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Dec 10 03:29
• Med sounds like *ciloxacab* 200 mg used in place of diclofenac. ?? nm
+ F
Sat Dec 10 13:31:10 2016 F

** • Nvm. I got it! It's celecoxib. + F
Sat Dec 10 13:36:27 2016 F


• On admission to the CCU here, the patient was in cardiogenic shock wit ...
+ wav
Sat Dec 10 04:15:05 2016 wav
On admission to the CCU here, the patient was in cardiogenic shock with severe acidosis and lactate greater than 12. He was on large doses of epinephrine and Levophed infusions to maintain a MAP in the 50s. He was intubated and on relatively high vent settings including a ____ 10 to maintain his oxygen saturations.
** • PEEP of - nnm
Sat Dec 10 04:16:50 2016 nnm

**** • Thanks a lot. - guy
Sat Dec 10 04:18:48 2016 guy


• FINDINGS: Exam under anesthesia, small, six-week, anteverted uterus, ...
+ wav
Sat Dec 10 01:12:12 2016 wav
FINDINGS: Exam under anesthesia, small, six-week, anteverted uterus, mobile. No adnexal masses. Hysteroscopy, large posterior fundal polyp involving the majority of the endometrial cavity down to the level of the internal os. Bilateral ostia visualized. Polyp removed in two segments with polyp forceps. Minimal atrophic endometrial _____ via D&C.

SPECIMENS: Endometrial polyp, endometrial curetting.

** • nevermind. - guy
Sat Dec 10 01:21:02 2016 guy


• Next, an 8 mm x 45 mm partially-threaded cannulated screw was passed f ...
+ wav
Sat Dec 10 00:41:43 2016 wav
Next, an 8 mm x 45 mm partially-threaded cannulated screw was passed from the medial distal tibia into the lateral talar head. The guidewire was removed and _____ of the screws was confirmed in AP and lateral fluoroscopy.
** • ... + c g k b f d
Sat Dec 10 01:12:02 2016 c g k b f d

** • got it. thanks. - guy
Sat Dec 10 00:50:55 2016 guy


• Preoperative Diagnosis: CERVICAL INTRAEPITHELIAL NEOPLASIA 3 WITH S ...
+ wav
Fri Dec 9 21:21:10 2016 wav
Preoperative Diagnosis:
CERVICAL INTRAEPITHELIAL NEOPLASIA 3 WITH SUPERFICIAL FOCAL INVASION.

Procedure:
COLD KNIFE CONE AND VAGINAL BIOPSY.

FINDINGS: EUA revealed substantial size cervix with no gross lesions and no lesions noted after application of acetic acid. Small less than 1 cm blue _____ lesion at 6 oclock position on posterior fourchette.
** • nevermind. - guy
Fri Dec 9 21:45:32 2016 guy


• FINDINGS: 1. Exam under anesthesia showed large globular fibroid u ...
+ mp3
Fri Dec 9 19:08:28 2016 mp3
FINDINGS:
1. Exam under anesthesia showed large globular fibroid uterus, 13 weeks in size.
2. Laparoscopy revealed 13-week size uterus with large posterior fibroid removed via laparoscopic _____ and hand morcellation via the vagina.

** • hyst (erectomy) - nm
Fri Dec 9 19:20:03 2016 nm

**** • Thanks a lot. - guy
Fri Dec 9 19:26:02 2016 guy


• Preoperative Diagnosis: SYMPTOMATIC FIBROID UTERUS. Procedur ...
+ wav
Fri Dec 9 19:04:46 2016 wav
Preoperative Diagnosis:
SYMPTOMATIC FIBROID UTERUS.

Procedure:
TLH, BILATERAL SALPINGECTOMY, CYSTOSCOPY.

SURGERY START TIME: Wednesday, 11/02/16 at 1052

SURGERY END TIME: Wednesday, 11/02/16 at _____

** • I THINK I hear "time three ten" - Questyr
Fri Dec 9 19:06:17 2016 Questyr

**** • Thanks a lot. - guy
Fri Dec 9 19:15:43 2016 guy


• The right foot was then dressed in Betadine-soaked Adaptic. The digit ...
+ wav
Fri Dec 9 18:26:49 2016 wav
The right foot was then dressed in Betadine-soaked Adaptic. The digits were _____ with 4 x 8 gauze and the right foot was dressed with gauze, Kling, and an Ace bandage.
** • splinted - poi
Fri Dec 9 18:34:37 2016 poi

**** • Thanks a lot. - guy
Fri Dec 9 18:43:55 2016 guy


• Preoperative Diagnosis: PROLAPSING LOOP ILEOSTOMY. Procedure ...
+ wav
Fri Dec 9 17:40:55 2016 wav
Preoperative Diagnosis:
PROLAPSING LOOP ILEOSTOMY.

Procedure:
REDUCTION OF PROLAPSED ILEOSTOMY.

The loop ileostomy was unable to be reduced manually. Sugar was applied to the prolapsing ostomy with a small amount of reduction in the prolapse. Ice and pressure were both applied also with again minimal reduction in the prolapse and finally _____ morphine were administered by the ED to aid in relaxation and again the loop ileostomy was unable to be reduced.
** • Versed and - Questyr
Fri Dec 9 17:50:20 2016 Questyr

**** • see link + Q
Fri Dec 9 17:51:11 2016 Q
link
****** • Thanks for the link. I couldn't make out they were two words in first place. :-) - guy
Fri Dec 9 18:27:51 2016 guy

**** • Thanks a lot. - guy
Fri Dec 9 17:50:59 2016 guy


• He was found to have a prominently ______ vertebrobasilar artery which was sm
+ wav :)
Fri Dec 9 13:09:30 2016 wav :)
displacing and distorting the left trigeminal nerve.
** • dolichoectatic (see link for dolichoectasia...I'm using new browser so this may not work) + Questyr
Fri Dec 9 13:22:07 2016 Questyr
link
**** • It doesn't work..so google dolichoectasia - Q
Fri Dec 9 13:22:41 2016 Q


• Gamma knife radiosurgery of left trigeminal nerve using 1 shot with a 4 mm sm
+ wav :)
Fri Dec 9 12:43:05 2016 wav :)
__________ using 42.5 Gy to 50% for a maximum dose of 85 Gy.
** • collimator, and Knife should be capitalized for "Gamma Knife" - taco
Fri Dec 9 12:55:55 2016 taco

**** • Thanks and yes I went back and capped those. - :)
Fri Dec 9 13:07:34 2016 :)


• Monocryl suture was utilized *to inform* subdermal repair
+ sm
Fri Dec 9 11:13:28 2016 sm

Once this was completed, the separately identifiable medial wound was at this point approached. Post debridement, interrupted #5-0 Monocryl suture was utilized *to inform* subdermal repair and reapproximation. Once this was completed, further #5-0 Monocryl intracuticular suture was utilized for skin closure.
** • to perform? - b k l o l i
Fri Dec 9 11:16:36 2016 b k l o l i


• Preoperative Diagnosis: RIGHT FOOT GAS GANGRENE. Procedure: ...
+ wav
Fri Dec 9 05:56:41 2016 wav
Preoperative Diagnosis:
RIGHT FOOT GAS GANGRENE.

Procedure:
RIGHT FOOT TRANSMETATARSAL AMPUTATION, IRRIGATION AND DEBRIDEMENT, AND PMMA BEAD PLACEMENT.

FINDINGS: Proximal tracking infection _____ necrotic tissue to hindfoot.
** • dishwater something - isgal
Fri Dec 9 06:29:17 2016 isgal

**** • dishwater purulent necrotic tissue to hindfoot what I hear - b k l o l i
Fri Dec 9 07:58:37 2016 b k l o l i

**** • agree with dishwater. Google dishwater purulence to infection - jil
Fri Dec 9 07:50:39 2016 jil

****** • Thanks a lot everybody - guy
Fri Dec 9 17:42:09 2016 guy

** • flagged the blank but would like to know what is he saying. you can post your wav over if + guy
Fri Dec 9 05:57:56 2016 guy
no luck with my blank. Thanks.

• In retrospect, compared to the CT of July 2016, the ventricles are sma ...
+ wav
Fri Dec 9 03:13:25 2016 wav
In retrospect, compared to the CT of July 2016, the ventricles are smaller and there was resolution of the _____.
** • not my post. - guy
Fri Dec 9 05:54:20 2016 guy

** • ... - midline shift
Fri Dec 9 05:52:16 2016 midline shift


• The umbilicus was marked with a long 2-0 Vicryl stitch in the 12 oclo ...
+ wav
Fri Dec 9 02:32:00 2016 wav
The umbilicus was marked with a long 2-0 Vicryl stitch in the 12 oclock position in order to ensure adequate insetting later on. _____ and stapler was used to approximate the superior and inferior incisions and minimize dog ears laterally.
** • nevermind. - guy
Fri Dec 9 02:42:21 2016 guy


• Preoperative Diagnosis: LEFT FOOT FIFTH HAMMERTOE. Procedure ...
+ wav
Fri Dec 9 01:33:45 2016 wav
Preoperative Diagnosis:
LEFT FOOT FIFTH HAMMERTOE.

Procedure:
LEFT FIFTH ARTHROPLASTY OF THE PROXIMAL PHALANX OF THE LEFT FIFTH TOE.

The left foot was then prepped and draped in the usual sterile manner. A _____ was noted at the lateral aspect of the left proximal interphalangeal joint of the fifth toe.
** • keratoderma - poi
Fri Dec 9 01:39:45 2016 poi

**** • Thanks a lot. - guy
Fri Dec 9 01:42:03 2016 guy


• The cecum was then identified, palpated, and inspected throughout its ...
+ wav
Thu Dec 8 23:49:27 2016 wav
The cecum was then identified, palpated, and inspected throughout its length including the ascending colon, hepatic flexure, and transverse colon. We next turned our attention to resection of the _____ portion of the transverse colon. We identified the proximal and distal sites
** • ischemic - Questyr
Thu Dec 8 23:52:49 2016 Questyr

** • ischemic - poi
Thu Dec 8 23:52:46 2016 poi

**** • Thanks a lot everybody - guy
Thu Dec 8 23:54:13 2016 guy


• A complex closure was performed in a layered fashion with #0 Vicryl st ...
+ wav
Thu Dec 8 23:17:00 2016 wav
A complex closure was performed in a layered fashion with #0 Vicryl stitches and fascial layer with 2-0 in the subcutaneous layer and a running Monocryl 3-0 stitch. _____ was applied. Sterile dressing, Aquacel, gauze, and Ace wrap were applied.
** • nevermind. - guy
Thu Dec 8 23:28:35 2016 guy


• Attention was then turned to the femoral component. At this time, an ...
+ wav
Thu Dec 8 22:55:10 2016 wav
Attention was then turned to the femoral component. At this time, an osteotome was utilized to circumferentially osteotome a small portion of the _____ liner of the femoral aspect and a microsagittal saw was then utilized to cut between the cement and the implants.
** • outer? - poi
Thu Dec 8 22:56:23 2016 poi

**** • Thanks a lot. - guy
Thu Dec 8 23:04:57 2016 guy


• Rapide Vicryl suture in subcuticular fashion as well. The wounds were ...
+ wav
Thu Dec 8 22:05:20 2016 wav
Rapide Vicryl suture in subcuticular fashion as well. The wounds were dressed with benzoin and Steri-Strips with Telfa and Tegaderm over the umbilical _____. The patient was then extubated and brought to the recovery room in stable condition
** • ... + j g f i p n
Fri Dec 9 01:33:25 2016 j g f i p n

** • incision - poi
Thu Dec 8 22:09:58 2016 poi

**** • Thanks a lot. - guy
Thu Dec 8 22:11:06 2016 guy


• s/l Sea Lon (ear surgery)
+ kitty
Thu Dec 8 21:16:32 2016 kitty
A curved suction was then placed into the frontal sinus to evacuate additional thick mucus. Next, the inferior turbinates were addressed. The left inferior turbinate was pierced with ______ setting on 20. Several passes were made to shrink the overlying mucosa. A small flap was elevated with a Cottle elevator and portions were removed using Takahashi forceps.
** • The Celon method is a minimally invasive treatment option for the ther ... + google info -poi
Thu Dec 8 21:24:22 2016 google info -poi
The Celon method is a minimally invasive treatment option for the thermoablation of tissue, used (among other things) to treat chronically enlarged nasal turbinates. It is a proven, state-of-the-art, gentle procedure based on radiofrequency energy.

**** • Thank You!!! - kitty
Thu Dec 8 21:31:11 2016 kitty


• Preoperative Diagnosis: HISTORY OF NASAL BONE FRACTURE AND DIFFICUL ...
+ wav
Thu Dec 8 19:50:09 2016 wav
Preoperative Diagnosis:
HISTORY OF NASAL BONE FRACTURE AND DIFFICULTY BREATHING.

Procedure:
REVISION RHINOPLASTY.

He was consented for revision rhinoplasty either via close or an open approach. The addition of the possibility of _____ cartilage for the nasal dorsum, either a rib graft or auricular cartilage may be necessary. Additionally, we may need to take or perform nasal bone osteotomies.
** • needing cartilage for the nasal dorsum - Jeannine
Thu Dec 8 20:00:12 2016 Jeannine

**** • Thanks a lot. - guy
Thu Dec 8 20:01:46 2016 guy


• the clinical presentation back 3-4 months ago does sound in keeping with Coxsackie
+ mp3
Thu Dec 8 19:27:09 2016 mp3
virus x2 with subsequent multiple _____ viral processes afterward.
** • hits of? - poi
Thu Dec 8 19:30:20 2016 poi

**** • perhaps hints? (though I do hear hits) - poi
Thu Dec 8 19:33:05 2016 poi

****** • ... - thanks
Thu Dec 8 19:33:56 2016 thanks


• Is coxsackie capped?
- tia
Thu Dec 8 18:58:41 2016 tia

** • That's one I've never capped, for some reason. + LOL
Thu Dec 8 21:25:57 2016 LOL
I don't know why not though.
** • named after a town in NY, so I guess I would. - fwiw - poi
Thu Dec 8 19:02:21 2016 fwiw - poi

**** • ... - thanks
Thu Dec 8 19:05:55 2016 thanks


• Preoperative Diagnosis: THIS IS A 43-YEAR-OLD GRAVIDA 4, PARA 3-0-1 ...
+ wav
Thu Dec 8 18:58:24 2016 wav
Preoperative Diagnosis:
THIS IS A 43-YEAR-OLD GRAVIDA 4, PARA 3-0-1-2 WITH ABNORMAL UTERINE BLEEDING AND _____ SYMPTOMS, FOR DEFINITIVE MANAGEMENT VIA TOTAL ABDOMINAL HYSTERECTOMY AND BILATERAL SALPINGECTOMY.

Procedure:
TOTAL ABDOMINAL HYSTERECTOMY AND BILATERAL SALPINGECTOMY.

** • bulk - isgal
Thu Dec 8 18:59:43 2016 isgal

** • bulk? - poi
Thu Dec 8 18:59:37 2016 poi

**** • Thanks a lot everybody - guy
Thu Dec 8 19:07:08 2016 guy


• Proper fracture reduction and wire placement was once again confirmed ...
+ wav
Thu Dec 8 18:41:49 2016 wav
Proper fracture reduction and wire placement was once again confirmed using fluoroscopy. The wires were then trimmed and capped with yellow rubber _____ Xeroform. The tourniquet was removed.
** • stoppers. The pins were wrapped with - b k l o l i
Thu Dec 8 18:46:33 2016 b k l o l i

**** • Thanks a lot. - guy
Thu Dec 8 18:47:23 2016 guy


• He sustained a right small finer distal phalanx fracture with a bony m ...
+ wav
Thu Dec 8 18:27:28 2016 wav
He sustained a right small finer distal phalanx fracture with a bony mallet deformity. He presented to the hand surgery clinic with a mallet deformity _____ fracture fragment. Multiple options were discussed at length with the patient including closed reduction
** • "finer" should be finger in 1st sentence. Blank: and a large - nm
Thu Dec 8 18:38:45 2016 nm

**** • Thanks a lot. Thanks for the correction. - guy
Thu Dec 8 18:39:41 2016 guy


• He has had previous *GOs* at this [treatment]. No clue how to type it. TIA
- nm
Thu Dec 8 17:34:25 2016 nm

** • goes - b k l o l i
Thu Dec 8 18:19:59 2016 b k l o l i

**** • Just found that as well. Thank you! :) - OP
Thu Dec 8 18:31:34 2016 OP


• We will monitor estimated length of stay. It is still very hard to estimate if sm
+ wav :)
Thu Dec 8 14:25:30 2016 wav :)
she is still with _____ gains from her hospital visit.
** • limited - poi
Thu Dec 8 14:30:03 2016 poi

**** • Thanks poi. - :)
Thu Dec 8 14:33:47 2016 :)


• history of angle closure s/l "attack" in the past. ?
+ thanks!
Thu Dec 8 14:22:40 2016 thanks!
Patient referred for glaucoma evaluation after being found to have narrow angles with a history of angle closure s/l "attack" in the past.
** • seems verifiable + link - poi
Thu Dec 8 14:31:19 2016 link - poi
link
**** • okay! thanks. I went with it. :) - op
Thu Dec 8 14:40:23 2016 op


• Admitted with worsening agitation and aggression. I do not see any ____ medical sm
+ wav :)
Thu Dec 8 13:57:41 2016 wav :)
etiology for his confusion. Is she just changing her mind to any medical etiology?
** • any overt medical etiology - taco
Thu Dec 8 14:01:21 2016 taco

**** • Thanks taco. - :)
Thu Dec 8 14:10:01 2016 :)


• Patient has bilateral flat feet. ____ cooler to touch.
- : ) wav
Thu Dec 8 13:39:05 2016 : ) wav

** • Tips of digits - taco
Thu Dec 8 13:40:37 2016 taco

**** • Thanks taco. - :)
Thu Dec 8 13:45:41 2016 :)


• Overactive bladder, possibly overflow incontinence. Will discontinue s/l petanicol?
- tia
Thu Dec 8 13:25:40 2016 tia

** • bethanechol - taco
Thu Dec 8 13:36:02 2016 taco

**** • thank you!! - op
Thu Dec 8 13:40:09 2016 op


• A few questions
+ mp4
Thu Dec 8 13:18:08 2016 mp4
Given his history of PE, he is continued to be managed with anticoagulation on Coumadin and was treated for chest discomfort and shortness of breath postoperatively. The incisions are healing well. ______ echocardiogram ______ pericardial effusion by the end of his hospital stay, he is to continue _____ stable 11/28/2016, he was discharged.
** • last one is "vital signs" Punctuation seems off all over the place. - ?
Thu Dec 8 14:08:41 2016 ?


• depressions on EKG _____, ventricular arrhythmias, and ______.
+ mp3
Thu Dec 8 13:09:16 2016 mp3
It was noted he had ST depressions on EKG _____, ventricular arrhythmias, and ______.

PAST MEDICAL HISTORY: Significant for COPD, PE, and sinus tachycardia.

PAST SURGICAL HISTORY: Significant for head injury and hand surgery.

** • and requires CABG. - nm
Thu Dec 8 13:21:44 2016 nm

**** • thanks - -
Thu Dec 8 14:40:32 2016 -

** • 1. critical left main ostial stenosis, ventricular arrythmias in the cath lab - b k l o l i
Thu Dec 8 13:12:10 2016 b k l o l i

**** • ty - nm
Thu Dec 8 13:20:22 2016 nm


• right arm, and ______ cardiac catheterization
+ wav
Thu Dec 8 13:07:48 2016 wav
is a 60-year-old gentleman who presents for cardiac catheterization to further evaluate symptoms of chest pain radiating to the left jaw, mid back, right arm, and ______ cardiac catheterization, he became symptomatic with substernal chest pain not relieved by nitroglycerin and intraaortic balloon pump was placed
** • right arm as above. Following cardiac.. - b k l o l i
Thu Dec 8 13:12:49 2016 b k l o l i

**** • thank you - !
Thu Dec 8 13:18:19 2016 !


• Hypoattenuation of the periventricular white matter with ___ dilatation of the sm
+ wav :)
Thu Dec 8 12:21:47 2016 wav :)
left lateral ventricle next to the encephalomalacia.
** • ex vacuo - nm
Thu Dec 8 12:29:05 2016 nm

**** • Yes this is it. Thanks. - :)
Thu Dec 8 12:29:52 2016 :)

****** • I'm glad you waited! I didn't think my answer was right. :/ - t
Thu Dec 8 12:37:15 2016 t

** • sounds like "ex facto" to me, but you might want to wait for another ear. - taco
Thu Dec 8 12:26:55 2016 taco

**** • Thanks for trying taco. That's what I kept hearing too but could not find it. LOL - :)
Thu Dec 8 12:30:14 2016 :)


• Lung Transplant
+ b o h b c p
Thu Dec 8 11:51:01 2016 b o h b c p
The staple lines were transected and then the left atrial anastomosis was performed in an end-to-end fashion using running 4-0 Prolene sutures. "Standard Thermeral" tourniquet, and the pulmonary artery anastomosis was performed in an end-to-end fashion using running 5-0 Prolene suture.
** • Listen for "Rummel tourniquet" in there (maybe "suture as a standard Rummel tourniquet") - taco
Thu Dec 8 12:06:43 2016 taco


• need help fixing up this sentence
+ tia
Thu Dec 8 11:47:43 2016 tia
I think the risk-versus-benefit ratio of starting Zantac either prior to bedtime and trialing also first thing in the morning and a smaller volume of formula in the morning may minimize Xs vomiting episodes.
** • I'm not sure that's fixable since the subject doesn't go with verb... + t
Thu Dec 8 12:09:05 2016 t
in other words, the subject of "risk-vs-benefit ratio" does not go with "may minimize" and also there is an "either" without an "or" - the sentence is messed up. Sorry I can't help. :(
**** • Thanks. I think she got lost on the way. I had to send the report to QA with a + op
Thu Dec 8 12:36:18 2016 op
blank anyway, so I asked her to look at this sentence too.

• peroneal _______ visualize in the anterior tib ______ via
+ wav
Thu Dec 8 11:13:01 2016 wav
With the aid of this catheter wire was used to reverse the occlusion and advanced in the tibial peroneal trunk. The catheter was advanced into the tibial peroneal trunk. Angiogram through this catheter demonstrated peroneal _______ visualize in the anterior tib ______ via collateral. The posterior tib did not visualize.
** • the peroneal not to visualize and the anterior tib to visualize via a collateral. - taco
Thu Dec 8 11:17:49 2016 taco

**** • ty - -
Thu Dec 8 11:45:41 2016 -


• biopsy proven carcinoma of the prostate. ______ disease workup was negative
+ wav
Thu Dec 8 08:44:17 2016 wav
This is a 70-year-old gentleman who had a biopsy proven carcinoma of the prostate. ______ disease workup was negative. The patient was admitted, underwent a laparoscopic robotically assisted radical retrograde prostatectomy with bilateral lymph node dissection.
** • i keep hearing "adenocarcinoma of the prostate" too. - b k l o l i
Thu Dec 8 08:56:24 2016 b k l o l i

** • Extent of disease? - b k l o l i
Thu Dec 8 08:55:40 2016 b k l o l i

**** • that, or extended disease? or extensive disease? (I also hear the "adeno-" part too) - taco
Thu Dec 8 08:59:10 2016 taco

****** • thanks - -
Thu Dec 8 09:16:29 2016 -


• This is a 56-year-old gentleman, type 1 diabetic, who presented to the ...
+ wav
Thu Dec 8 06:10:58 2016 wav
This is a 56-year-old gentleman, type 1 diabetic, who presented to the ER with left lower quadrant pain. No prior history of stones and was afebrile. The patient was found to have proximal obstructing 1 cm stone causing AKI with a creatinine of 1.4 from a baseline of 0.6. The patient was hemodynamically stable, but given the AKI decision was made to meet the patient for observation and consideration of stent placement during the daytime _____ however it was then noticed that the patients sugars were not responding to insulin and remained elevated in 400 and 500. The medicine team
** • as patient arrived in the middle of the night. - nnm
Thu Dec 8 07:46:28 2016 nnm

**** • Thanks a lot. - guy
Thu Dec 8 19:51:27 2016 guy

** • nevermind. - guy
Thu Dec 8 06:24:59 2016 guy


• We discussed the fact that her disease status does seem to be worsening. ______ fact
+ mp3
Thu Dec 8 05:28:28 2016 mp3
We discussed the fact that her disease status does seem to be worsening. ______ muscle tone in her lower extremities was more hypotonic than hypertonic.
** • I thought, in fact, her - nm
Thu Dec 8 13:04:57 2016 nm


• Preoperative Diagnosis: BUCCAL SQUAMOUS CELL CARCINOMA ON THE RIGHT ...
+ wav
Thu Dec 8 01:24:50 2016 wav
Preoperative Diagnosis:
BUCCAL SQUAMOUS CELL CARCINOMA ON THE RIGHT SIDE.

Procedures:
1. HARVEST OF THE LEFT ANTEROLATERAL THIGH FLAP.
2. INSET OF THE FLAP INTO THE LEFT CHEEK DEFECT WITH A DOUBLE SKIN PADDLE DESIGN AND MICROVASCULAR ANASTOMOSIS.

PROCEDURE IN DETAIL: The patient was identified in the preoperative area and was brought to the operating theater. He was placed supine on the operating table. After uneventful induction of general anesthesia, performance of the tracheotomy _____ which will be _____. The patient was prepped and draped in usual sterile surgical fashion again. The left thigh was prepped. The perforators were marked with Doppler.
** • nevermind. - guy
Thu Dec 8 01:42:01 2016 guy


• CLINICAL INDICATION: This is a 46-year-old female who presented to ou ...
+ wav
Thu Dec 8 00:18:01 2016 wav
CLINICAL INDICATION: This is a 46-year-old female who presented to our clinic after having found a lesion causing galactorrhea and headache at an outside hospital _____ prolactinoma due to mildly elevated prolactin levels and started her on medical therapy.
** • They believed it was a - poi
Thu Dec 8 00:24:59 2016 poi

**** • Thanks a lot. - guy
Thu Dec 8 00:26:13 2016 guy


• Preoperative Diagnosis: RIGHT INDEX FINGER RADIAL DIGITAL NERVE LAC ...
+ wav
Wed Dec 7 23:38:14 2016 wav
Preoperative Diagnosis:
RIGHT INDEX FINGER RADIAL DIGITAL NERVE LACERATION.

Procedure:
RIGHT INDEX FINGER RADIAL DIGITAL NERVE REPAIR WITH 3 CM OF _____ NERVE GRAFT.

** • allogeneic - poi
Wed Dec 7 23:39:54 2016 poi

**** • Thanks a lot. - guy
Wed Dec 7 23:42:43 2016 guy


• Preoperative Diagnosis: A 27-YEAR-OLD GRAVIDA 2, PARA 0-0-1-0 AT 37 ...
+ wav
Wed Dec 7 23:13:34 2016 wav
Preoperative Diagnosis:
A 27-YEAR-OLD GRAVIDA 2, PARA 0-0-1-0 AT 37-4 WEEKS FOR STAT PRIMARY CESAREAN SECTION FOR _____.

** • cord prolapse. - billybob
Wed Dec 7 23:20:45 2016 billybob

**** • Thanks a lot. - guy
Wed Dec 7 23:30:15 2016 guy


• same word as below
+ wav
Wed Dec 7 21:04:11 2016 wav
Dilute Pitressin solution 20 units and 200 cc of NS was then injected via spinal needle into the myoma bed. _____ incision was then used to make a horizontal incision over the myoma and the serosa was dissected off the capsule
** • nevermind. - guy
Wed Dec 7 21:10:56 2016 guy


• The 5-mm single-tooth tenaculum was then applied to the myoma to achie ...
+ mp3
Wed Dec 7 20:58:22 2016 mp3
The 5-mm single-tooth tenaculum was then applied to the myoma to achieve adequate retraction and the fibroid was dissected from its bed with a _____. Cavity was not entered. Myometrium was not entered.
** • side?? slight?? incision - poi
Wed Dec 7 21:01:45 2016 poi

**** • maybe small? - poi
Wed Dec 7 21:02:07 2016 poi

****** • Thanks a lot. - guy
Wed Dec 7 21:02:48 2016 guy


• Preoperative Diagnosis: THIS IS A 28-YEAR-OLD GRAVIDA 0 WITH SYMPTO ...
+ wav
Wed Dec 7 20:47:27 2016 wav
Preoperative Diagnosis:
THIS IS A 28-YEAR-OLD GRAVIDA 0 WITH SYMPTOMATIC FIBROID UTERUS.

Procedure:
LAPAROSCOPIC MYOMECTOMY.

FINDINGS: Exam under anesthesia demonstrated small anteverted uterus with a 7 cm mobile fibroid. Nothing palpable in the adnexa. Laparoscopy significant for 7 cm degenerating benign appearing fundal pedunculated fibroid on a 3 cm stalk. Hemostasis at the conclusion of the case. Normal uterus. Bilateral fallopian tubes and ovaries. Normal upper abdomen survey. The patient may have a normal vaginal delivery as fibroid did not involve the myometrium. Attending present and participated throughout _____.

COMPLICATIONS: None.

ANTIBIOTICS: None.

** • agreed with the note? - poi
Wed Dec 7 20:59:36 2016 poi

**** • Thanks a lot. - guy
Wed Dec 7 21:01:44 2016 guy


• Patient's other history significant again ____ listed above.
- :) wav
Wed Dec 7 16:36:27 2016 :) wav

** • bleeding? breathing? what was "listed above" talking about? - poi
Wed Dec 7 17:21:25 2016 poi


• He additionally recommended invasive cervical traction to see if this would improve
+ wav
Wed Dec 7 15:51:02 2016 wav
her symptomatically ___ recommend a cervical stabilization procedure.

• This led to an extensive workup over the last 7 months including multiple MRIs of the
+ mp4
Wed Dec 7 15:46:30 2016 mp4
brain and spine which have given her the diagnosis of occipitocervical instability, a thoracic syrinx, _____ hypertrophy.
** • styloid hypertrophy. - billybob
Wed Dec 7 18:26:12 2016 billybob


• All surgical _____ . The fascia was closed in running fashion
+ mp3
Wed Dec 7 15:00:56 2016 mp3
At this point, the omentum was then immobilized and placed as a buttress in between the colon and the bladder, completing the creation of omental J-flap. All surgical _____ . The fascia was closed in running fashion using #1 loop PDS sutures. Subcutaneous tissues were reapproximated using 2-0 Vicryl suture and subcuticular closure was done all surgical site using 4-0 Monocryl suture.

• At this point, the fluid in the pelvis _____ anastomosis
+ wav
Wed Dec 7 14:50:28 2016 wav
At this point, the fluid in the pelvis _____ anastomosis. Proctosigmoidoscopy was performed, which revealed a circumferential hemostatic staple line without any evidence of gross anastomotic leak. Air was then suctioned out, as was the fluid in the pelvis. All surgical personnel then changed their gowns and gloves.

• to the proximal colon _____. Staples were fired and
+ mp4
Wed Dec 7 14:20:18 2016 mp4
Two ends of the staple were attached and the staple was cross fired, fired in stable and proper orientation to the proximal colon _____. Staples were fired and anastomosis was completed. Staples were then removed transanally, both the proximal and distal doughnuts were circumferentially intact and sent to pathology for evaluation.

• the annulus was _____ tied down. Staples were then passed transanally and _____ pos
+ mp3
Wed Dec 7 14:18:49 2016 mp3
. Bowel was divided and sent to pathology for evaluation including the sigmoid colon, rectum, phlegmon, and colo-vesicular fistula, which had been taken down and mobilized using the blunt dissection and the LigaSure device. The bladder was then repaired in interrupted fashion using 2-0 Vicryl suture. At this point, pursestring was identified and the annulus was _____ tied down. Staples were then passed transanally and _____ posterior to staple line.
** • ___ was extruded just (not sure what he is saying was extruded. - b k l o l i
Wed Dec 7 14:51:10 2016 b k l o l i

** • not annulus - anvil was placed within the pursestring and subsequently tied down. - b k l o l i
Wed Dec 7 14:50:08 2016 b k l o l i

**** • thank you - !
Wed Dec 7 14:59:03 2016 !


• The mesentery _____ and divided using
+ wav
Wed Dec 7 14:17:32 2016 wav
This was excised and sent to pathology individually for evaluation. Window was made at top of sacral promontory both on the right and left side and the phlegmonous mass was mobilized up and the soft pliable rectum was identified. The mesentery _____ and divided using the LigaSure device. At this point, incision was made approximately two fingerbreadths above the level of the pubis through the skin down to the fascia.
** • was serially ligated - taco
Wed Dec 7 14:32:33 2016 taco

**** • ty - -
Wed Dec 7 14:49:06 2016 -


• s/l middle schwarz
+ ?
Wed Dec 7 14:14:44 2016 ?
This is a 16-year-old white female with five-day history of vague abdominal pain associated with no vomiting and mild anorexia.

IMPRESSION AND PLAN: Probable viral infection with no definite etiology. __________ is a possibility but because of the right upper quadrant pain, it is less likely, however, it is a possibility. Again the probable impression is that of gastroenteritis with no definite pathology noted in the gallbladder or appendix.
** • flagged - -
Wed Dec 7 14:31:56 2016 -

**** • I hope not - t
Wed Dec 7 14:34:03 2016 t

** • Mittelschmerz (if you google "middle schwarz" you find it) - taco
Wed Dec 7 14:31:54 2016 taco

**** • thank you! - -
Wed Dec 7 14:39:14 2016 -


• epinephrine s/l I A M B
+ sm
Wed Dec 7 13:19:03 2016 sm
Treatment completed. A 2-inch throat pack was placed under direct vision and then incised with 36 mg of 2% lidocaine with 1:100,000 epinephrine via ________ lower right side for tooth #T. Restorations completed. Tooth #I stainless steel crown cemented with Ketac Cem size D7, tooth #J stainless steel crown cemented with Ketac Cem size E6, tooth #K occlusal buccal composite, #H Prime & Bond, A2 Tetric EvoCeram composite, tooth #L stainless steel crown cemented with Ketac Cem size D7, tooth #T extraction simple, all apices visualized.
** • inferior alveolar nerve block IAMB - b k l o l i
Wed Dec 7 14:12:20 2016 b k l o l i

** • flagged - -
Wed Dec 7 14:10:42 2016 -


• Preoperative Diagnosis: RIGHT LOWER LOBE LUNG MASS AND MULTIPLE PUL ...
+ wav
Wed Dec 7 03:03:26 2016 wav
Preoperative Diagnosis:
RIGHT LOWER LOBE LUNG MASS AND MULTIPLE PULMONARY NODULES.

Procedure:
RIGHT THORACOSCOPY AND WEDGE RESECTION OF LARGE RIGHT LOWER LOBE MASS AND RIGHT MIDDLE LOBE WEDGE RESECTION OF PULMONARY NODULES.

INDICATIONS: This is a 69-year-old male with a history of oral cancer who presents with a right lower lobe mass which appeared to be a primary lung cancer and decreased pulmonary function. _____ thoracoscopy for this reason. Risks, benefits, and alternatives of the procedure were discussed with the patient including intraoperative myocardial infarction, renal failure, respiratory failure, bleeding, infection, and death.
** • We were asked to diagnose the patient and perform a - poi
Wed Dec 7 13:20:01 2016 poi

** • nevermind. - guy
Wed Dec 7 03:09:18 2016 guy


• Proximally, the sac was dissected to the internal ring and then tied o ...
+ wav
Wed Dec 7 00:32:28 2016 wav
Proximally, the sac was dissected to the internal ring and then tied off with a 3-0 Vicryl suture and a 4-0 Vicryl suture ligature. The excess sac was excised and passed down to pathology. The sac was _____ groin. The testicle was returned into the scrotum.
** • terminated in the - poi
Wed Dec 7 00:53:12 2016 poi

**** • Thanks a lot. - guy
Wed Dec 7 01:24:40 2016 guy

** • nevermind. - guy
Wed Dec 7 00:44:28 2016 guy


• French chest tube was placed posteriorly and superiorly to the apex of ...
+ mp3
Tue Dec 6 23:35:25 2016 mp3
French chest tube was placed posteriorly and superiorly to the apex of the patients left chest, and connected to a Pleurovac under sterile conditions. Approximately 150 cc of blood was returned and filled the _____. The chest tube was secured with a #0 silk suture x2.
** • pneumovac - poi
Tue Dec 6 23:40:43 2016 poi

**** • Thanks a lot. - guy
Tue Dec 6 23:47:14 2016 guy


• Preoperative Diagnosis: STATUS POST TRAUMA AND SPLENECTOMY. ...
+ wav
Tue Dec 6 23:19:31 2016 wav
Preoperative Diagnosis:
STATUS POST TRAUMA AND SPLENECTOMY.

Procedure:
EXPLORATORY LAPAROTOMY, PLACEMENT OF AN ABTHERA WOUND VAC AND LEFT CHEST TUBE PLACEMENT.

This is an 81-year-old male who was struck by a speeding automobile and eventually had a splenectomy with drain placement early in the day. The patient had a left hip hematoma that was bleeding; however, seemed to be controlled at the moment. The patient was in the ICU and doing well; however, after talking with interventional radiology and realizing the patient was stable, we decided that taking the patient to IR for embolization of the small bleeder in the patients left flank was probable not necessary. Soon after talking to IR, the patient put out 300 cc of sanguinous fluid from his JP and became increasingly hypotensive. Moments later, the patients _____ and CPR was initiated. Within a minute of CPR, the patient regained spontaneous heart rhythm and resuscitation was continued.
** • the patient flat lined - poi
Tue Dec 6 23:36:41 2016 poi




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