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Jan 20 09:26
• for high cholesterol, s/l "step wise therapy"?
+ sm- tia
Fri Jan 20 12:53:03 2017 sm- tia
Her insurance company is asking her to switch from Crestor and try _____ [stepwise] therapy. She has used Lipitor, Zocor and Zetia in the past and had muscle aches. She has not tried pravastatin, which she will try now.

• ferritin 8.9 _____ low level.
+ wav
Fri Jan 20 09:25:21 2017 wav
PHYSICAL EXAMINATION: He is a well-developed, overweight man who is obviously pale. He is alert and nontoxic. Temperature 97.8, blood pressure 118/68, pulse 84. His chest was clear and heart sounds regular. Abdomen was soft with no tenderness or masses.

LABORATORY: His hemoglobin this evening 6.6 g%. It was 4.8 in the emergency room last night. BUN 21, creatinine 0.9, albumin 2.5. LFTs are normal. His iron saturation was 3%, ferritin 8.9 _____ low level.

** • was a low level - what I hear
Fri Jan 20 09:54:52 2017 what I hear

**** • k - ty
Fri Jan 20 10:06:14 2017 ty


• med s/l lumegan
+ sm
Fri Jan 20 07:29:10 2017 sm
As you recall, he is a man with a history of premature ventricular beats. He had good ventricular function. He did wear a 30 monitor and this did demonstrate some bradyarrythmias but he was asymptomatic and rejected additional intervention. He wore a monitor in the last several weeks and this showed 12,000 premature ventricular beats per day. He had couplets but no ventricular tachycardia. The morphology of the PVC suggested left ventricular outflow tract beat.

He is currently on Norvasc, Brilinta, Alphagan, ______, metoprolol and lovastatin.

** • Sorry, got it - Lumigan
Fri Jan 20 07:57:36 2017 Lumigan


• and 65 units at bedtime. 7. _____ 20 mEq daily.
+ pie, mp3
Fri Jan 20 02:36:02 2017 pie, mp3
CURRENT MEDICATIONS: The list was done preoperatively:
1. Carvedilol 25 mg 2 times a day.
2. Clonidine 0.2 mg at bedtime daily.
3. Fenofibrate 54 mg p.o. daily.
4. Ferrous sulfate 324 mg at bedtime daily.
5. Furosemide 80 mg 2 times a day.
6. Humalog insulin subcutaneously 5 units 3 times per day with meals plus sliding scale.
7. Humulin N 60 units in the morning and 65 units at bedtime.
8. _____ 20 mEq daily.
9. Losartan 100 mg every morning.
10. Nifedipine 90 mg every morning.
11. Simvastatin 10 mg every morning.
12. Spiriva 2.5 mcg inhalation every morning.
13. Valsartan 160 mg every morning.
14. Zantac 150 mg p.o. at bedtime daily.

PAST MEDICAL HISTORY: Diabetes, hypertension, hypertensive heart disease with documented heart failure, hyperlipidemia, chronic kidney disease stage III, obesity, history of obstructive sleep apnea.
** • got it. Klor "dash" Con. thanks to any who tried. - mp3 deleted, pie
Fri Jan 20 03:02:14 2017 mp3 deleted, pie


• The wound was prepped and draped in the usual sterile fashion. Antibi ...
+ wav
Fri Jan 20 00:34:44 2017 wav
The wound was prepped and draped in the usual sterile fashion. Antibiotics had been withheld prior to the incision, so as to get back _____ from any wound cultures. The wound was prepped and draped
** • some yield - poi
Fri Jan 20 01:13:21 2017 poi

**** • Thanks a lot. - guy
Fri Jan 20 02:35:33 2017 guy


• A clean margin was obtained from the distal aspect of the metatarsal n ...
+ wav
Fri Jan 20 00:03:57 2017 wav
A clean margin was obtained from the distal aspect of the metatarsal neck at 1, 2, 3, 4, and 5 and sent to pathology for inspection. The remaining soft tissue was _____. The surgical site was then closed
** • revisioned - poi
Fri Jan 20 00:06:03 2017 poi

**** • Thanks a lot. - guy
Fri Jan 20 00:07:03 2017 guy


• Preoperative Diagnosis: A 38-YEAR-OLD WITH PRIMARY INFERTILITY, MYO ...
+ wav
Thu Jan 19 22:05:18 2017 wav
Preoperative Diagnosis:
A 38-YEAR-OLD WITH PRIMARY INFERTILITY, MYOMATOUS UTERUS, AND ENDOMETRIAL POLYP ON ULTRASOUND FOR HYSTEROSCOPY, D&C, ABDOMINAL MYOMECTOMY, CHROMOTUBATION.

Procedure:
HYSTEROSCOPY, D&C, ABDOMINAL MYOMECTOMY, AND CHROMOTUBATION.

The rectus muscle was separated in the midline and the abdominal cavity was entered bluntly without trauma to underlying organs. The incision was then extended inferiorly. A ____ incision was then made to facilitate better abdominal visualization. The uterus was then delivered from the pelvis.
** • I think she means Maylard. - isgal
Thu Jan 19 23:42:41 2017 isgal

** • She's sayng Maynard but it is Maylard incision - e h p h c i
Thu Jan 19 23:42:02 2017 e h p h c i

**** • Thanks a lot everybody - guy
Fri Jan 20 00:04:21 2017 guy


• Following this, a spinal needle was inserted medially into the hip cap ...
+ wav
Thu Jan 19 20:42:45 2017 wav
Following this, a spinal needle was inserted medially into the hip capsule under fluoroscopic guidance and 5 cc of Omnipaque dye were injected into the hip. The arthrogram demonstrated a concentrically reduced hip with minimal medial _____ and the hip was stable at rest.
** • got it. thanks. - guy
Thu Jan 19 20:44:14 2017 guy


• s/l kap-row-sin skin closure (neck node excision)
- kitty
Thu Jan 19 20:34:21 2017 kitty

** • found Caprosyn FYI - itty
Thu Jan 19 20:35:58 2017 itty


• The catheter was cut at about 11 cm and attached to the proximal end o ...
+ mp3
Thu Jan 19 20:09:17 2017 mp3
The catheter was cut at about 11 cm and attached to the proximal end of the valve and secured with a 2-0 Tevdek tie. Next, attention was turned to placement of the _____ of the peritoneum. An abdominal trocar was used to puncture the peritoneum once a facial incision had been made and the distal catheter which had CSF dripping freely was passed into
** • nevermind. - guy
Thu Jan 19 20:21:27 2017 guy


• Procedure: PLACEMENT OF RIGHT OCCIPITAL VENTRICULOPERITONEAL SHUNT. ...
+ wav
Thu Jan 19 20:03:23 2017 wav
Procedure:
PLACEMENT OF RIGHT OCCIPITAL VENTRICULOPERITONEAL SHUNT.

Next, attention was turned to placement of the cranial incision and Hudson brace was used to make the bur hole at the top end of the incision and once the bur hole was sufficient and dura was seen, a straight curette was used to make the _____ slightly larger. A brain needle was used to coagulate the dura along with the monopolar cautery and pass through it as well as to coagulate the pia.
** • nevermind. - guy
Thu Jan 19 20:21:19 2017 guy


• Two screws were utilized for further fixation, the first 30 mm and the ...
+ mp3
Thu Jan 19 18:44:13 2017 mp3
Two screws were utilized for further fixation, the first 30 mm and the second 20 mm. A 10-degree lip liner was then inserted and impacted into the cup and found to be stable. The _____ retractors and anterior acetabular retractor were then removed. The hip was flexed, adducted, and internally rotated to allow exposure of the femoral neck and calcar.
** • wing - poi
Thu Jan 19 18:55:53 2017 poi

**** • Thanks a lot. - guy
Thu Jan 19 18:56:06 2017 guy


• Preoperative Diagnosis: RIGHT HIP AVASCULAR NECROSIS. Proced ...
+ wav
Thu Jan 19 18:30:07 2017 wav
Preoperative Diagnosis:
RIGHT HIP AVASCULAR NECROSIS.

Procedure:
RIGHT TOTAL HIP REPLACEMENT.

We released the inferior capsule to allow for easy retraction of the shaft anteriorly. A ____ retractor was placed superiorly above the acetabulum and the ilium and also posteriorly in the ischium to allow for 360-degree visualization of the acetabulum.
** • wing - poi
Thu Jan 19 18:55:26 2017 poi

**** • Thanks a lot. - guy
Thu Jan 19 18:55:58 2017 guy


• Hyphenate left greater than right?
+ hyphens
Thu Jan 19 18:20:22 2017 hyphens
The patient is a 65-year-old male who on December 9, 2016, had a pancisternal left greater than right subarachnoid hemorrhage.
** • I would, yes. - CO MT
Thu Jan 19 18:21:13 2017 CO MT

**** • ... - thanks
Thu Jan 19 18:25:39 2017 thanks


• Still has ____ septum, particularly anteriorly to the right. (sinus surgery)
+ mp3 posted
Thu Jan 19 16:57:50 2017 mp3 posted
Has had some inferior turbinate reduction procedures in the past. Still has ____ septum, particularly anteriorly to the right.
** • deformity of the - taco
Thu Jan 19 17:04:16 2017 taco

**** • Thanks, taco - mp3 posted
Thu Jan 19 17:05:14 2017 mp3 posted


• s/l 'thin, diffuse' epimacular proliferation. Does that sound right?
+ e a e m g g
Thu Jan 19 16:26:23 2017 e a e m g g
The patient's macula was then dusted with ICG, which was immediately removed with the MVC. This did not stain the ILM, and it became clear that the s/l thin, diffuse epimacular proliferation probably in the form of persistent posterior hyaloidal retinal detachment was present.
** • Sounds reasonable based on description of epimacular proliferation (see link) + Questyr
Thu Jan 19 17:10:30 2017 Questyr
link
**** • Thanks, Questyr! You're such an excellent researcher. - e a e m g g
Thu Jan 19 17:19:04 2017 e a e m g g

****** • Ty. - Q
Thu Jan 19 20:26:38 2017 Q


• s/l DM or diem (see message)
+ mt
Thu Jan 19 14:51:58 2017 mt
The patient reports having CPAP at home though he has never had a CPAP titration. He may benefit from this if there is a need for s/l DM related insurance assistance.

Thinking it might be diem? Does that make sense?
** • DME? (durable medical equipment) + poi
Thu Jan 19 15:16:48 2017 poi
that would be the company which would bill the insurance for CPAP equipment.
**** • That makes more sense - thank you! - mt
Thu Jan 19 15:21:28 2017 mt


• pravastatin, ProAir HFA p.r.n., sertraline, senna, Risperdal, _______, zolpidem.
+ mp3 posted
Thu Jan 19 14:33:29 2017 mp3 posted
note, he said sertraline twice, so omitted second on purpose.
** • tolterodine? - mt
Thu Jan 19 15:13:27 2017 mt

**** • thanks! - OP
Thu Jan 19 15:28:48 2017 OP


• course(?) and caliber of optic nerves?
+ sm- tia
Thu Jan 19 14:05:31 2017 sm- tia
Fundus examination: She did have small tilted optic nerves and a PVD in the left eye. Otherwise, she had normal _____ [course?] and caliber of the vessels.
** • thanks! - op
Thu Jan 19 15:15:08 2017 op

** • makes sense - like the course or paths of the vessels are in the normal locations. - taco
Thu Jan 19 14:17:39 2017 taco


• magnesium, vitamin D, iron, _____ and Protonix, Carafate.
+ wav
Thu Jan 19 12:17:29 2017 wav
PAST SURGICAL HISTORY: Medical history also includes breast lumpectomy, hysterectomy, cholecystectomy, abdominoplasty. A polyp was removed in 1997. She had multiple colonoscopies since then showing diverticular disease only.

MEDICATIONS: Her home medications include calcium, magnesium, vitamin D, iron, _____ and Protonix, Carafate.

** • Xalatan. - billybob
Thu Jan 19 13:23:14 2017 billybob


• med s/l zyleta
+ ?
Thu Jan 19 09:10:01 2017 ?
PAST SURGICAL HISTORY: Medical history also includes breast lumpectomy, hysterectomy, cholecystectomy, abdominoplasty. A polyp was removed in 1997. She had multiple colonoscopies since then showing diverticular disease only.

MEDICATIONS: Her home medications include calcium, magnesium, vitamin D, iron, _____ and Protonix, Carafate.


• s/l act in oh mycosis infection
+ sm
Thu Jan 19 09:04:22 2017 sm
is a 65-year-old woman known to me who called me today because of severe pain. She does have history of prior bariatric surgery, anastomotic ulcers and _____ mycosis infection.
** • you sounded it out well, you just needed to google - actinomycosis. - taco
Thu Jan 19 09:15:57 2017 taco

**** • oh boy, thanks - i googled it differently and couldn't find anything - sorry
Thu Jan 19 09:27:51 2017 sorry

****** • no problem - :)
Thu Jan 19 09:46:29 2017 :)


• A few questions
+ wav
Thu Jan 19 08:42:03 2017 wav
PLAN: Open reduction and internal fixation of fracture with metal plates and screws in the soft tissue ______ medical remission and optimization, n.p.o. after midnight, IV fluids, and follow up and ______ planned for surgical intervention for tomorrow once hardware available and soft tissue _______. The patient was explained risks and benefits of surgical intervention and the patient understands risks of infection, nonunion, malunion, failure of hardware, DVT and compartment syndrome.
** • flagged - -
Thu Jan 19 11:40:40 2017 -


• There is electrodiagnostic evidence of very mild left median mononeuropathy _____
+ mp3
Thu Jan 19 05:09:31 2017 mp3
There is electrodiagnostic evidence of very mild left median mononeuropathy _____/carpal tunnel syndrome with no evidence of ongoing denervation.
** • never mind, got it - op
Thu Jan 19 05:12:20 2017 op


• This is a 35-year-old male who for the past several years has noted an ...
+ wav
Wed Jan 18 23:50:42 2017 wav
This is a 35-year-old male who for the past several years has noted an enlarging left neck mass. On MRI, it appeared to be cystic _____ for a malignant lesion, but given its growing size, the patient requested to have it removed, so we proceeded with the excision of the left neck mass.
** • and unconcerning - poi
Wed Jan 18 23:53:59 2017 poi

**** • Thanks a lot. - guy
Wed Jan 18 23:54:31 2017 guy


• At this point, a small area of tissue was noted that could be the faci ...
+ wav
Wed Jan 18 20:57:52 2017 wav
At this point, a small area of tissue was noted that could be the facial nerve versus a small air cell, so a decision was made to take down the incus _____ and trace the facial nerve _____ portion. Facial nerve was then identified posterior to a small air cell with inflammatory tissue.
** • bar ... from the tympanic - nnm
Wed Jan 18 21:02:33 2017 nnm

**** • Thanks a lot. - guy
Wed Jan 18 21:17:27 2017 guy


• It was noted that the mastoid was not well aerated and there were sign ...
+ mp3
Wed Jan 18 20:46:42 2017 mp3
It was noted that the mastoid was not well aerated and there were significant inflammatory tissues in the _____. As previously noted, there was a small area of dehiscence on the tegmen. A small dural tear was made which will be repaired later in the surgery.
** • air cells - nnm
Wed Jan 18 20:49:46 2017 nnm

**** • Thanks a lot. - guy
Wed Jan 18 20:50:38 2017 guy


• myeloperoxidase antibodies. This raises the concern for s/l tragus-ross syndrome. TIA
+ syndrome?
Wed Jan 18 20:43:38 2017 syndrome?
The lab results revealed positive pANCA with elevated myeloperoxidase antibodies. This raises the concern for ____ syndrome.
** • It is Churg-Strauss. Thank you both for the suggestions. - OP
Wed Jan 18 22:28:00 2017 OP

** • Churg-Strauss ? - nnm
Wed Jan 18 20:50:45 2017 nnm

** • Trousseau syndrome? - guy
Wed Jan 18 20:50:16 2017 guy


• Then, the microscope was brought back in and the posterior EAC skin wa ...
+ wav
Wed Jan 18 20:42:12 2017 wav
Then, the microscope was brought back in and the posterior EAC skin was carefully raised with a Freer and then _____ until the previous posterior horizontal incision was identified and the vasculature was completed using a disposable Beaver blade and was also retracted forward so that the TM was exposed.
** • a duckbill - nnm
Wed Jan 18 20:52:20 2017 nnm

**** • Thanks a lot. - guy
Wed Jan 18 20:53:47 2017 guy


• The polyp was debrided and sent for pathology. There was no obvious p ...
+ mp3
Wed Jan 18 20:35:36 2017 mp3
The polyp was debrided and sent for pathology. There was no obvious perforation; however, there was retraction pocket and a small amount of mucoid fluid was sucked from middle ear. Next, _____ removed, the postauricular incision was made. Palva flap was raised in standard fashion and the area was retracted with cerebellar retractor.
** • got it. thanks. - guy
Wed Jan 18 20:37:09 2017 guy


• 8. Chorda tympani was sacrificed. 9. _____ of sputum was _____wit ...
+ mp3
Wed Jan 18 20:14:11 2017 mp3
8. Chorda tympani was sacrificed.
9. _____ of sputum was _____with small conchal cartilage graft.

** • Erosion of scutum was_____ with small conceal cartilage graft. - Jeannine
Wed Jan 18 20:25:02 2017 Jeannine

**** • ??conceal cartilage?? or is that just a typo? - Q
Wed Jan 18 20:31:35 2017 Q

****** • just a typo . . . sorry - Jeannine
Wed Jan 18 20:35:12 2017 Jeannine

**** • Thanks a lot. - guy
Wed Jan 18 20:27:34 2017 guy

** • #1 Erosion #2 cultured ...BTW not sputum, but scutum - Questyr
Wed Jan 18 20:22:41 2017 Questyr

**** • Thanks a lot. Thanks for the correction. - guy
Wed Jan 18 20:24:07 2017 guy


• 5. Cholesteatoma-filled epitympanum. 6. Stapes including capitell ...
+ wav
Wed Jan 18 20:08:56 2017 wav
5. Cholesteatoma-filled epitympanum.
6. Stapes including capitellum intact. **Long** process of incus and manubrium of malleus also intact; however, head of the malleus and **long** process of incus were eroded.

** • Yes, long process...see pub med link + Questyr
Wed Jan 18 20:21:24 2017 Questyr
link
** • I hear long process of incus. - Jeannine
Wed Jan 18 20:21:06 2017 Jeannine

**** • yes, but i am confused + guy
Wed Jan 18 20:23:51 2017 guy
how can long process of incus be both intact and eroded at the same time?
****** • Now that you bring it to our attention, your question makes sense. I would question it too - Q
Wed Jan 18 20:30:27 2017 Q

******** • i tried to hear short instead of long in first one but clearly saying long in both places - guy
Wed Jan 18 20:32:28 2017 guy


• PACU course was unremarkable. The patient was discharged home the fol ...
+ wav
Wed Jan 18 19:38:07 2017 wav
PACU course was unremarkable. The patient was discharged home the following day due to lack of _____ home.
** • escort - nnm
Wed Jan 18 19:44:07 2017 nnm

**** • Thanks a lot. - guy
Wed Jan 18 19:50:21 2017 guy


• Once large enough and entrance was made into the middle ear, a gimmick ...
+ wav
Wed Jan 18 19:16:38 2017 wav
Once large enough and entrance was made into the middle ear, a gimmick was used to first raise the tympanomeatal flap inferiorly and lift the annulus up. Next, _____ superiorly taking care to preserve the chorda tympani.
** • it was carefully raised superiorly Also, I think it should be: Once large enough, an SM + Jeannine
Wed Jan 18 19:19:59 2017 Jeannine
not and

**** • Thanks a lot. Thanks for the correction. - guy
Wed Jan 18 19:20:20 2017 guy


• Next, attention was turned back to the ear canal. Then, 1:100,000 epi ...
+ mp3
Wed Jan 18 19:04:24 2017 mp3
Next, attention was turned back to the ear canal. Then, 1:100,000 epinephrine was injected superiorly in all four quadrants of the external auditory ear canal. Next, the _____ table was setup to appropriately visualize the posterior, superior part of the tympanic membrane.
** • could she be saying hover? I do find there is such a table, but + Questyr
Wed Jan 18 19:21:51 2017 Questyr
whether it would be used with your surgery I don't know.
** • the hover table - Jeannine
Wed Jan 18 19:21:28 2017 Jeannine

**** • Thanks a lot everybody - guy
Wed Jan 18 19:22:38 2017 guy


• She has had no other history of ear infections or surgeries. Her exam ...
+ wav
Wed Jan 18 18:51:52 2017 wav
She has had no other history of ear infections or surgeries. Her exam was otherwise normal. Her audio showed bilateral severe-to-mild conductive hearing loss _____ at 2000 Hz and good speech discrimination to type A tymps bilaterally.
** • with the notch (see link for google explanation hits) + Questyr
Wed Jan 18 19:08:06 2017 Questyr
link
**** • Thanks a lot. Thanks for the link. - guy
Wed Jan 18 19:09:11 2017 guy


• SURGERIES: Circumcision at birth with dental fillings.
- say what?
Wed Jan 18 17:07:11 2017 say what?

** • just change the with to and - and keep laughing - poi
Wed Jan 18 17:26:12 2017 poi

**** • haha - t
Wed Jan 18 18:21:49 2017 t


• I then placed retractors ____ placed, identified the tibia.
- wav :)
Wed Jan 18 17:03:28 2017 wav :)

** • into place? - poi
Wed Jan 18 17:25:12 2017 poi


• Medacta GMK ___ size 2, right.
- wav :)
Wed Jan 18 16:44:55 2017 wav :)

** • GMK HINGE - poi
Wed Jan 18 16:50:15 2017 poi

**** • thanks poi i kept hearing hang. - :)
Wed Jan 18 16:51:34 2017 :)


• Extremities: No deformities, normal joints without swelling or ____, well perfused,
+ mp3
Wed Jan 18 16:34:18 2017 mp3
negative for edema, negative for clubbing or cyanosis.
** • fluctuance - :)
Wed Jan 18 16:45:40 2017 :)

**** • ... - thanks
Wed Jan 18 17:07:45 2017 thanks


• She had successful stent placement in ____, but unable to cross circumflex with sm
+ wav :)
Wed Jan 18 16:20:35 2017 wav :)
wire and procedure was aborted.
** • RPL (right posterolateral) - taco
Wed Jan 18 16:27:17 2017 taco

**** • Thanks taco! - :)
Wed Jan 18 16:30:31 2017 :)


• The patient was again tried on multiple medications and diuretics in the past and sm
+ wav :)
Wed Jan 18 15:51:54 2017 wav :)
_____ this likely did not improve her symptoms.
** • sent in - :)
Wed Jan 18 16:08:31 2017 :)


• IV antibiotic s/l ma Cubicin IV 500 mg
+ sm
Wed Jan 18 15:37:05 2017 sm
He is also currently on s/l ma Cubicin IV 500 mg.

Only finding cubicin
** • nevermind, saying "the" cubicin - ugh
Wed Jan 18 15:38:05 2017 ugh


• having some generalized weakness, loss of strength, and does not participate in sm
+ wav :)
Wed Jan 18 14:37:23 2017 wav :)
__________. (This guy is terrible)
** • Thanks Questyr. I finally let QC deal wt him. - :)
Wed Jan 18 15:50:47 2017 :)

** • Sorry, I can't help...but, you have my sympathies. - Questyr
Wed Jan 18 15:10:59 2017 Questyr


• SOCIAL HISTORY: ______ unknown.
- wav :)
Wed Jan 18 14:20:34 2017 wav :)

** • largely - taco
Wed Jan 18 14:33:35 2017 taco

**** • Thanks taco. - :)
Wed Jan 18 14:36:31 2017 :)

** • Also? - isgal
Wed Jan 18 14:26:12 2017 isgal

**** • He says also and then changes it. I think maybe he is saying marginally unknown. - :)
Wed Jan 18 14:30:25 2017 :)

****** • He then goes on to say patient lives in a skilled nursing facility, otherwise unknown. - :)
Wed Jan 18 14:31:03 2017 :)


• I surveyed the bladder as best to my entirely. (?How to minimally "fix" grammar)
- mm
Wed Jan 18 13:18:22 2017 mm

** • Difficult to say because I'm not sure what he is + Questyr
Wed Jan 18 15:13:09 2017 Questyr
trying to say, i.e.
a) to best of my ability
b) as best as possible in its entirety.
c) other?

• She was recently for ____ pneumonia as well.
- :) wav
Wed Jan 18 13:01:46 2017 :) wav

** • healthcare-acquired - taco
Wed Jan 18 13:09:07 2017 taco

**** • thanks taco. - :)
Wed Jan 18 13:13:15 2017 :)


• The patient also ______ to have some cough with yellowish sputum and wheezing as well
- :) wav
Wed Jan 18 12:55:34 2017 :) wav

** • Just a guess - allegedly? - j h d f a n
Wed Jan 18 12:59:21 2017 j h d f a n

**** • Yes! Thanks. - :)
Wed Jan 18 13:00:43 2017 :)


• Blank sounds like wobbly or widely. Any ideas. I found 2 past reports and they both
+ j h d f a n
Wed Jan 18 12:22:24 2017 j h d f a n
blanked it.

leftsided *------* trapezial excision suspension arthroplasty
** • Moving on, more than 1 blank now. Thanks. - j h d f a n
Wed Jan 18 12:40:57 2017 j h d f a n

**** • Found it! Weilby - j h d f a n
Wed Jan 18 12:52:55 2017 j h d f a n

****** • good job - thanks for posting. That's a new one for me as well. - t
Wed Jan 18 13:09:31 2017 t


• Gentleman with functioning left upper arm ____ fistula.
- wav :)
Wed Jan 18 12:11:05 2017 wav :)

** • go ahead and post, we got the last wav - t
Wed Jan 18 12:12:10 2017 t

**** • Posted. - :)
Wed Jan 18 12:14:09 2017 :)

****** • AV fistula, I think - b n p p c e
Wed Jan 18 12:17:40 2017 b n p p c e

******** • Ok that was what I thought it should be but I think he is distracted by someone crying sm + :)
Wed Jan 18 12:19:47 2017 :)
in the background.


• intact and stopped the _____ there. The necrotic
+ mp4
Wed Jan 18 12:11:04 2017 mp4
I did see a branch of the nerve and an artery intact and so based on the preoperative exam of having bulk sensation and less than 3 second cap refill, I concluded that patient was neurovascularly intact and stopped the _____ there. The necrotic and ischemic tissues were all sharply excised.
** • exploration - taco
Wed Jan 18 12:11:41 2017 taco

**** • thank - ypi
Wed Jan 18 13:15:41 2017 ypi


• evidenced by a normal ______ and intact tenodesis.
+ mp3
Wed Jan 18 12:10:01 2017 mp3
This was all done under fluoroscopic guidance. Once the bone was in good position and the finger demonstrated good positioning without rotation as evidenced by a normal ______ and intact tenodesis. I then turned my attention to the soft tissue beginning on the volar aspect. The flexor tendon was intact. The injury extended more on the ulnar side of the finger and so this neurovascular bundle was explored due to the avulsion type injury.
** • cascade - taco
Wed Jan 18 12:11:16 2017 taco

**** • thanks - -
Wed Jan 18 13:15:06 2017 -


• significant soft tissue _____ injury and a nailbed
+ wav
Wed Jan 18 12:07:42 2017 wav
This is a 41-year-old gentleman who was working with a piece of machinery at work and thought it to be off; however, upon manipulation, the patients left long finger was pulled into the machine resulting in a comminuted fracture of the middle phalanx, as well as a significant soft tissue _____ injury and a nailbed laceration. The patient presented to the St. Joseph Hospital ED where he was evaluated and consented for surgery. The risks and benefits included prolonged joint stiffness, nonunion, pain et cetera. The patient was willing to proceed.
** • envelope - taco
Wed Jan 18 12:10:45 2017 taco

** • envelope - what I hear
Wed Jan 18 12:10:41 2017 what I hear

**** • thanks - -
Wed Jan 18 13:14:23 2017 -


• ANESTHESIA: ______. (It sounds like he says LMAC, I have heard of MAC, but he sm
+ wav :)
Wed Jan 18 11:55:00 2017 wav :)
says something else after that too).
** • Probably local with monitored anesthesia care (sm) + b n p p c e
Wed Jan 18 12:02:58 2017 b n p p c e
and after that saying Preop and Postop Diagnoses: #1 (can't make the rest out)
**** • Thanks. - :)
Wed Jan 18 12:11:45 2017 :)


• In terms of the wrist, she had a comminuted distal radius *polly's?* type fracture.
- CC
Wed Jan 18 11:17:46 2017 CC

** • Colles - poi
Wed Jan 18 11:18:55 2017 poi

**** • Thank you! - CC
Wed Jan 18 11:22:35 2017 CC


• 4 x 4 gauze, _____ to the right lower extremity
+ mp4
Wed Jan 18 09:53:41 2017 mp4
The foot was then dressed with Xeroform, 4 x 4 gauze, _____ to the right lower extremity. The patient tolerated the procedure and anesthesia well. The patient was brought to the PACU where all postoperative instructions were reinforced.
** • Kling, ____ were applied to the... - e h p h c i
Wed Jan 18 10:17:08 2017 e h p h c i

**** • _____ splint? - poi
Wed Jan 18 11:25:43 2017 poi

****** • thank - you
Wed Jan 18 12:16:40 2017 you


• using two Mitek _____ anchors
+ mp3
Wed Jan 18 09:52:26 2017 mp3
The tendon was reattached to the bone using two Mitek _____ anchors. The remaining deep closure was approximated with #4-0 Vicryl suture. Surgical site was coapted with #4-0 Monocryl and Dermabond.
** • mini QUICKANCHOR - poi
Wed Jan 18 11:23:37 2017 poi

**** • thanks - !
Wed Jan 18 12:15:44 2017 !


• Fluoroscopy was utilized to _____/The _____ bone was sent/removal of the _____ the bo
+ wav
Wed Jan 18 09:51:04 2017 wav
Next, the posterior tibial tendon was identified as attachment at the navicular tuberosity. An incision was made through the superior aspect of the tendon and freed off the navicula. Fluoroscopy was utilized to _____. Small pieces of navicular bone was then removed with an osteotome. The _____ bone was sent off to pathology. Following removal of the _____ the bone, the wound was flushed and irrigated using copious amounts of normal sterile saline.
** • the segment of bone - billybob
Wed Jan 18 10:15:23 2017 billybob

**** • thanks - !
Wed Jan 18 12:11:36 2017 !


• Right _____ block with LMA,
- mp4
Wed Jan 18 09:08:40 2017 mp4


• OPERATION: _____ right foot with mini C-arm.
- mp3
Wed Jan 18 09:06:38 2017 mp3

** • Kidner procedure - taco
Wed Jan 18 09:23:40 2017 taco

**** • thank you - -
Wed Jan 18 09:47:21 2017 -


• Posterior tibial tendon _____ right foot.
+ wav
Wed Jan 18 09:05:07 2017 wav
PREOPERATIVE DIAGNOSIS: Posterior tibial tendon _____ right foot.

POSTOPERATIVE DIAGNOSIS: Posterior tibial tendon _____ right foot.

** • enthesopathy - taco
Wed Jan 18 09:21:59 2017 taco

**** • ty - !
Wed Jan 18 09:46:56 2017 !


• 6. R lateral lower leg: Multiple oval, red, scaling papules. Some of ...
+ wav
Wed Jan 18 02:02:46 2017 wav
6. R lateral lower leg: Multiple oval, red, scaling papules. Some of the lesions were __ angular.
** • patches, not papules. - e h p h c i
Wed Jan 18 07:20:42 2017 e h p h c i

** • Can you get a better audio? Very hard to hear this - isgal
Wed Jan 18 04:25:06 2017 isgal


• Once inside the pleural space, some loose adhesions were noted. They ...
+ wav
Wed Jan 18 00:05:50 2017 wav
Once inside the pleural space, some loose adhesions were noted. They were gently taken down with blunt dissection until we could get clear space and then _____ we were able to takedown the adhesions and inspect the pleural cavity. There was definitely evidence for possible inflammatory process in this space. The area of nodularity
** • working inside the scope in a single port ? - nnm
Wed Jan 18 00:59:24 2017 nnm

** • fyi: perform a takedown, but "take down the adhesions" - nnm
Wed Jan 18 00:57:49 2017 nnm

**** • Thanks a lot. Thanks for the info. - guy
Wed Jan 18 19:11:29 2017 guy

** • nevermind. - guy
Wed Jan 18 00:10:24 2017 guy


• FINDINGS: Exam under anesthesia, normal external female genitalia, no ...
+ wav
Tue Jan 17 23:22:58 2017 wav
FINDINGS: Exam under anesthesia, normal external female genitalia, normal vaginal mucosa, well rugated and pink. Vaginal cuff well healed with no masses noted. No mesh erosion noted. On cystoscopy, friable epithelium with bleeding from trauma _____ urethra. No mesh erosion in bladder. No bladder masses. Bilateral ureteral orifices seen with clear jets of urine.
** • of the scope at? - poi
Tue Jan 17 23:26:40 2017 poi

**** • Thanks a lot. - guy
Tue Jan 17 23:29:56 2017 guy


• Sterile drapes were then applied in the usual fashion. The right brea ...
+ wav
Tue Jan 17 21:31:30 2017 wav
Sterile drapes were then applied in the usual fashion. The right breast was _____ with a latissimus dorsi flap and the right breast incision was opened with a #15 blade along the inferior margin of the prior flap.
** • nevermind. - i j h j b a
Tue Jan 17 21:51:38 2017 i j h j b a


• Preoperative Diagnosis: END-STAGE RENAL DISEASE REQUIRING HEMODIALY ...
+ wav
Tue Jan 17 20:27:30 2017 wav
Preoperative Diagnosis:
END-STAGE RENAL DISEASE REQUIRING HEMODIALYSIS.

Procedure:
LEFT BRACHIOCEPHALIC ARTERIOVENOUS FISTULA CREATION.

The decision was therefore made to proceed with the brachiocephalic AV fistula instead of a radiocephalic AV fistula. Once _____ was complete, the patients left upper extremity was prepped and draped in a sterile and circumferential fashion.
** • the ultrasound - poi
Tue Jan 17 21:20:05 2017 poi




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