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Aug 14 08:24
• Preoperative Diagnosis: RIGHT HAND TRAUMA. Procedure: REP ...
+ wav
Thu Aug 16 20:32:33 2018 wav
Preoperative Diagnosis:
RIGHT HAND TRAUMA.

Procedure:
REPAIR OF RIGHT INDEX FINGER FDP, REPAIR OF THE RIGHT INDEX FINGER ULNAR DIGITAL NERVE WITH NERVE CONDUIT.

The tendon was then placed through the A1 pulley using smooth forceps and the feeding tube was gently retracted distally with the tendon attached and then the proximal FDP tendon was delivered through the tendon sheath. The distal FDS was dissected off of the distal FDP stump and FDS was trimmed back sharply with tenotomy scissors. The distal FDP was freed up. The proximal FDP stump was secured in place with a 25-gauge needle so as to not allow retraction. Using a _____ technique for repair of the flexor tendon, a 4-0 FiberWire core suture was placed in a modified Kessler technique.
** • Tang - poi
Thu Aug 16 20:48:02 2018 poi

**** • Thanks a lot. - guy
Thu Aug 16 20:55:28 2018 guy


• s/l mini essen therapy - list of meds
+ l i e i m d
Thu Aug 16 19:40:48 2018 l i e i m d
patient with hypertension, atrial fibrillation, coronary valve disease, gout, peripheral neuropathy.



• Preoperative Diagnoses: 1. STATUS POST RIGHT TOTAL KNEE ARTHROPLAS ...
+ wav
Thu Aug 16 19:34:43 2018 wav
Preoperative Diagnoses:
1. STATUS POST RIGHT TOTAL KNEE ARTHROPLASTY.
2. PERSISTENT WOUND DRAINAGE.

Procedures:
1. IRRIGATION AND DEBRIDEMENT.
2. POLYETHYLENE EXCHANGE.
3. WOUND VAC PLACEMENT.

We then removed the previously placed polyethylene liner. The wounds were then copiously irrigated with approximately 9 liters of normal saline with antibiotics impregnated. A new polyethylene was then inserted. The medial parapatellar arthrotomy was then closed again using _____.
** • 2-0 V-Loc? - poi
Thu Aug 16 19:38:20 2018 poi

**** • Thanks a lot. - guy
Thu Aug 16 19:38:46 2018 guy


• The abdomen was deflated, and extra few(?)___ of anesthesia ______to evacuate the
+ mp3
Thu Aug 16 16:19:11 2018 mp3
hydrotubation in the retrograde with methylene blue, and easily passed both tubes. She tolerated the procedure well. Case concluded. The abdomen was deflated, and extra few(?)___ of anesthesia ______to evacuate the pelvis. At this time, the ports were removed.
** • Not sure ??? and extra few of anesthesia breaths to evacuate the pelvis??? - Questyr
Thu Aug 16 16:31:49 2018 Questyr

**** • I hear that. NOt sure though. Will use anyway. Thanks again, Questyr - mp3
Thu Aug 16 19:34:07 2018 mp3


• ____________ sample was biopsied and will be sent to Pathology.
+ wav
Thu Aug 16 16:16:35 2018 wav
FINDINGS: She had bilateral patches of dye without resistance with normal-looking tubes, ovaries, and in the cul-de-sac around the uterus-sacrum, she had some areas that could be consistent with endometriosis. ____________ sample was biopsied and will be sent to Pathology.
** • Not sure, but ???A relative??? - Questyr
Thu Aug 16 16:27:24 2018 Questyr

**** • Can't think of anything else myself. Thanks, Questyr - wav
Thu Aug 16 16:30:12 2018 wav


• 30 mL of 0.25% Marcaine with epinephrine were instilled in and around the knee.
+ j h i g p c
Thu Aug 16 15:48:51 2018 j h i g p c
Typed as dictated. Is editing to .'epinephrine WAS instilled...' necessary. Thank you
** • "was" is correct - taco
Thu Aug 16 16:09:55 2018 taco

**** • Thanks, taco - j h i g p c
Thu Aug 16 16:16:14 2018 j h i g p c


• Dictating prescriptions - s/l thenocobalamin. I can find cobalamin but not with the
+ Rx question
Thu Aug 16 15:14:38 2018 Rx question
"theno" . Thanks.
** • cyanocobalamin - taco
Thu Aug 16 15:28:25 2018 taco

**** • I think this is it! Thanks. NM + OP
Thu Aug 16 15:36:00 2018 OP

** • what are exact words before your s/l...understand it is a list of Rx, but is he numbering - them? changing? etc
Thu Aug 16 15:24:25 2018 them? changing? etc

**** • He is just dictating a list without numbers. SM + OP
Thu Aug 16 15:30:38 2018 OP
Her medications include glipizide, lisinopril, multivitamin, ferrous sulfate, thenocobalamine, folic acid, metoprolol, latanoprost eye solution, Eliquis, Xanax, Lipitor, famotidine, oxycodone.

• ortho term, preop dx, not sure what I am hearing. Sm plse
+ tl
Thu Aug 16 13:42:46 2018 tl
Preop Dx:
1. Left great toe traumatic partial amputation through proximal phalanx.
2. **Cuss-low** Anderson.
3. Open fracture.

** • open fractures are ....Gustilo and Anderson - poi
Thu Aug 16 14:20:21 2018 poi

**** • classification for open fracture - poi
Thu Aug 16 14:22:14 2018 poi

****** • thank you very much for your help! - tl
Thu Aug 16 14:24:50 2018 tl


• TAH/BSO surgery, under operative finings, s/l "for 8" pls sm for context
+ tl
Thu Aug 16 12:58:22 2018 tl
1. Right ovarian fibroma.
2. "Normal left ovary s/l ***for 8*** in brackets (atrophic) and also fallopian tube.

There is no clue in the body of the report.
** • ? Normal left ovary for age (atrophic). - ltt
Thu Aug 16 13:11:23 2018 ltt

**** • Thank you thank you thank you!!!! - OP
Thu Aug 16 13:18:07 2018 OP


• This was then opened. Anterior flap was allowed to egress. The inter ...
+ wav
Thu Aug 16 09:45:56 2018 wav
This was then opened. Anterior flap was allowed to egress. The internal auditory canal was then skeletonized carefully around the porus acusticus _____ degrees. A large apical cell superiorly was opened and eventually sacrificed. It would be packed _____ later in the case.
** • 300?? with fat? - taco
Thu Aug 16 09:57:50 2018 taco

**** • I did a search with your terms, and it looks like 300 would fit. - taco
Thu Aug 16 09:59:08 2018 taco

****** • and "packed with fat" makes sense too - t :)
Thu Aug 16 10:00:08 2018 t :)

******** • Thanks a lot. - guy
Thu Aug 16 10:08:34 2018 guy


• A labyrinthectomy was then performed using cutting and diamond burs. ...
+ mp3
Thu Aug 16 09:40:56 2018 mp3
A labyrinthectomy was then performed using cutting and diamond burs. At this point, the internal auditory canal was then identified laterally and dissected medially. The jugular bulb was carefully skeletonized at this point. The dissection was carried medial to the jugular bulb and _____ jugular bulb anteriorly till the _____ was found.
** • around the ... cochlear aqueduct - p o l i j c
Thu Aug 16 09:45:18 2018 p o l i j c

**** • Thanks a lot. - guy
Thu Aug 16 09:46:10 2018 guy


• Preoperative Diagnosis: RECURRENT LEFT VESTIBULAR SCHWANNOMA. ...
+ wav
Thu Aug 16 09:35:15 2018 wav
Preoperative Diagnosis:
RECURRENT LEFT VESTIBULAR SCHWANNOMA.

Procedure:
LEFT TRANSLABYRINTHINE APPROACH FOR RESECTION OF RECURRENT LEFT VESTIBULAR SCHWANNOMA.

This was incised through the skin and subcutaneous tissue down to the level of the periosteum. This was then elevated forward in the supraperiosteal plane and the flap was based on the auricle and eventually held in place with a cerebellar retractor. At this point, a periosteal flap was elevated forward as well and held in place. Now, a _____ mastoidectomy was performed using cutting and diamond burs.
** • wide full? - p o l i j c
Thu Aug 16 09:43:23 2018 p o l i j c

**** • Thanks a lot. - guy
Thu Aug 16 09:45:41 2018 guy


• Preoperative Diagnosis: RIGHT BREAST FIBROADENOMA. Procedure ...
+ wav
Thu Aug 16 08:44:16 2018 wav
Preoperative Diagnosis:
RIGHT BREAST FIBROADENOMA.

Procedure:
RIGHT BREAST EXCISIONAL BIOPSY.

The patient is a 31-year-old healthy lady with bilateral palpable breast masses. Portal biopsies of both were reviewed in interdepartmental conference and a consensus was obtained for a diagnosis of fibroadenoma. The right mass had measured over 2 cm while the left measured 1.2 cm. Risks, benefits, and alternatives were discussed with the patient and the plan was to proceed with right breast excisional biopsy; although, 1.2 cm left fibroadenoma would not be _____ with an ultrasound in six months.
** • will be surveilled with an .... - k d i e m n
Thu Aug 16 09:11:40 2018 k d i e m n

**** • I agree with this - t
Thu Aug 16 09:21:49 2018 t

****** • Thanks a lot everybody - guy
Thu Aug 16 09:35:00 2018 guy

** • would not be surveilled with? - d a c i m b
Thu Aug 16 09:05:22 2018 d a c i m b

** • will be followed up? - billybob
Thu Aug 16 08:59:35 2018 billybob

**** • Thanks a lot. - guy
Thu Aug 16 09:04:22 2018 guy


• CT scan of the abdomen and pelvis personally reviewed by myself shows distended sm
+ wav :)
Thu Aug 16 01:25:01 2018 wav :)
gallbladder with some _____ wall thickening and pericholecystic fluid consistent with acute cholecystitis.
** • wav doesn't match - k d i e m n
Thu Aug 16 07:05:58 2018 k d i e m n


• Preoperative Diagnosis: RIGHT SMALL FINGER OBLIQUE P1 FRACTURE. ...
+ wav
Thu Aug 16 01:21:01 2018 wav
Preoperative Diagnosis:
RIGHT SMALL FINGER OBLIQUE P1 FRACTURE.

Procedure:
OPEN REDUCTION AND PERCUTANEOUS PINNING OF RIGHT SMALL P1 FRACTURE.

A dental tool was used to clean out the fracture as well as the callus. Good mobility of the fragment was noted and a lobster claw was used to bring the fracture out to length as well as to get good reduction. This was confirmed with intraoperative fluoroscopy. Given that there was good reduction, a 0.035 K-wire was then taken in an antegrade manner in a modified _____ technique. The K-wire was taken from the MP joint at the proximal extent of the proximal phalanx of the small finger and was driven longitudinally down in an oblique manner to capture the distal ulnar fragment.
** • never mind. Thanks to anyone who tried. - guy
Thu Aug 16 01:36:14 2018 guy


• Through the sheath, a flexible Glidewire and catheter were then used t ...
+ wav
Wed Aug 15 22:24:39 2018 wav
Through the sheath, a flexible Glidewire and catheter were then used to cannulate the left internal iliac artery. This was confirmed with angiography. The Glidewire was then replaced with a Magic Torque and 12-French sheath was introduced through the 16-French sheath on the right into the left hypogastric artery. A _____ was deployed in the distal left hypogastric artery and this was followed by placement of two internal iliac components ensuring adequate overlap with the iliac branch component.
** • The stent was deployed - poi
Wed Aug 15 22:28:11 2018 poi

**** • VBX stent - guy
Wed Aug 15 22:35:08 2018 guy

**** • Thanks a lot. - guy
Wed Aug 15 22:31:05 2018 guy


• The specimens were then sent for permanent pathology. Due to the pati ...
+ mp3
Wed Aug 15 20:38:38 2018 mp3
The specimens were then sent for permanent pathology. Due to the patients obesity and bowel obstructing also the vision, decisions were made to not proceed with peritoneal biopsies of the diaphragm or right paracolic gutter due to safety concern. Next, the omentum was _____ and was brought down to the pelvis. There was no evidence of disease noted on the omentum.
** • Found this surgical description that talks about packing the omentum (see link) + Questyr
Wed Aug 15 20:49:43 2018 Questyr
link
**** • Thanks a lot. - guy
Wed Aug 15 21:09:51 2018 guy

**** • yes, but what did you hear? - poi
Wed Aug 15 21:08:12 2018 poi

****** • I hear unpacked. - Q
Wed Aug 15 22:35:22 2018 Q

******** • thanks. I wasn't sure. - poi
Wed Aug 15 22:41:08 2018 poi

** • unpacked? uptacted? - poi
Wed Aug 15 20:42:08 2018 poi

**** • untacked - poi
Wed Aug 15 20:42:46 2018 poi

**** • Thanks a lot. - guy-
Wed Aug 15 20:42:36 2018 guy-


• Preoperative Diagnosis: RIGHT ADNEXAL MASS. Procedure: EX ...
+ wav
Wed Aug 15 19:51:06 2018 wav
Preoperative Diagnosis:
RIGHT ADNEXAL MASS.

Procedure:
EXPLORATORY LAPAROTOMY, TOTAL ABDOMINAL HYSTERECTOMY, BILATERAL SALPINGO-OOPHORECTOMY, OMENTECTOMY, AND STAGING PROCEDURE.

The incision was extended cephalad and caudally. The peritoneum was entered bluntly and was extended with electrocautery. The abdomen and pelvis were visually and manually explored. Intraoperative findings are described above. Pelvic washings were then obtained. The right adnexal mass was gently elevated out of the ovary and was noted to be coming from the right ovary and was _____. The right pelvic sidewall was entered using electrocautery and the ureter was identified. A window was made between the ureter and the right IP ligament and the IP ligament was then isolated.
** • detached? - poi
Wed Aug 15 20:45:17 2018 poi

**** • Thanks a lot. - guy
Wed Aug 15 20:46:53 2018 guy


• s/l postal steroids
+ sn
Wed Aug 15 16:03:35 2018 sn
The patient admitted for further evaluation and treatment. Had evaluation by nephrology. Had extensive workup including kidney biopsy. The results are obtained. Preliminary showed membranous glomerulonephritis . The patient started on _____ steroids and had evaluation by rheumatology and started on Rituxan treatment.
** • NOTE: S/B Nephrology and Rheumatology as they are being + Questyr
Wed Aug 15 20:56:14 2018 Questyr
referred to as entities per BoS 2 page 47.
**** • depends on acct specs - where I work, we are not allowed to capitalize those. + (I'm not the OP)
Thu Aug 16 09:18:11 2018 (I'm not the OP)
It's good to point out the rule, just keep in mind "should be" doesn't apply to everyone. I hate that we don't follow the personification rule where I work, but if I capped those entities, I would be "dinged" by QA.
****** • Sorry for the confusion..I thot the "s/b...per BoS 2"...would indicate those + Q
Thu Aug 16 11:06:15 2018 Q
who follow BoS 2 guidelines. Sometimes trying to be brief does not address all points.
** • I think your first interpretation is kinda cute. - jer
Wed Aug 15 19:51:02 2018 jer

** • bolus steroids + link
Wed Aug 15 17:04:41 2018 link
link
** • a burst of steroids? - taco
Wed Aug 15 16:23:56 2018 taco

**** • This is it! - Thanks
Wed Aug 15 21:50:48 2018 Thanks


• X-rays taken showed marked *debonation* of bone and marked narrowing of the joint
+ ?
Wed Aug 15 15:10:01 2018 ?
The patient is a 64-year-old female admitted for elective total hip replacement on the left side. She has been followed in the office, treated with nonsteroidal medication, physical therapy, conservative modalities. X-rays taken showed marked _____ of bone and marked narrowing of the joint space.
** • can you hear "eburnation"? - taco
Wed Aug 15 15:30:01 2018 taco

**** • yep - thanks so much - !
Wed Aug 15 15:53:18 2018 !


• Spironolactone, allicin, _____ dietary supplements, Zyrtec
- mp3 posted
Wed Aug 15 13:45:10 2018 mp3 posted

** • Rosicon? - wag
Wed Aug 15 16:37:26 2018 wag

**** • thanks for the suggestion. - OP
Wed Aug 15 20:48:43 2018 OP


• acute intervention, he will require another *diload*).
+ ?
Wed Aug 15 10:23:16 2018 ?
In addition, he was on IV heparin with a mildly elevated PTT. If he does have a large vessel occlusion, he may still be a candidate for mechanical thrombectomy. I am sending him for a stat MRI of his brain and MRA of his intracranial vessels to assess for LVO (CTA was deferred due to elevated creatinine and the fact that if he needs an acute intervention, he will require another diload).
** • ... - dye load?
Wed Aug 15 10:44:45 2018 dye load?

**** • duh - t
Wed Aug 15 11:16:57 2018 t

****** • thank you - -
Wed Aug 15 11:17:09 2018 -


• echo results. what term fits here? hearing d sound only
+ sm
Wed Aug 15 09:10:37 2018 sm
showed a moderate-sized LAD system with a small branch and diagonal branch. There was no significant disease. Left circumflex with a small ramus with a small to moderate obtuse marginal vessel. No significant atheroma or obstructive disease. Right s/l ___(hearing d sound only) with a moderate-sized PDA. There was no significant atheroma or obstructive disease. The left vein was normal.
** • These are not echo results. Can you refine what your sound-like sounds like? - nm
Wed Aug 15 17:07:28 2018 nm

**** • Yeah - those are cath results. - t
Thu Aug 16 09:20:09 2018 t

**** • Also...it's "the left MAIN was normal" (not vein) - nm
Wed Aug 15 17:10:50 2018 nm

****** • I think your blank is: "LAD with a moderate-sized PDA." Listen for that. + sm
Wed Aug 15 17:15:26 2018 sm
The PDA arises from the LAD.
******** • First sentence: Listen for "LAD system with a SEPTAL branch and diagonal branch" + sm
Wed Aug 15 17:20:28 2018 sm
I think there are some significant problems with your transcription here.

• s/l watchman predicted normals
+ help
Wed Aug 15 08:56:11 2018 help
A recent exercise test performed on August 14, 2018 demonstrated a normal anaerobic threshold with a VO2 max of 84% predicted at the lower limits of normal by the s/l watchman predicted normals.
** • nm - it's Wasserman - help
Wed Aug 15 09:03:31 2018 help

**** • ... + e e b k d c
Thu Aug 16 01:21:09 2018 e e b k d c


• PTSD with s/l dis si mex disorder
+ sm
Wed Aug 15 07:41:51 2018 sm
The patient's diagnosis of posttraumatic stress disorder with dis si mex disorder. Also work trauma.
** • got it, dysthmic - nm
Wed Aug 15 07:45:53 2018 nm

**** • Think you mean dysthymic - Questyr
Wed Aug 15 15:45:09 2018 Questyr


• Preoperative Diagnosis: LEFT INDEX FINGER OSTEOMYELITIS. Pro ...
+ wav
Wed Aug 15 00:09:16 2018 wav
Preoperative Diagnosis:
LEFT INDEX FINGER OSTEOMYELITIS.

Procedure:
LEFT INDEX FINGER AMPUTATION.

INDICATIONS FOR OPERATION: This is a 65-year-old male with a history of laceration _____ to left index finger two weeks ago, now presents with worsening swelling erythema.
** • swelling and erythema. not sure on the blank. I'm late as usual. - k d i e m n
Wed Aug 15 17:29:00 2018 k d i e m n

**** • Thanks for the correction. - guy
Wed Aug 15 19:52:11 2018 guy

** • never mind. Thanks to anyone who tried. - guy-
Wed Aug 15 00:46:36 2018 guy-


• At the end of the core suture, the looped suture was passed onto itsel ...
+ mp3
Tue Aug 14 23:26:50 2018 mp3
At the end of the core suture, the looped suture was passed onto itself and one edge was cut and tied, six knots were tied. The knot was on the outside. There was noted to be minimal _____ of the tendon and no gapping.
** • got it. thanks. + guy
Tue Aug 14 23:31:37 2018 guy
bunching

• Preoperative Diagnosis: RIGHT THUMB FLEXOR POLLICIS LONGUS LACERATI ...
+ wav
Tue Aug 14 23:11:50 2018 wav
Preoperative Diagnosis:
RIGHT THUMB FLEXOR POLLICIS LONGUS LACERATION.

Procedure:
REPAIR OF RIGHT FPL (FLEXOR POLLICIS LONGUS) TENDON.

It was noted that the proximal FPL stump was identified here. A #15 blade was used to vent the A1 pulley and the tendon was delivered into the field. The edges were noted to be somewhat frayed and the edges of the both proximal and distal stump were incised sharply to get to good healthy tendon. The oblique pulley was noted to be relatively intact and was taken care to preserve it. A 4-0 looped FiberWire was used as the core suture and a _____ technique for the core suture was used to reapproximate the tendon. First, a 4-0 looped FiberWire was used
** • never mind. Thanks to anyone who tried. - guy
Tue Aug 14 23:40:19 2018 guy


• Preoperative Diagnosis: TONSILLAR HYPERTROPHY, SLEEP-DISORDERED BRE ...
+ wav
Tue Aug 14 21:55:45 2018 wav
Preoperative Diagnosis:
TONSILLAR HYPERTROPHY, SLEEP-DISORDERED BREATHING, AND RECURRENT TONSILLITIS.

Procedure:
PARTIAL TONSILLECTOMY AND ADENOIDECTOMY.

The patient was brought to the room. General endotracheal anesthesia was administered using a 4.5 endotracheal tube. The patient was then rotated 90 degrees. A Crowe-Davis mouthgag and retractor, size #2, was placed in the mouth. The tonsils were examined and found to be 4+. The adenoids were examined and found to be _____ occlusive of the choana using a dental mirror.
** • I hear "____ percent" - Questyr
Tue Aug 14 22:03:39 2018 Questyr

**** • Thanks a lot. - guy
Tue Aug 14 22:05:25 2018 guy


• All counts were correct at the conclusion of the procedure. There wer ...
+ wav
Tue Aug 14 20:09:26 2018 wav
All counts were correct at the conclusion of the procedure. There were no known complications during the procedure. Doctor was present and scrubbed through all key portions of the procedure. At the present time, we were awaiting extubation by the Anesthesia team _____.
** • team and further neurologic exam. ... + f o h h b h
Tue Aug 14 20:18:47 2018 f o h h b h
team and further neurologic exam.
** • never mind. Thanks to anyone who tried. - guy
Tue Aug 14 20:16:20 2018 guy


• Several surrounding petrosal veins were coagulated. We followed this ...
+ mp3
Tue Aug 14 19:55:40 2018 mp3
Several surrounding petrosal veins were coagulated. We followed this plane down until the _____ was visualized and the middle cerebellar peduncle was visualized. Tumor was elevated and systematically aspirated with _____ aspirator.
** • The second one might be ultrasonic. I see ultrasonic aspirators in Stedman's Neuro. - nm
Tue Aug 14 20:36:10 2018 nm

** • I think the first one may be brainstem. - nm
Tue Aug 14 20:33:26 2018 nm

**** • Thanks a lot. - guy
Tue Aug 14 21:56:07 2018 guy

** • sorry, can't get these - poi
Tue Aug 14 20:07:12 2018 poi

**** • Thanks for the effort. - guy
Tue Aug 14 20:09:08 2018 guy

****** • never mind. Thanks to anyone who tried. - guy
Tue Aug 14 20:16:26 2018 guy


• ...
- mp
Tue Aug 14 19:55:29 2018 mp


• We worked systematically around the tumor with bipolar electrocautery ...
+ mp4
Tue Aug 14 19:46:33 2018 mp4
We worked systematically around the tumor with bipolar electrocautery with the Rhoton #3 and Rhoton #5 instruments as well as with the duckbill elevator. The tumor had very poor _____ in all directions and thus the dissection proved to be very challenging.
** • planes - poi
Tue Aug 14 20:04:27 2018 poi

**** • Thanks a lot. - guy-
Tue Aug 14 20:09:44 2018 guy-

** • I don't hear anything for mp4 - poi
Tue Aug 14 19:49:23 2018 poi

**** • posted wav. thanks - guy
Tue Aug 14 19:52:17 2018 guy


• The neurosurgery team performed the incision. An initial dissection _ ...
+ mp3
Tue Aug 14 19:40:52 2018 mp3
The neurosurgery team performed the incision. An initial dissection _____ the edges of the prior craniectomy with care to avoid the underlying _____. Once we had achieved exposure anterior to the craniectomy, the otolaryngology team took over and performed a translabyrinthine drillout, which will be dictated separately.
** • finding...cerebellum - poi
Tue Aug 14 19:48:26 2018 poi

**** • Thanks a lot. - guy-
Tue Aug 14 19:52:32 2018 guy-


• On the day of the procedure, the patient was laid supine into the oper ...
+ wav
Tue Aug 14 19:32:58 2018 wav
On the day of the procedure, the patient was laid supine into the operating theater. She was transferred to Mizuho bed. Headpins were applied and the patient was turned to the right into the near lateral position so that we could access her prior retroauricular incision. Antibiotics were given. A time-out was performed. Decadron was given. The patient was prepped and draped in the usual fashion. The abdominal _____ were prepped for abdominal fat graft. The neurosurgery team performed the incision.
** • regions? - poi
Tue Aug 14 19:47:33 2018 poi

**** • Thanks a lot. - guy
Tue Aug 14 19:52:27 2018 guy


• Preoperative Diagnosis: LEFT KNEE ANTERIOR CRUCIATE LIGAMENT TEAR, ...
+ wav
Tue Aug 14 18:59:01 2018 wav
Preoperative Diagnosis:
LEFT KNEE ANTERIOR CRUCIATE LIGAMENT TEAR, LATERAL MENISCUS TEAR.

Procedure:
LEFT KNEE ARTHROSCOPY, ARTHROSCOPIC ACL REPAIR, AND LATERAL MENISCUS DEBRIDEMENT.

The patient was brought to the operating room and placed supine on the operating room table. All bony prominences were padded and a non-sterile thigh tourniquet was applied. Anesthesia was induced and the left lower extremity was prepped and draped in the usual sterile fashion. A diagnostic knee arthroscopy was then performed using two 0.25-inch incisions and demonstrating a normal patellofemoral compartment, medial compartment, and a low-grade partial tear of the origin of the ACL, as well as a completely deficient lateral meniscus with significant _____ remodelling of the posterior horn as well as grade 2 chondral changes on the lateral tibial plateau.
** • bulbous - poi
Tue Aug 14 19:04:30 2018 poi

**** • Thanks a lot. - guy
Tue Aug 14 19:07:52 2018 guy


• A KLS s/l*ladder* plate was then placed over the body of the sternum and fixed to the
+ SM
Tue Aug 14 14:52:33 2018 SM
A 24-French Blake drain was placed in the anterior mediastinum. A 24-French Blake drain was placed in the left chest. The sternum was reapproximated with #7 sternal wires and sternal cables. Secondary to the sternum being thin, it was also repaired with rigid sternal fixation. A KLS s/l*ladder* plate was then placed over the body of the sternum and fixed to the left hemisternum with screws. The cables were secured over the plate and the right side of the plate was fixed to the right hemisternum with screws.
** • I find there is a KLS sternal talon plate (see link) + Questyr
Tue Aug 14 18:42:22 2018 Questyr
link
**** • so I'm thinking ladder might be talon - Q
Tue Aug 14 22:06:07 2018 Q


• soft on his blood pressure in the "110 to one-teens". sm
+ val c.
Tue Aug 14 13:51:35 2018 val c.
I know one-teens is written 110s, but how do I make this not look odd? Thank you
** • if that's what was dictated, "one-tens to one-teens." - billybob
Tue Aug 14 16:57:57 2018 billybob

** • If you can, I would just put "in the 110s" because that covers "110 to one-teens" - taco
Tue Aug 14 13:52:46 2018 taco

**** • thanks taco. Verbatim, though. 110 to one-teens? nm - p b j f o o
Tue Aug 14 13:55:46 2018 p b j f o o

****** • I guess so, or 1-teens (our style guide here says to use 1-teens, but I hate that) - taco
Tue Aug 14 14:04:43 2018 taco


• 62yo male with chronic osteo with Staph aureus. sm plse
+ nt
Tue Aug 14 13:34:49 2018 nt
I don't know what doc is referring to with "osteo". This is an infectious disease consult. There is no clue in the rest of the report, except he refers to "the wound". In an old report, there is reference to an infected tib-fib plate.


** • osteomyelitis - taco
Tue Aug 14 13:51:54 2018 taco

**** • thank you! - nt
Tue Aug 14 16:28:36 2018 nt


• Help please s/l * burbages * sm. TIA
+ TC
Tue Aug 14 13:12:14 2018 TC
The ** are not consistent with the expansile nature of the femoral and tibial tunnels.
** • blurred edges? - poi
Tue Aug 14 13:27:02 2018 poi


• The left ovary was adhesed to the sidewall and the s/l**valvis** was meticulously fre
+ SM Please
Tue Aug 14 12:42:20 2018 SM Please
The round ligaments were taken down with the Harmonic scalpel. The bladder was taken down sharply and without complication. The left ovary was adhesed to the sidewall and the s/l**valvis** was meticulously freed until all of the anatomy had been restored to normal. There were some powder-burn lesions of the posterior cul-de-sac, which were fulgurated and no other endometriosis visible.
** • ?volvulus - nm
Tue Aug 14 12:44:54 2018 nm


• Preoperative Diagnoses: 1. BILATERAL DISTAL ONE-THIRD SPIRAL TIBIA ...
+ wav
Tue Aug 14 08:35:50 2018 wav
Preoperative Diagnoses:
1. BILATERAL DISTAL ONE-THIRD SPIRAL TIBIAL SHAFT FRACTURES.
2. BILATERAL POSTERIOR MALLEOLUS FRACTURES.
3. AORTIC STENOSIS.

Procedures:
1. INTRAMEDULLARY NAILING, BILATERAL TIBIA FRACTURES.
2. PERCUTANEOUS FIXATION, BILATERAL POSTERIOR MALLEOLUS FRACTURES.

Due to her extensive cardiac risk profile, a decision was made with the cardiac and cardiothoracic surgery teams to further have the patient undergo a left heart cath and aortic balloon valvuloplasty followed by fixation of her tibia fractures and with plans for likely a _____ later in the week.
** • TAVR (transcatheter aortic valve replacement) - taco
Tue Aug 14 09:03:15 2018 taco

**** • Thanks a lot. - guy
Tue Aug 14 09:07:34 2018 guy


• Also, in the midline the Scarpas fascia was incised above the umbilic ...
+ mp3
Tue Aug 14 02:52:40 2018 mp3
Also, in the midline the Scarpas fascia was incised above the umbilicus. Once the progressive tension sutures were all placed, the Scarpas was repaired from the upper abdominal flap to the _____ using 2-0 Vicryl in a buried fashion.
** • mons area - k d i e m n
Tue Aug 14 06:36:48 2018 k d i e m n

**** • Thanks a lot. - guy
Tue Aug 14 08:36:35 2018 guy

** • never mind. Thanks to anyone who tried. - guy
Tue Aug 14 03:08:49 2018 guy


• Preoperative Diagnosis: MASSIVE WEIGHT LOSS WITH ABDOMINAL PANNUS A ...
+ wav
Tue Aug 14 02:40:34 2018 wav
Preoperative Diagnosis:
MASSIVE WEIGHT LOSS WITH ABDOMINAL PANNUS AND RECTUS DIASTASIS.

Procedure:
PANNICULECTOMY.

Dissection of the abdominal flap then continued around the umbilicus to the level of the costal margins bilaterally and the xiphoid superiorly. Once this was reached, hemostasis was achieved. The patient had _____ estimate the superior limit of the resection which was at a level approximating that which had been marked preoperatively just above the umbilicus.
** • had her ___ reassessed at he superior??? probably wrong. - k d i e m n
Tue Aug 14 06:38:31 2018 k d i e m n

**** • *the* not he. - k d i e m n
Tue Aug 14 06:38:49 2018 k d i e m n

****** • Thanks a lot. - guy
Tue Aug 14 08:36:26 2018 guy

** • never mind. Thanks to anyone who tried. - guy
Tue Aug 14 03:08:41 2018 guy


• Images were stored in the **Eyesight System**.
+ Can't verify/SM
Mon Aug 13 15:16:17 2018 Can't verify/SM
We then retrieved the enema catheter and allowed the rectum to decompress. Images were stored in the **Eyesight System**. The surgeon afforded real-time interpretation of the study, displaying an ileocolic stenosis that will require operative intervention.
** • I believe it is "iSite" check it out in the context of intraop imaging -looks like it fits - taco
Mon Aug 13 15:21:43 2018 taco


• On latanoprost nightly and on _____ s/l "gareen-top" every morning.
+ tia
Mon Aug 13 14:04:42 2018 tia
Patient has cystoid macular edema and cataracts.
** • Gilenya topical (top for short)? - k d i e m n
Mon Aug 13 16:39:05 2018 k d i e m n

**** • or Gilenya drop? - k d i e m n
Mon Aug 13 16:39:52 2018 k d i e m n


• Dictated, after anesthesia, Ancef 1 g. ANESTHESIA: General end ...
+ e a e c d c
Mon Aug 13 11:22:00 2018 e a e c d c
Dictated, after anesthesia, Ancef 1 g.

ANESTHESIA: General endotracheal.

INTRAVENOUS: Ancef 1 g.

The heading Intravenous by itself does not look right. Should I add intravenous injection, intravenous addition? Any ideas?

Thank you

** • ANTIBIOTICS: Intravenous Ancef 1 g? - cb
Mon Aug 13 12:51:59 2018 cb

** • was intravenous dictated? Maybe just medications? - poi
Mon Aug 13 12:00:57 2018 poi

**** • Hi poi. No, I got the intravenous from body of report. I think Ancef 1 g is only available + e a e c d c
Mon Aug 13 13:18:57 2018 e a e c d c
through IV, but I may be wrong.

Antibiotics is a sufficiently enough heading. Thank you!
****** • I agree, just would not have added, that is why I asked if dictated. - poi
Mon Aug 13 14:13:00 2018 poi

** • I decided on Intravenous Antibiotic but open to other suggestions. Thanks - e a e c d c
Mon Aug 13 11:27:40 2018 e a e c d c

**** • Don't do that. If you must have a heading, Type: Other - nm
Mon Aug 13 18:04:49 2018 nm


• It is not unusual with a temporary malabsorption of the purees that it can cause a __
+ mp3
Mon Aug 13 10:30:54 2018 mp3
It is not unusual with a temporary malabsorption of the purees that it can cause a ____ diarrhea and acid rash.
** • can cause explosive diarrhea - ltt
Mon Aug 13 10:39:35 2018 ltt

**** • ... - thanks a lot
Mon Aug 13 10:44:22 2018 thanks a lot


• The patient has bilateral vocal cord polyps on clinical exam in the of ...
+ wav
Sun Aug 12 20:12:55 2018 wav
The patient has bilateral vocal cord polyps on clinical exam in the office. He understands benefits, alternative, risks _____________ sequentially.
** • I think I hear "procedure(s)" ???? but really not sure - Q
Sun Aug 12 20:26:40 2018 Q

** • Clip is defective. Repost the clip. - Questyr
Sun Aug 12 20:13:58 2018 Questyr

**** • ... - wav reposted
Sun Aug 12 20:20:43 2018 wav reposted

****** • Could you make the clip a little longer and a little louder...if not, I can't get it from + Questyr
Sun Aug 12 20:25:53 2018 Questyr
this...sorry.
******** • Thanks, Questyr. It is a little longer now and louder. - wav
Sun Aug 12 20:29:36 2018 wav

********** • more text now: + wav
Sun Aug 12 20:30:22 2018 wav
INDICATIONS: As mentioned above. The patient has bilateral vocal cord polyps on clinical exam in the office. He understands benefits, alternative, risks ______________ sequentially.

DESCRIPTION OF PROCEDURE: Tooth guard placed. Hypopharynx, larynx systematically examined.
************ • I only hear him say "procedures, procedures, procedures" and that + Q
Sun Aug 12 20:35:15 2018 Q
really doesn't fit in with what you've got posted. I rebooted my computer to see if it had loaded the correct WAV, but I heard the same thing again.
************** • after the sequentially he says: Paragraphs, procedures. Which is the next heading. - wav
Sun Aug 12 20:39:02 2018 wav

**************** • Bummer! He says paragraph, procedures. - wav
Sun Aug 12 20:39:27 2018 wav

****************** • Sorry...can't get it. - Q
Sun Aug 12 20:42:12 2018 Q

******************** • Thanks so much for trying, Q! Will have to flag - wav
Sun Aug 12 20:44:05 2018 wav


• ENT
+ abc
Sun Aug 12 16:42:56 2018 abc
s/l thyrocece cytomolecular genetic testing was performed
** • ThryoSeq - nm
Mon Aug 13 09:11:35 2018 nm

**** • Typo - sorry: ThyroSeq - nm
Mon Aug 13 09:11:55 2018 nm


• Preoperative Diagnosis: TYPE 1 CHOLEDOCHAL CYST. Procedure: ...
+ wav
Sat Aug 11 10:17:50 2018 wav
Preoperative Diagnosis:
TYPE 1 CHOLEDOCHAL CYST.

Procedure:
OPEN RESECTION OF CHOLEDOCHAL CYST AND ROUX-EN-Y CHOLEDOCHOJEJUNOSTOMY.

At this point, we decided to divide the common bile duct with a #15 blade proximal to the cyst to aid in posterior dissection. A 2-0 Vicryl suture was placed on the distal duct containing the choledochal cyst to aid in retraction. We then dissected down to the level of normal appearing duct behind the head of the pancreas and the cyst was resected from the duct distally with a #60 _____ Endo GIA stapler. All hemostasis was achieved and the stapled end of the common bile duct was not bleeding.
** • gold ski-tip - poi
Sat Aug 11 10:32:20 2018 poi

**** • Thanks a lot. - guy
Sat Aug 11 10:39:16 2018 guy


• Preoperative Diagnosis: TYMPANIC MEMBRANE PERFORATION. Proce ...
+ wav
Sat Aug 11 07:32:07 2018 wav
Preoperative Diagnosis:
TYMPANIC MEMBRANE PERFORATION.

Procedure:
ENDOSCOPIC TYMPANOPLASTY WITH TRAGAL CARTILAGE GRAFT.

This is a 65-year-old female who was referred to us for otorrhea for several months and has been on and off for 10 to 20 years, no otalgia, but has had pain in the past, occasional episodes of vertigo, but _____. She eventually _____ that she feels air coming out of her ears. No history of otologic surgery.
** • but unfortunately cannot quantify how often? eventually said that... - k d i e m n
Sat Aug 11 08:02:58 2018 k d i e m n

**** • Thanks a lot. - guy
Sat Aug 11 08:07:00 2018 guy


• A soft tip was then brought into the operative field and three rounds ...
+ wav
Fri Aug 10 23:11:41 2018 wav
A soft tip was then brought into the operative field and three rounds of repeated air-fluid exchange were performed taking care to remove the silicone oil at the meniscus between the fluid and the air. A final partial air-fluid exchange was performed _____ about 50% BSS and 50% air. Careful inspection of the retina noted that it was still intact with no visible _____ after the removal of the oil. The instruments were then removed from the eye.
** • 1. leaving 2. change? - poi
Fri Aug 10 23:14:08 2018 poi




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