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Sep 12 18:11
• catheter was advanced through the **envoy**. The Synchro 2 was shaped in
+ sm
Mon Sep 25 11:20:50 2017 sm
Subsequently, an appropriate angle was identified to coil the right internal carotid artery aneurysm and under maximum magnification, we performed a roadmap after again selectively the right internal carotid on the right.

The ongoing catheter was parked at the origin of the petrous carotid and subsequently an SL-10 catheter through and then subsequently a Synchro 2 wire through an SL-10 catheter was advanced through the **envoy**. The Synchro 2 was shaped in a J fashion. The SL-10 catheter with a lead wire was advanced to pass the aneurysm and the Synchro 2 wire was subsequently removed in order to remove the tension from the catheter.

• endocardial definition ______ precludes analysis
+ mp3
Mon Sep 25 08:59:53 2017 mp3
Clinical picture seems less consistent with acute coronary syndrome. Okay to continue aspirin, coronary calcifications noted on chest CT. We will check lipids. Telemetry shows periods of complete heart block. No reported history of syncope. Echocardiogram from 09/23/2017 was personally reviewed, EVEF is preserved; however, poor endocardial definition ______ precludes analysis of regional wall motion.
1. Discontinue clopidogrel and continue aspirin 81 mg daily.
2. Check lipids.
3. Discontinue timolol eye drops.
4. Avoid anti-nodal agents.
5. EP evaluation for advanced AV block, Dr. Weber consulted.

** • on offset images? - mn
Mon Sep 25 09:12:40 2017 mn

**** • ty - -
Mon Sep 25 10:09:11 2017 -


• mEq once daily, _______ eye drops
+ wav
Mon Sep 25 08:58:16 2017 wav
PAST MEDICAL HISTORY: He carries a diagnosis of hypertension, but is not on any antihypertensive, type 2 diabetes mellitus, benign prostatic hyperplasia, history of kidney cancer, status post right nephrectomy, status post cholecystectomy. He also has possible glaucoma based on review of his medicated eye drops.

MEDICATION: At home, metformin, magnesium oxide 800 mg once daily, pantoprazole 40 mg once daily, potassium chloride 20 mEq once daily, _______ eye drops, possibly timolol eye drops as well, sodium bicarb 650 mg three times daily.

** • Dorzolamide? - mn
Mon Sep 25 09:09:36 2017 mn

**** • ty - -
Mon Sep 25 10:08:36 2017 -


• The patient has *index event of* severe epigastric pain
+ ok?
Mon Sep 25 07:10:39 2017 ok?
SYSTEMATIC REVIEW: GI: The patient has __________ severe epigastric pain. No history of known gallstones. No history of previous change in appetite or bowel function. The patient denies any prior colonoscopy. Neurological: Intact. Cardiovascular: No shortness of breath, chest pain or history of ankle edema. Lungs: No cough. No wheezing. No shortness of breath. Neurologically, the patient denies any focal neurological symptoms. GU: The patient reports a dark urine over the past 24 hours commenced with obstructive jaundice.
** • nm - using this - ty
Mon Sep 25 08:19:33 2017 ty


• esl help
+ sea
Sun Sep 24 16:19:59 2017 sea
Allergies: s/l Valene and Betadine.
** • Valium. - billybob
Sun Sep 24 19:04:31 2017 billybob


• radical hysterectomy
- s/l eggslap
Sun Sep 24 08:34:03 2017 s/l eggslap

** • WAG--ex lap (exploratory laparotomy)? Please give more context + RMT
Sun Sep 24 09:53:56 2017 RMT
such as a sentence or two before or after if you can.
**** • it's in PMH that she underwent ex lap radical hysterectomy with possib ... + g a j i m i
Sun Sep 24 09:55:17 2017 g a j i m i
it's in PMH that she underwent ex lap radical hysterectomy with possible bilateral salpingo oophrectomy

• Intervening sutures were then placed in order to anchor the ileostomy ...
+ mp3
Sun Sep 24 02:18:12 2017 mp3
Intervening sutures were then placed in order to anchor the ileostomy to the skin and the fascia. The red rubber catheter was then left in situ with the edges sutured together. The patient was then cleaned. Ostomy appliance and ____ were then placed. The Foley catheter was left in situ. The NG tube was removed by Anesthesia.
** • wafer (see link) + Questyr
Sun Sep 24 02:26:24 2017 Questyr
link
**** • Thanks a lot. - guy
Sun Sep 24 02:27:24 2017 guy


• A 2-cm incision was made along the loop and the edges of the ileostomy ...
+ guy
Sun Sep 24 02:14:24 2017 guy
A 2-cm incision was made along the loop and the edges of the ileostomy was then everted and tied in a **rosewood** fashion with four 2-0 Vicryl sutures in a circumferential fashion
** • rosebud (see link..but I checked Webster's and it's one word) + Questyr
Sun Sep 24 02:22:07 2017 Questyr
link
**** • Thanks a lot. wav also posted. - guy
Sun Sep 24 02:22:18 2017 guy

****** • Yes, she says rosebud - Q
Sun Sep 24 02:26:59 2017 Q

******** • Thanks a lot. - guy
Sun Sep 24 02:27:33 2017 guy


• Procedure: LAPAROSCOPIC LOOP ILEOSTOMY. PROCEDURE IN DETAIL: ...
+ wav
Sun Sep 24 01:56:15 2017 wav
Procedure:
LAPAROSCOPIC LOOP ILEOSTOMY.

PROCEDURE IN DETAIL: This is a 58-year-old with progressive stage 2B endocervical adenocarcinoma who had started radiation treatment x2 days and then admitted with a malignant high-grade small bowel obstruction. The patient had been undergoing _____ NG tube decompression x6 days without improvement clinically and radiographically.
** • bowel rest with - Questyr
Sun Sep 24 02:19:31 2017 Questyr

**** • Thanks a lot. - guy
Sun Sep 24 02:20:34 2017 guy


• FINDINGS: A 22-week size uterus with seven cervical dilators, removed ...
+ mp3
Sat Sep 23 23:31:36 2017 mp3
FINDINGS: A 22-week size uterus with seven cervical dilators, removed from the cervix as well as two sponges, dilated 1 cm to 2 cm at the beginning of the case. Cervix serially dilated to 25-French. Amniotomy was performed _____ catheter and evacuation performed with Bierer forceps in usual fashion. Amniotomy was then performed _____ with evacuation in the usual fashion. All _____ accounted for at the end of the case, 14 mm suction catheter used for suction curettage and sharp curettage performed. Thin endometrial _____ at the conclusion of the case. Multiple posterior fibroids noted _____. Ultrasound used throughout the entire procedure. Mirena IUD was inserted in the usual fashion.
** • 3) all instruments and *** accounted 4) Thin endometrial stripe noted 5) fibroids noted, - all intramural. ltt
Sat Sep 23 23:50:37 2017 all intramural. ltt

**** • With your help got this. Thanks a lot. + guy
Sun Sep 24 00:06:50 2017 guy
FINDINGS: A 22-week size uterus with seven cervical dilators, removed from the cervix as well as two sponges, dilated 1 cm to 2 cm at the beginning of the case. Cervix serially dilated to 25-French. Amniotomy was performed _____ catheter and evacuation performed with Bierer forceps in usual fashion. Amniotomy was then performed on twin B with evacuation in the usual fashion. All instruments and calvariae were accounted for at the end of the case, 14 mm suction catheter used for suction curettage and sharp curettage performed with thin endometrial stripe at the conclusion of the case. Multiple posterior fibroids noted, all intramural. Ultrasound used throughout the entire procedure. Mirena IUD was inserted in the usual fashion.
**** • Thanks a lot. - guy
Sat Sep 23 23:51:15 2017 guy


• SPECIMENS: Products of conception. IMPLANTS: None. IS ...
+ mp3
Sat Sep 23 23:13:42 2017 mp3
SPECIMENS: Products of conception.

IMPLANTS: None.

IS AND OS: In, 1 L of lactated Ringers. Out, _____ cc urine.

ESTIMATED BLOOD LOSS: 300 cc.


** • sorry - poor sound quality, can't get it - ltt
Sat Sep 23 23:23:05 2017 ltt

**** • Thanks for the effort. - guy
Sat Sep 23 23:25:34 2017 guy


• Preoperative Diagnosis: A 34-YEAR-OLD GRAVIDA 6, PARA 1-1-3-0 AT 19 ...
+ wav
Sat Sep 23 23:12:08 2017 wav
Preoperative Diagnosis:
A 34-YEAR-OLD GRAVIDA 6, PARA 1-1-3-0 AT 19 WEEKS 3 DAYS, UNDERGOING ELECTIVE TERMINATION OF PREGNANCY.

Procedure:
EXAM UNDER ANESTHESIA, DILATION AND EVACUATION, REMOVAL OF CERVICAL DILATORS.

FINDINGS: Uterine fundus at the level of the umbilicus. Cervix 3 cm dilated after removal of nine laminaria. No adnexal masses. Cervix dilated serially _____ and noted to have a possibility of cervix to have three prior cervical lacerations and _____ without other abnormal findings. _____ in usual manner with Bierer forceps. All lines _____ endometrial lining with no visible POC at end of case.

i don't know why she is saying so fast in Findings section. dictating normally throughout the report otherwise.
** • the only thing I can get is "cervix dilated serially to 25 French" - ltt
Sat Sep 23 23:21:45 2017 ltt

**** • Thanks a lot. - guy
Sat Sep 23 23:25:40 2017 guy


• Range of motion was full and there was no impingement of the pins on t ...
+ mp3
Sat Sep 23 22:31:54 2017 mp3
Range of motion was full and there was no impingement of the pins on the skin following reduction. The plaster long arm cast was placed on the left upper extremity and _____ to fiberglass. The patient was awakened from anesthesia and taken to recovery room in a stable condition. She remained neurovascularly intact following the procedure.
** • and over-wrapped with fiberglass - ltt
Sat Sep 23 23:04:59 2017 ltt

**** • Thanks a lot. - guy
Sat Sep 23 23:09:02 2017 guy

** • never mind. Thanks to anyone who tried. - guy
Sat Sep 23 22:46:04 2017 guy


• Preoperative Diagnosis: LEFT TYPE 3 SUPRACONDYLAR HUMERUS FRACTURE. ...
+ wav
Sat Sep 23 22:28:49 2017 wav
Preoperative Diagnosis:
LEFT TYPE 3 SUPRACONDYLAR HUMERUS FRACTURE.

Procedure:
LEFT ELBOW CLOSED REDUCTION, PERCUTANEOUS PINNING, CAST PLACEMENT.

POSTOPERATIVE PLAN: The patient will be nonweightbearing on the left upper extremity. She will follow up in approximately one week for a repeat AP and lateral x-rays of the left elbow in a cast. She will _____ followup subsequently in three weeks for pin removal and cast removal at the four-week time point postop.
** • She will then, if reduction is maintained, follow up ... - ltt
Sat Sep 23 23:05:40 2017 ltt

**** • Thanks a lot. - guy
Sat Sep 23 23:09:15 2017 guy

**** • t - guy
Sat Sep 23 23:08:56 2017 guy

** • never mind. Thanks to anyone who tried. - guy
Sat Sep 23 22:45:58 2017 guy


• Both the patient and her mother understood all these risks and wished ...
+ wav
Fri Sep 22 23:27:21 2017 wav
Both the patient and her mother understood all these risks and wished to proceed. We subsequently discussed also resecting the thoracic anterior cervical tumor, but decided to hold off at this time as her symptoms were for cervical spondylosis and her mother also _____.
** • never mind. Thanks to anyone who tried. - guy
Fri Sep 22 23:44:30 2017 guy


• All risks, benefits, and alternatives were discussed with the patient ...
+ mp3
Fri Sep 22 23:18:11 2017 mp3
All risks, benefits, and alternatives were discussed with the patient and her mother. These risks included, but were not limited to bleeding, infection, CSF leak, paralysis, and/or _____, need for tracheostomy, need for perivascular injury leading to stroke, coma, and death.
** • quadriplegia, ____ palsy - poi
Fri Sep 22 23:20:30 2017 poi

** • ERROR: s/b tracheostomy, need for PEG, vascular injury..etc (don't know your blank) - Questyr
Fri Sep 22 23:19:48 2017 Questyr

**** • Thanks a lot. Thanks for the correction everybody. - guy-wag
Fri Sep 22 23:23:21 2017 guy-wag

****** • sorry. "wag" was auotex entry. - guy
Fri Sep 22 23:24:17 2017 guy


• Preoperative Diagnosis: CERVICAL SPONDYLOTIC MYELOPATHY. Pro ...
+ wav
Fri Sep 22 23:08:42 2017 wav
Preoperative Diagnosis:
CERVICAL SPONDYLOTIC MYELOPATHY.

Procedure:
C3 TO C7 LAMINECTOMY AND POSTEROLATERAL INSTRUMENTED FUSION, USE OF ALLOGRAFT, AND AUTOGRAFT.

The patient is a 55-year-old female presenting with subacute and chronic left-sided weakness, arms greater than legs. She reports clumsiness at home leading to multiple falls, subsequently leading to weakness. MRI of the cervical spine revealed cervical spondylosis with severe spinal cord stenosis and some intrinsic _____ signal change. There was also incidentally found _____ heterogeneously enhancing mass. Given the patients symptoms included both arms and legs and the arms were worse than the legs, we believed that the patient was symptomatic on the cervical stenosis and spondylosis.
** • #1 CT - poi
Fri Sep 22 23:12:00 2017 poi

**** • gosh, I am not doing very well tonite. Probably not CT since describing an MRI exam - sorry - poi
Fri Sep 22 23:13:24 2017 sorry - poi

****** • 3-T - poi
Fri Sep 22 23:17:27 2017 poi

******** • just a guess...I still hear CT - poi
Fri Sep 22 23:18:50 2017 poi

** • #2 T4 - poi
Fri Sep 22 23:10:57 2017 poi

**** • hmmm...must be C4? - poi
Fri Sep 22 23:11:18 2017 poi

****** • I do hear T4 - poi
Fri Sep 22 23:14:08 2017 poi

******** • Thanks a lot. - guy
Fri Sep 22 23:16:52 2017 guy


• Both screws obtained excellent purchase of the right-sided ilium and b ...
+ wav
Fri Sep 22 22:27:56 2017 wav
Both screws obtained excellent purchase of the right-sided ilium and both guidewires were removed with _____ wire driver. The final positions of the screws were checked on the AP, inlet and outlet views.
** • I hear M-K wire driver, but not able to verify - fwiw-poi
Fri Sep 22 22:31:02 2017 fwiw-poi

**** • could be saying (um) K-wire driver - poi
Fri Sep 22 22:32:14 2017 poi

****** • Thanks a lot. was hearing "empty"! - guy
Fri Sep 22 22:37:47 2017 guy


• The anterior wound was closed in a layered fashion after thorough ____ ...
+ mp3
Fri Sep 22 21:57:53 2017 mp3
The anterior wound was closed in a layered fashion after thorough _____ irrigation. The linea alba was closed using a running #1 Vicryl suture.
** • bulb syringe - poi
Fri Sep 22 22:16:57 2017 poi

**** • Thanks a lot. - guy
Fri Sep 22 22:26:00 2017 guy


• Preoperative Diagnosis: PELVIS RIGHT VERTICAL SHEAR TYPE FRACTURE D ...
+ wav
Fri Sep 22 21:40:06 2017 wav
Preoperative Diagnosis:
PELVIS RIGHT VERTICAL SHEAR TYPE FRACTURE DISLOCATION.

Procedures:
1. OPEN REDUCTION AND INTERNAL FIXATION OF PUBIC SYMPHYSIS.
2. PERCUTANEOUS TRANSILIAC AND TRANSSACRAL S1-S2 SCREW FIXATION.

The patient was brought to the operating room where general anesthesia was administered. The patient was placed in supine position on a radiolucent table with a small _____ bump under his sacrum. The patients abdomen and pubic symphyseal region was prepped and draped in the usual sterile fashion.
** • one sheet? - poi
Fri Sep 22 22:15:34 2017 poi

**** • Thanks a lot. - guy
Fri Sep 22 22:25:52 2017 guy


• A partially-threaded cannulated screw was placed over the wire across ...
+ wav
Fri Sep 22 20:43:29 2017 wav
A partially-threaded cannulated screw was placed over the wire across the left SI joint and the position of the sacral ala was then checked on obturator outlet views and it was determined that it was not over-compressed by the screw. This first guidewire was then removed. _____ was then repositioned on the slip of the sacral ala, slightly caudal and posterior to the first and then such that it was confirmed on both views to be within a trajectory to cross the sacrum and the S2 osseous pathway such that the wire would be parallel to the first screw placed in both the anterior-posterior and superior-inferior directions
** • never mind. Thanks to anyone who tried. - guy
Fri Sep 22 21:05:22 2017 guy


• At this point, inlet and outlet views of the pelvis were obtained whic ...
+ mp3
Fri Sep 22 19:38:39 2017 mp3
At this point, inlet and outlet views of the pelvis were obtained which demonstrated that the sacral fracture was reduced. Both inlet and outlet views were used to position the guidewire. Appropriate trajectory for the S1 sacral body. _____(6:08) was placed over the wire and then moved to ensure appropriate starting point. The guidewire was then advanced across the SI joint within the S1 osseous pathway and then advanced to the right neural foramen. At this point, the position of the wire was checked on inlet and outlet views and determined to not be in a trajectory such that it would enter the neural foramen.
** • The _______ cannulated instrument ____ - poi
Fri Sep 22 19:45:14 2017 poi

**** • not finding anything...sorry - poi
Fri Sep 22 19:51:45 2017 poi

****** • Thanks for the effort. - guy
Fri Sep 22 19:53:40 2017 guy

******** • never mind. Thanks to anyone who tried. - guy
Fri Sep 22 21:05:35 2017 guy


• At this point, inlet and outlet views of the pelvis were obtained whic ...
+ wav
Fri Sep 22 19:30:43 2017 wav
At this point, inlet and outlet views of the pelvis were obtained which demonstrated that the sacral fracture was reduced. Both inlet and outlet views were used to position the guidewire. Appropriate trajectory for the _____ sacral body
** • I do hear L1, but believe she meant to say S1 - fwiw-poi
Fri Sep 22 19:36:26 2017 fwiw-poi

**** • Thanks a lot. - guy
Fri Sep 22 19:38:08 2017 guy


• compressed by scar and _______ about the biceps muscle belly
+ mp3
Fri Sep 22 17:45:27 2017 mp3
The lateral antebrachial cutaneous nerve was compressed by scar and _______ about the biceps muscle belly at the time of surgery.
** • fascia? - nm
Fri Sep 22 17:57:09 2017 nm

** • fascia - nm
Fri Sep 22 17:56:54 2017 nm

**** • That has to be it, although slightly distorted. Thank you, guys. - mp3
Fri Sep 22 18:23:55 2017 mp3


• The**eye eye** was positioned so as
+ sm
Fri Sep 22 15:09:50 2017 sm

TITLE OF OPERATION: BILATERAL SACROILIAC JOINT INJECTIONS


PROCEDURE: After obtaining informed consent and performing time-out immediately prior to procedure, the patient was placed in the prone position. Once she was adequately sedated, 1% lidocaine skin wheals were raised after prepping and draping her buttocks in sterile fashion. The**eye eye** was positioned so as to bring the anterior and posterior joints into alignment.

** • II - image intensifier (possibly) - taco
Fri Sep 22 17:34:26 2017 taco

** • flagged - -
Fri Sep 22 15:22:55 2017 -


• No suspicious *well* sign.
+ ?
Fri Sep 22 14:23:50 2017 ?
PROCEDURE: The scope was carefully advanced down the oropharynx and into the esophagus under direct visualization and entered into the stomach. Retroflexion was performed. The duodenal bulb was intubated. The scope was withdrawn carefully. Please note the following findings.

ESOPHAGUS: In lateral portion of distal esophagus, there was evidence of grade 2 esophageal varices. No active bleeding. No suspicious _____ sign.

** • wale sign - taco
Fri Sep 22 17:35:55 2017 taco

** • flagging - -
Fri Sep 22 14:54:53 2017 -


• you had no arachnodactyly. Your recent __were both negative
+ WAV
Fri Sep 22 12:32:42 2017 WAV
From a Marfan's perspective, you had no arachnodactyly. Your recent __were both negative
** • your wrist and thumb sign (not "recent") - taco
Fri Sep 22 13:01:49 2017 taco

**** • thank you taco!!! - :)
Fri Sep 22 13:04:05 2017 :)

** • anyone have a guess please!??? - help!!!
Fri Sep 22 12:44:56 2017 help!!!

**** • I was thinking maybe a blood test, but maybe he is saying ___ and son? - cb
Fri Sep 22 13:02:18 2017 cb

**** • sorry, not able to access your WAV; could you pls repost it? - len
Fri Sep 22 12:54:16 2017 len

****** • reposted :) - :)
Fri Sep 22 12:56:45 2017 :)

******** • sorry, must be me, can't access. Do you have a sound like? - len
Fri Sep 22 12:59:18 2017 len


• orthopedic assessment
+ Cleo
Fri Sep 22 08:43:54 2017 Cleo
"Based on his present examination, he has significant impairment in both his axial and appendicular skeleton. This has resulted in s/l **attendant** disability with respect to not only his previous employ but as well as with activities of daily living. He requires further ongoing assistance on a long-term basis in this regard."

Any suggestions on what s/l attendant would be? Thanks!
** • adjective: occurring with or as a result of; accompanying. - may be attendant
Fri Sep 22 08:57:20 2017 may be attendant

**** • Thanks! After thinking further about it, believe it is attendant. ... + Cleo
Fri Sep 22 09:06:19 2017 Cleo
Thanks! After thinking further about it, believe it is attendant.
****** • ... + l d a h o d
Fri Sep 22 23:27:07 2017 l d a h o d


• _____ started for colchicine
+ ?
Fri Sep 22 07:55:23 2017 ?
He was V-paced with R-on-T. Changes were made when the ICD was interrogated and was also noted that the generator was near its ERI. A-fib was treated. Coumadin was started for anticoagulation. ____ was started for colchicine. He was diuresed. Acute on chronic diastolic congestive heart failure was treated.
** • gout (colchicine was started for gout?) - nm
Fri Sep 22 08:30:40 2017 nm

**** • thanks - thought so, she said it backwards - -
Fri Sep 22 08:46:53 2017 -


• INDICATIONS: This is a 58-year-old male who presented to an outside h ...
+ wav
Fri Sep 22 03:58:56 2017 wav
INDICATIONS: This is a 58-year-old male who presented to an outside hospital with three days of epigastric pain and a history of weeks to months of intermittent vomiting of unknown etiology. On presentation to the outside hospital, the patient was diaphoretic and tachycardic. An NG tube was placed. He received a CT scan which showed the NG tube travelling distally into the esophagus, but penetrating the wall into the esophagus and terminating through the pneumoperitoneum, never making it to the stomach. The patient was promptly transferred to our Hospital where a CT surgery and general surgery were consulted and the decision was made to bring the patient to the operating room emergently for an EGD and exploratory laparotomy with possible esophagectomy. Risks, benefits, and alternatives to the procedure were discussed with the patient who at this time was intubated, minimally sedated, and on a small amount of pressors and were also discussed with his sister. They both understood
** • receiving some ___ and fentanyl at that time. - #1
Fri Sep 22 04:44:04 2017 #1

**** • I think the other blank s/l Precedex. - :)
Fri Sep 22 04:44:56 2017 :)

** • #2 writing down appropriate questions. - :)
Fri Sep 22 04:43:08 2017 :)

**** • Thanks a lot. Thanks for the correction. - guy
Fri Sep 22 04:47:34 2017 guy


• A Freer elevator was used to resect the periosteum from the proximal a ...
+ mp3
Fri Sep 22 00:47:52 2017 mp3
A Freer elevator was used to resect the periosteum from the proximal and distal phalanges _____ surgical site. A palpable exostosis was noted on the proximal phalanx and distal phalanx adjacent to the interphalangeal joint.
** • within the? - b o l b o m
Fri Sep 22 08:36:24 2017 b o l b o m

** • never mind. Thanks to anyone who tried. - guy
Fri Sep 22 01:18:14 2017 guy


• The proximal exposure was very well developed and was curetted sharply to expose sm
+ wav :)
Fri Sep 22 00:26:33 2017 wav :)
it to its very medial and lateral ______ respectively, so as to decrease risk of recurrence.
** • sent in. - :)
Fri Sep 22 00:31:48 2017 :)


• Preoperative Diagnosis: _____ AND INTERPHALANGEAL JOINT EXOSTOSIS, ...
+ wav
Fri Sep 22 00:23:51 2017 wav
Preoperative Diagnosis:
_____ AND INTERPHALANGEAL JOINT EXOSTOSIS, LEFT FOOT.

Procedure:
CHEILECTOMY OF IPJ AND EXOSTECTOMY OF THE LEFT _____.

** • sorry, can't get #1 - poi
Fri Sep 22 00:34:10 2017 poi

**** • could he be saying pes planus?? - wag - poi
Fri Sep 22 00:47:18 2017 wag - poi

****** • yeah. thanks a lot - guy
Fri Sep 22 01:06:46 2017 guy

** • 2. hallux - poi
Fri Sep 22 00:25:15 2017 poi

**** • Thanks a lot. - guy
Fri Sep 22 00:44:56 2017 guy


• Throughout his clinical evaluations, he has brought up difficulty with recurrent sm
+ wav :)
Thu Sep 21 23:53:32 2017 wav :)
onychomycosis since _______. He is very diligent about maintenance and has periodically required antibiotics.
** • a youth - poi
Fri Sep 22 00:12:39 2017 poi

**** • Thanks poi. - :)
Fri Sep 22 00:24:52 2017 :)


• She will be given an appointment in the fracture clinic at approximate ...
+ mp3
Thu Sep 21 21:08:41 2017 mp3
She will be given an appointment in the fracture clinic at approximately three weeks postoperatively for possible suture removal. The patient _____ in California and may follow up there for her postoperative care. She has been instructed that she would need to be seen for serial x-ray examinations at six weeks, three months, six months, and one year to ensure appropriate healing of her fracture.
** • does reside - poi
Thu Sep 21 21:14:16 2017 poi

**** • Thanks a lot. - guy
Thu Sep 21 21:25:25 2017 guy


• A 3.5 cortical nonlocking screw was placed from medial to lateral, jus ...
+ wav
Thu Sep 21 20:57:47 2017 wav
A 3.5 cortical nonlocking screw was placed from medial to lateral, just proximal to the apex of the anteromedial fracture fragment, again for buttress type fixation. Fluoroscopic evaluation of _____ confirmed maintenance of fracture reduction and acceptable alignment of the articular surface.
** • NOTE: in case not a typo, s/b buttress-type (with hyphen) as it is + Questyr
Thu Sep 21 22:47:52 2017 Questyr
modifying fixation
** • evaluation at this time - nm
Thu Sep 21 21:25:51 2017 nm

**** • Thanks a lot. - guy
Thu Sep 21 21:35:07 2017 guy

** • this? - poi
Thu Sep 21 21:13:51 2017 poi

**** • Thanks a lot. - guy
Thu Sep 21 21:25:20 2017 guy


• Preoperative Diagnosis: RIGHT TYPE 3 OPEN PILON FRACTURE. Pr ...
+ wav
Thu Sep 21 20:13:07 2017 wav
Preoperative Diagnosis:
RIGHT TYPE 3 OPEN PILON FRACTURE.

Procedure:
OPEN REDUCTION AND INTERNAL FIXATION OF RIGHT PILON FRACTURE.

IMPLANTS: Zimmer six-hole medial distal tibial plate and Zimmer five-hole one-third _____ plate.
** • tubular - poi
Thu Sep 21 20:14:51 2017 poi

**** • Thanks a lot. - guy
Thu Sep 21 20:18:25 2017 guy


• Preoperative Diagnosis: LEFT EXTENSOR POLLICIS LONGUS AND EXTENSOR ...
+ wav
Thu Sep 21 19:47:00 2017 wav
Preoperative Diagnosis:
LEFT EXTENSOR POLLICIS LONGUS AND EXTENSOR POLLICIS BREVIS TENDON LACERATION.

Procedure:
LEFT THUMB EXPLORATION, REPAIR OF EXTENSOR POLLICIS LONGUS AND EXTENSOR POLLICIS BREVIS TENDONS.

The redundant scar and intervening tendon was then excised. At this point, an epitendinous repair was then done using a 6-0 Prolene suture in a running locking stitch. The distal and proximal ends of the tendon were appropriately matched by size. There was excellent gliding and tenodesis and the repair did not _____. Attention was then paid to the extensor pollicis brevis which again appeared to have two slips in the tendon, one slip was in continuity. It was dissected down to its insertion onto the base of the proximal phalanx of the thumb. The other slip appeared to have been lacerated at the level of its insertion.
** • enter underneath the extensor (and then it fades out) - poi
Thu Sep 21 20:00:15 2017 poi

** • ???enter underneath the extensor hood ____??? - Questyr
Thu Sep 21 19:59:42 2017 Questyr

**** • Thanks a lot everybody - guy
Thu Sep 21 20:01:23 2017 guy


• We then pulled tension on our sutures and tied them, ____ in place.
+ mp4
Thu Sep 21 17:11:28 2017 mp4
another 0 FiberWire suture was used, crossed through the center hole and through the tendon and then back out the proximal hole. We then pulled tension on our sutures and tied them, ____ in place. Good apposition of the flexor-pronator mass back to the medial epicondyle was obtained.
** • I think it is....and tied them sutured in place. Thanks - mp4
Thu Sep 21 17:33:48 2017 mp4


• hip surgery s/l en egg nol wire
+ sm
Thu Sep 21 17:10:11 2017 sm
Insufflation with sterile saline with good return confirmed intraarticular position. Next, s/l en egg nol wire was passed to the spinal needle and a 4.5 mm cannula was passed over the guidewire into the hip joint.
** • a Nitinol (see link) + Questyr
Thu Sep 21 18:54:28 2017 Questyr
link
**** • Apparently no need to capitalize it...nitinol...as trademark is dead - Q
Thu Sep 21 18:56:15 2017 Q


• transverse carpal ligament below. _____ thenar musculature ___ radially off of
+ mp4
Thu Sep 21 15:33:32 2017 mp4
This was incised longitudinally. We identified the transverse carpal ligament below. _____ thenar musculature ___ radially off of the transverse carpal ligament. Under direct visualization, we then incised the transverse carpal ligament distally
** • #2 was reflected - Questyr
Thu Sep 21 16:28:37 2017 Questyr

**** • Thank you so much for finding out #2, Questyr - mp4
Thu Sep 21 16:55:54 2017 mp4

****** • I think I can just wing it now and start a new sentence. ..The thenar musculature... - mp4
Thu Sep 21 16:57:18 2017 mp4


• at the level of the fat pad. ________ was obtained.
+ mp4 posted
Thu Sep 21 15:14:13 2017 mp4 posted
Full release of the median nerve to the distal forearm fascia proximally as well as throughout the transverse carpal ligament distally at the level of the fat pad. ________ was obtained. The median nerve was dissected free from underneath the radial leaflet of the transverse carpal ligament just off of the hook of the hamate.
** • Got it now: ..level of the fat pad and 'vascular arch' was obtained. Thanks - mp4 posted
Thu Sep 21 15:25:19 2017 mp4 posted


• sounds like antrahepatic - they did an ultrasound but could not see the gallbladder
+ j h d f a n
Thu Sep 21 14:29:58 2017 j h d f a n
Did a HIDA scan - gallbladder does not demonstrate uptake on the exam. This would be consistent with cholecystitis, either acute or chronic. Dr.xxx saw the patient formally then on 9/20/17 and noted patient with suspected chronic cholecystitis. He was not currently showing evidence of pain or systemic illness but his liver function studies were elevated. He went on further to note that the gallbladder position is mostly ***hepatic

Anterohepatic is what I would like to use but cannot document it anywhere.

I found enterohepatic but the definition does not fit - relating to or denoting the circulation of bile salts and other secretions from the liver to the intestine
** • Found it! intrahepatic - j h d f a n
Thu Sep 21 14:31:09 2017 j h d f a n


• PNH cytogenetics and molecular testing for __ abnormalities
+ WAV
Thu Sep 21 14:22:19 2017 WAV
I note that she is likely to have an underlying diagnosis of a myelodysplasia but given that a bone marrow transplant would be difficult, this will be observed currently with suggestions for a screen for PNH cytogenetics and molecular testing for __ abnormalities
** • myeloid - cb
Thu Sep 21 14:27:41 2017 cb

**** • thank you! - dr
Thu Sep 21 14:48:01 2017 dr


• Preoperative Diagnosis: VISUALLY SIGNIFICANT CATARACT, LEFT EYE. ...
+ mp3
Thu Sep 21 11:00:55 2017 mp3
Preoperative Diagnosis:
VISUALLY SIGNIFICANT CATARACT, LEFT EYE.

Procedure:
CATARACT EXTRACTION WITH PHACOEMULSIFICATION LEFT EYE WITH INTRAOCULAR LENS IMPLANTATION, INSERTION OF CAPSULAR TENSION RING, LEFT EYE.

Next, a temporal biplanar clear corneal incision was created with a 2.8-mm keratome. Next, a continuous curvilinear capsulorrhexis was completed using both a cystotome and a Utrata forceps. It was noted at this time that there was left zonular countertraction inferiorly. Extra care was taken to minimize the _____ placed on the zonules throughout the rest of the case.
** • amount of stress - poi
Thu Sep 21 11:07:46 2017 poi

**** • Thanks a lot. - guy
Thu Sep 21 11:08:00 2017 guy


• The distal aspect of the SVC had the patch made up actually more than ...
+ mp3
Thu Sep 21 10:31:28 2017 mp3
The distal aspect of the SVC had the patch made up actually more than 50% of the circumference and this was also the case in the area of the baffle which was deficient in native SVC tissue. Once this was completed, the patch was closed and found to have an excellent _____, the mechanical ventilation was resumed. The patient was weaned from cardiopulmonary bypass without difficulty. Cardiopulmonary bypass central venous pressures were 8 to 12 whereas preoperatively they were 28 to 33.
** • geometric lie - Sea
Thu Sep 21 10:47:51 2017 Sea

**** • Thanks a lot. - guy
Thu Sep 21 10:48:14 2017 guy


• The patient was systemically heparinized with 300 units/kg of heparin. ...
+ wav
Thu Sep 21 10:21:29 2017 wav
The patient was systemically heparinized with 300 units/kg of heparin. Once we had an appropriate ACT, the _____ cannulated and due to the issues with SVC reconstruction, I elected to cannulate the innominate vein. It was cannulated with a 20-French right-angle angle and the IVC was cannulated with a 28-French right-angle angle. Cardiopulmonary bypass was initiated with excellent drainage. The SVC was inspected and it appeared that there was potential narrowing at the high cannulation site and then a clamp was applied proximally. Distally, the SVC was opened anteriorly and it was noted that the baffle site had narrowed the 4:35
** • ascending? aorta - poi
Thu Sep 21 11:07:19 2017 poi

**** • Thanks a lot. - guy
Thu Sep 21 11:07:49 2017 guy


• FINDINGS OF OPERATION: There were two areas of focal narrowing in the ...
+ mp3
Thu Sep 21 10:10:41 2017 mp3
FINDINGS OF OPERATION: There were two areas of focal narrowing in the distal SVC which was already small, one at the superior aspect of the _____ site, another at the high cannulation site.
** • baffle - nm
Thu Sep 21 10:13:35 2017 nm

**** • Thanks a lot. - guy
Thu Sep 21 10:19:00 2017 guy


• Preoperative Diagnosis: SUPERIOR VENA CAVA OBSTRUCTION, STATUS POST ...
+ wav
Thu Sep 21 10:01:50 2017 wav
Preoperative Diagnosis:
SUPERIOR VENA CAVA OBSTRUCTION, STATUS POST SINUS VENOSUS ATRIAL SEPTAL DEFECT REPAIR.

Procedures:
_____ OF SUPERIOR VENA CAVA.

** • patch reconstruction? - nm
Thu Sep 21 10:12:18 2017 nm

**** • Thanks a lot. - guy
Thu Sep 21 10:19:07 2017 guy


• acute cholecystitis with _____ was diagnosed
+ mp4
Thu Sep 21 08:47:37 2017 mp4
presented to the emergency room of XX Medical Center early in the morning of 09/18 complaining of abdominal pain and acute cholecystitis with _____ was diagnosed.
** • _____ anemia? - cb
Thu Sep 21 09:00:06 2017 cb

**** • ty - -
Thu Sep 21 10:13:27 2017 -


• pulmonary embolism (______), and degenerative
+ wav
Thu Sep 21 08:42:01 2017 wav
Review of the patients medical systems reveals the above-noted acute pancreatitis, chronic venous insufficiency, prior pulmonary embolism (______), and degenerative osteoarthritis including low back syndrome.
** • not sure, but "osteoarthritis complicated by low...." - b o l b o m
Thu Sep 21 09:05:17 2017 b o l b o m

**** • ty - -
Thu Sep 21 10:20:42 2017 -

** • flagging - nm
Thu Sep 21 08:49:10 2017 nm


• present. _______ lesion within
+ mp3
Thu Sep 21 08:37:46 2017 mp3
Abdominal sonography was performed yesterday and revealed probable common bile duct without choledocholithiasis. Prior cholecystectomy was present. _______ lesion within the upper pole of the left kidney was noted. Pancreas and aorta were poorly visualized due to abdominal gas.
** • I hear 'homogeneous' lesions - mn
Thu Sep 21 08:59:11 2017 mn

** • flagged - -
Thu Sep 21 08:48:52 2017 -


• INDICATIONS FOR THE CASE: This is a 37-year-old female with complaints ...
+ mp3
Thu Sep 21 08:27:13 2017 mp3
INDICATIONS FOR THE CASE: This is a 37-year-old female with complaints of throat pain for two months at least. She _____ treated for strep in the ER in the past two months. She continues to report pain with no acid reflux symptoms. She was found to have severe and multiple tonsilloliths in bilateral tonsils in the clinic and the patient opted for surgery to have these removed as they were perhaps causing her pain and halitosis.
** • has been empirically - cb
Thu Sep 21 08:33:17 2017 cb

**** • Thanks a lot. - guy
Thu Sep 21 08:47:13 2017 guy


• Preoperative Diagnosis: CHRONIC TONSILLOLITHS AND TONSILLITIS. ...
+ wav
Thu Sep 21 07:47:08 2017 wav
Preoperative Diagnosis:
CHRONIC TONSILLOLITHS AND TONSILLITIS.

Procedure:
BILATERAL TONSILLECTOMY.

FINDINGS: 2+ tonsil on the right and 1+ tonsil on the left. Bilateral tonsils filled with foul-smelling tonsillolith with _____ on the right.
** • left more than on the right (?) - b o l b o m
Thu Sep 21 08:05:07 2017 b o l b o m

**** • Thanks a lot. - guy
Thu Sep 21 08:26:39 2017 guy


• patient was ______ to Eliquis therapy
+ mp3
Thu Sep 21 07:04:38 2017 mp3
The patient was admitted and started on anticoagulation therapy and O2 support. The patient did have some improvement of her symptomatology. Hematology/oncology consultation was requested and appreciated along with pulmonary. The patient was ______ to Eliquis therapy and sent home with home O2 as well to follow up with PMD, hematology/oncology, and pulmonology as an outpatient.
** • switched over to - mn
Thu Sep 21 07:08:48 2017 mn

**** • thank you - -
Thu Sep 21 07:47:51 2017 -


• He had _____ at the same interspace
+ wav
Thu Sep 21 06:58:31 2017 wav
The #8 contact MRI compatible stimulating electrode was then steered up the posterior epidural space and then the electrode was veered off to left side up to approximately T1-2 interspace level. After this was completed, using a similar technique slightly inferior to the initial needle, he had _____ at the same interspace, a second epidural needle was inserted and a second lead was then steered up off to the right side.



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