a guidewire, a guidewire was placed** and confirmed on two views under fluoroscopic guidance. The fracture fragment was then manipulated using a ball spike pusher
** • never mind. Thanks to anyone who tried. - guy
Mon Feb 19 16:21:34 2018 guy


• the risks of surgery include infection, bleeding, stiffness, pain, non ...
+ mp3
Mon Feb 19 15:59:41 2018 mp3
the risks of surgery include infection, bleeding, stiffness, pain, nonunion, malunion, need for revision surgery, risk for spread of his infection, potential failure of hardware, neurovascular compromise, and ultimately potential failure to mitigate his pain; however, the risks, benefits, and alternatives of conservative management include nonunion and potentially not healing his fracture _____ and associated medical comorbidities. After discussion of the said risks, benefits, and alternatives, the patient was brought to the operating suite after consenting for surgery in the form of placement of a short cephalomedullary nailing of the left hip.
** • never mind. Thanks to anyone who tried. - guy
Mon Feb 19 16:21:19 2018 guy


• Preoperative Diagnosis: LEFT HIP FRACTURE. Procedure: SHO ...
+ wav
Mon Feb 19 15:49:20 2018 wav
Preoperative Diagnosis:
LEFT HIP FRACTURE.

Procedure:
SHORT CEPHALOMEDULLARY NAILING OF THE LEFT HIP.

INDICATIONS: This is a 58-year-old male who had previously been admitted to the medical service for management of multiple medical comorbidities including, but not limited to chronic ulcers and gangrenous infection of his lower extremities as well as _____ issues of both of his distal lower extremities. The orthopedic service was consulted
** • vasculopathic - what I hear
Mon Feb 19 15:56:33 2018 what I hear

**** • Thanks a lot. - guy
Mon Feb 19 16:00:00 2018 guy


• ESL doc, questioning "perineum" in labour/OP report
+ mt
Mon Feb 19 11:07:54 2018 mt
She was still 4 cm, **perineum** was still high and we decided to do lower segment cesarean section.
** • I do find references to "high perineum" at this google link + Questyr
Wed Feb 21 00:45:16 2018 Questyr
link

• Procedure: LEFT LOWER EXTREMITY SPLIT-THICKNESS SKIN GRAFT WITH LEF ...
+ wav
Sun Feb 18 21:34:31 2018 wav
Procedure:
LEFT LOWER EXTREMITY SPLIT-THICKNESS SKIN GRAFT WITH LEFT THIGH DONOR SITE.

The wound was dressed with Xeroform and wound VAC. The donor site was dressed with Tegaderm and _____ dressing. The patient was awakened from general anesthesia and taken to the recovery room in stable condition.
** • ... - kerlix dressing
Sun Feb 18 22:11:45 2018 kerlix dressing

** • Coban?? - poi
Sun Feb 18 22:09:23 2018 poi

**** • Thanks a lot everybody - guy
Sun Feb 18 23:17:18 2018 guy


• Procedure: EXAM UNDER ANESTHESIA, DILATION AND CURETTAGE, BAKRI BAL ...
+ wav
Sun Feb 18 19:58:55 2018 wav
Procedure:
EXAM UNDER ANESTHESIA, DILATION AND CURETTAGE, BAKRI BALLOON PLACEMENT.

FINDINGS: Upon moving the patient from stretcher to the operating table, approximately 500 cc of blood was noted to be saturating the _____ below her. On examination, the uterus was approximately 18 weeks in size with watery blood expressed with uterine massage.
** • An absorbent disposable napkin covered on one side by plastic, which may be placed under a - Chucks
Sun Feb 18 21:04:35 2018 Chucks

**** • Thanks a lot. - guy
Sun Feb 18 21:34:58 2018 guy

** • never mind. Thanks to anyone who tried. - guy
Sun Feb 18 20:47:19 2018 guy


• Septoplasty and turbinate surgery.
+ mp3
Sun Feb 18 16:56:46 2018 mp3
All intranasal incisions were closed with chromic suture. Doyle splints placed externally and secured with a Prolene suture. ______ was then applied. Nasal drip dressing applied.
** • ... - mp3 deleted
Sun Feb 18 17:06:33 2018 mp3 deleted


• vertebra vs.vertebra and has vs. have
+ g l j a e p
Sun Feb 18 09:18:09 2018 g l j a e p
This is dictated:
The visualized vertebrae, L4-5, has marked disk space narrowing with a levoscoliosis.

I'm thinking L4-5 would be vertebrae, and the verb should be have instead of has.

Or, am I wrong, and it's vertebra or collectively would call for a singular verb?
** • I understand your question and I think I would have done it + Questyr
Mon Feb 19 01:41:20 2018 Questyr
as:
The visualized vertebrae: L4-5 has marked disk space narrowing with a levoscoliosis.

Because normally individual vertebrae are shown L4, L5 and the disc space is L4-5. BTJMO
**** • Thanks, Questyr. I like your suggestion. I'll make note of that for next time! :) - g l j a e p
Mon Feb 19 06:11:09 2018 g l j a e p

** • I went with vertebrae and changed has to have. Thanks anyway! - g l j a e p
Sun Feb 18 10:34:22 2018 g l j a e p


• Labs
+ ESL, yes
Sat Feb 17 16:29:47 2018 ESL, yes
Microcytic indices: "Retired oxybutynin rate" was 4.6 two days ago
** • maybe it is not a "rate" at all - can you hear "red cell distribution width"? - taco
Sat Feb 17 16:55:20 2018 taco

**** • That could be it... - b o h b c p
Sat Feb 17 21:29:10 2018 b o h b c p

** • not very close to your s/l but could it be "erythrocyte sedimentation rate"? - taco
Sat Feb 17 16:40:31 2018 taco

**** • Still not sound like that... - b o h b c p
Sat Feb 17 16:45:47 2018 b o h b c p

****** • *does not - b o h b c p
Sat Feb 17 16:46:12 2018 b o h b c p


• see message please--thanks!
+ tlh
Sat Feb 17 16:22:08 2018 tlh
well-maintained ankle joint with no fracture, dislocation or subluxation. There are tiny ossific fragments adjacent to the lateral process of the talus, possibly consistent with ligament avulsion fractures. There is a calcified, round mass about the posterior ankle joint, which is likely a ______[s/l flabella].
** • The main bones of the ankle region are the talus (in the foot), and the tibia and FIBULA?? - b o l b o m
Sun Feb 18 07:55:09 2018 b o l b o m

**** • but the fibula is not a "calcified, round mass" - nm
Sun Feb 18 10:15:00 2018 nm

** • Isn't fabella associated with the femur? This is an ankle. - rj
Sat Feb 17 20:29:29 2018 rj

** • fabella - google
Sat Feb 17 20:25:39 2018 google


• Toe wound: s/l soof-an-coal is to be applied to the edge of the callus. TIA!
- wound care?
Sat Feb 17 08:58:07 2018 wound care?

** • NM. Soothe and Cool - OP
Sat Feb 17 09:44:06 2018 OP


• Preoperative Diagnosis: RESPIRATORY FAILURE. Procedure: T ...
+ wav
Sat Feb 17 03:11:02 2018 wav
Preoperative Diagnosis:
RESPIRATORY FAILURE.

Procedure:
TRACHEOTOMY.

The patient is a 48-year-old female with multiple medical problems who has been critically ill in CCU for two weeks. Of note, he has HIV and HCV and his course was complicated by septic emboli to his brain and had a poor mental status in the recent past. At consultation on 02/13/18, recommended continuing care based on the patients current prognosis _____ **healthcare proxies in the assessment and recommendations at their E-mail, they recommended tracheostomy.** As such, the ENT team under two-physician consent agreed to proceed the trach procedure.
** • and the lack of health care proxies. - billybob
Sat Feb 17 07:59:46 2018 billybob

**** • Thanks a lot. - guy
Sun Feb 18 20:15:40 2018 guy




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