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May 12 17:11
• Left midfoot fractures with a stable Lisfranc.
+ sm please
Tue Aug 30 05:51:19 2016 sm please
Palpation through her forefoot and midfoot elicits general tenderness everywhere. There is nothing more grossly tender than another area. She expresses pain at the Lisfranc joint and across the entire s/l team teal-ing. She also expresses pain at all of her metatarsophalangeal joints. At the ankle, she has pain with palpation of the anteromedial malleolus as well as the medial talar dome.
** • TMT line (tarsometatarsal line)? - Oasis
Tue Aug 30 07:01:48 2016 Oasis


• It did reveal a subacute infarction involving the left frontotemporal __________ sm
+ :) wav
Tue Aug 30 02:42:10 2016 :) wav
left frontal and parietal cortex/subcortical white matter, as well as right insular cortex/subcortical white matter.

• The left groin was prepped and draped in the usual sterile fashion. A ...
+ wav
Tue Aug 30 02:07:56 2016 wav
The left groin was prepped and draped in the usual sterile fashion. An incision was made in a natural skin crease _____ the inguinal ligament over the hernia. The incision was deepened through the subcutaneous tissue, transverse fascia _____ maintaining careful hemostasis with electrocautery.

• Looking for a place in Texas that s/l Ver-tog-a.
- :)
Tue Aug 30 01:34:03 2016 :)

** • A place as in a city or area...or as in a facility of some kind...or other? - Questyr
Tue Aug 30 01:51:24 2016 Questyr

**** • I find a city called Victoria. - Q
Tue Aug 30 01:52:46 2016 Q

****** • Sorry this was some time ago. Already sent it in. Thanks though. - :)
Tue Aug 30 02:18:49 2016 :)


• Her symptoms are mainly when she turns her head to the left there was a concern sm
+ :) wav pending
Mon Aug 29 23:57:12 2016 :) wav pending
about nicking of __________ so the vascular surgeon was consulted
** • Got this. - :)
Tue Aug 30 00:16:31 2016 :)


• The fetal head was delivered with the baby in LOT position. There was ...
+ WAV
Mon Aug 29 22:29:28 2016 WAV
The fetal head was delivered with the baby in LOT position. There was no nuchal cord. The infant was delivered in excellent condition _____. The umbilical cord was doubly clamped and cut and cord gases were obtained. The infant was immediately handed to the pediatric care providers. Apgars were 9/9.

• This was cut sharply with a knife and then dissected down the Scarpas ...
+ guy
Mon Aug 29 21:35:33 2016 guy
This was cut sharply with a knife and then dissected down the Scarpas fascia with the Bovie beveling inward **sub-Scarpally**
** • just subscarpally, imo. like Bovie becomes bovied, etc. - nnm
Mon Aug 29 23:10:55 2016 nnm

**** • Thanks a lot. - guy
Tue Aug 30 01:08:05 2016 guy


• An antimesenteric enterotomy was performed 5 cm proximal to the end of ...
+ mp3
Mon Aug 29 20:44:28 2016 mp3
An antimesenteric enterotomy was performed 5 cm proximal to the end of the Roux limb about one half of the length of the bile duct and an end-to-side two-layer interrupted anastomosis was performed using 4-0 PDS for the _____ and 2-0 Vicryl for the _____. An 8-French pediatric feeding tube was placed
** • #1 underlayer #2 inner layer? - :)
Mon Aug 29 23:54:00 2016 :)

** • nevermind. - e o e g a o
Mon Aug 29 21:03:19 2016 e o e g a o


• The caudate lobe was included in the specimen. The rest of the parenc ...
+ wav
Mon Aug 29 20:33:11 2016 wav
The caudate lobe was included in the specimen. The rest of the parenchyma was taken with a serial _____ 60 mm lobes using the Endo GIA stapler.
** • with serial tan 60 mm loads (not lobes) + sorry i'm late
Mon Aug 29 21:18:03 2016 sorry i'm late
(Got interrupted by the phone)
**** • ... + e o e g a o
Mon Aug 29 21:37:04 2016 e o e g a o

**** • Thanks a lot. - guy
Mon Aug 29 21:33:20 2016 guy

** • nevermind. - guy
Mon Aug 29 21:03:13 2016 guy


• and he decided to come to the hospital for evaluation one week after t ...
+ mp3
Mon Aug 29 19:26:18 2016 mp3
and he decided to come to the hospital for evaluation one week after this as his occlusion and his pain were not improved. _____ the patient via transfascial incisions given the extensive visit _____ and location of fractures _____ the patient understood. All risks and benefits of the surgical plan were explained to the patient including facial paraesthesia.
** • can't get #1 or #2 - poi
Mon Aug 29 19:55:42 2016 poi

**** • Thanks for the effort. flagging. - guy
Mon Aug 29 19:56:08 2016 guy

** • #3. Which the patient. - poi
Mon Aug 29 19:54:45 2016 poi

**** • Thanks a lot. - guy
Mon Aug 29 19:55:30 2016 guy


• presented to the emergency room one week after assault with complaint ...
+ wav
Mon Aug 29 19:20:37 2016 wav
presented to the emergency room one week after assault with complaint of malocclusion. He reported that he had initially presented to _____ Hospital after the assault
** • got it. thanks. + guy
Mon Aug 29 19:50:18 2016 guy
Lenox Hill Hospital

• 5 pounds of skeletal traction was applied *through finger traps. *
+ sm
Mon Aug 29 15:41:37 2016 sm
PROCEDURE: The left wrist was identified and informed consent was obtained. All questions were answered at which point the left wrist was blocked using hematoma block with 1% lidocaine. Once the wrist was anesthetized, 5 pounds of skeletal traction was applied through finger traps.
** • Once the *deformed courses were* fatigued and closed - somes right after + sm
Mon Aug 29 15:42:49 2016 sm
is a very pleasant 87-year-old female who sustained a left intra-articular comminuted shortened distal radius fracture. I was consulted for treatment. I saw the patient, evaluated the patient, diagnosed her with same injury. I have discussed and attempted closed reduction and the patient was amenable. The risks, benefits, and alternatives, after care were discussed, at which point, the patient elected to proceed with the closed reduction to attempt to pursue nonoperative treatment. The patient did understand that there is persistent displacement and this would need ORIF surgical procedure.

PROCEDURE: The left wrist was identified and informed consent was obtained. All questions were answered at which point the left wrist was blocked using hematoma block with 1% lidocaine. Once the wrist was anesthetized, 5 pounds of skeletal traction was applied to finger traps. Once the *deformed courses were* fatigued and closed reduction was attempted with hyperexaggeration of the def
**** • I'd want to hear it. I cannot any such exact phrase with orthopedic reference. It + Questyr
Mon Aug 29 16:31:16 2016 Questyr
sounds like he's referring to anatomical deformities (caused by the injury) which he's trying to correct before applying the sugar tong. I just can't confirm that expression. Sorry.
****** • oops..left out a word...I can find any such etc.. - Q
Mon Aug 29 16:31:50 2016 Q

******** • thank you - -
Tue Aug 30 06:58:22 2016 -


• The risk of ___ metastases is still small, although present but once again, I
+ WAV
Mon Aug 29 13:56:29 2016 WAV
We can then decide whether or not to repeat his colonoscopy down the track to look for mucosal recurrence. The risk of ___ metastases is still small, although present but once again, I believe, not worth the risk of resection.
** • check your - punctuation.
Mon Aug 29 15:37:18 2016 punctuation.

** • lymph node - taco
Mon Aug 29 13:58:57 2016 taco

**** • thank you! - dt
Mon Aug 29 14:00:05 2016 dt


• canal finder was used to *breathe* the canal of both the proximal
+ sm
Mon Aug 29 12:54:20 2016 sm
Again, ensuring that the collateral ligaments were left unharmed and intact and just the most dorsal ridge of the middle phalanx was planed using the sagittal saw again because of the degree of bone loss already sustained to the middle phalanx from the initial injury. The right medical IP joint arthroplasty tray was opened onto the field and the canal finder was used to *breathe* the canal of both the proximal phalanx and middle phalanx. However, the patients anatomy did not allow given the first approach to be utilized, which was to be #2 approach.
** • Wright Medical - ~C
Mon Aug 29 15:13:08 2016 ~C

** • debride? - taco
Mon Aug 29 13:00:44 2016 taco


• . It was *nebulized* and mobilized so that the neighboring soft tissues could easily
+ ?
Mon Aug 29 12:49:57 2016 ?
The dense postsurgical scar from her previous procedures created a difficult to initial operative dissection and approach as the soft tissues subcutaneously were entirely matted down in a dense sheath of scar, which found the skin and subcutaneous tissue as well as the radial neurovascular bundle and underlying flexor tendon sheath and so via a very slow, cautious and meticulous soft tissue dissection, the radial neurovascular bundle was identified proximally and was traced out distally. It was *nebulized* and mobilized so that the neighboring soft tissues could easily be appreciated.
** • medialized? - taco
Mon Aug 29 13:01:09 2016 taco


• allergy to Maxolon as well as an old anaesthetic, ____ to which she developed anaphyl
+ WAV
Mon Aug 29 12:43:41 2016 WAV
She is currently on thyroxine, omeprazole, Cipramil, Elevit and Megafol with an allergy to Maxolon as well as an old anaesthetic, ____ to which she developed anaphylaxis as a child.
** • anyone have even a guess? - ??
Mon Aug 29 13:40:54 2016 ??


• right pleural effusion is _______ and she is referred now
+ wav
Mon Aug 29 09:21:35 2016 wav
is an 86-year-old woman with recurrent dyspnea and a large right pleural effusion. She had CT-guided core needle biopsy demonstrating lymphoma from periaortic lymph nodes in the abdomen. There is suspicion that her right pleural effusion is _______ and she is referred now for chemo port placement, so that XX can initiate chemotherapy and a right PleurX catheter for better pleural effusion management.
** • chylous - taco
Mon Aug 29 10:00:09 2016 taco

**** • thank - you
Mon Aug 29 11:15:44 2016 you


• a place to camp in Oregon or Washington?
+ RMT
Mon Aug 29 09:04:54 2016 RMT
I have an ESL dictating, and it sounds like she is saying this patient was camping about 2 weeks ago at s/l Seelrivert. I don't know if it's a name of a river or what. I'm going to continue attempting to Google this with my fuzzy s/l but thought I'd go ahead and post here as well.
** • Flagging it and moving on. Thanks anyway! ~ nm - RMT
Mon Aug 29 09:19:36 2016 RMT

** • I'm not hearing Snake River or Two Rivers ~ nm - RMT
Mon Aug 29 09:07:14 2016 RMT


• that her right pleural effusion is *callus* and she is referred now
+ ?
Mon Aug 29 08:49:52 2016 ?
is an 86-year-old woman with recurrent dyspnea and a large right pleural effusion. She had CT-guided core needle biopsy, demonstrating lymphoma from periaortic lymph nodes in the abdomen. There is suspicion that her right pleural effusion is callus and she is referred now for chemo port placement, so that XX can initiate chemotherapy and a right PleurX catheter for better pleural effusion management.
** • pleural cavity and pink *callus* fluid was aspirated + can't be...
Mon Aug 29 08:56:50 2016 can't be...
colorless since he says pink, right? Not sure what this could be.

Fluoroscopy was again utilized and a thin-walled #18 gauge needle was advanced laterally into the right pleural cavity and pink *callus* fluid was aspirated. A 0.038 guidewire was advanced into the right pleural cavity under fluoroscopic control. A small transverse incision was made at that site and a counter incision was made inferomedially. PleurX catheter was tunneled from the inferior to the superomedial insertion site with Dacron cuff along the subcutaneous plane.

• normal diastolic dysfunction
+ SUN
Mon Aug 29 03:35:01 2016 SUN
Echo here showed EF of 60-65%, trace MR, normal diastolic dysfunction and trace TR.

Doctor is dictating as normal diastolic dysfunction. Can it be documented. Please help.
** • How can it be explained that doctor is right? ... + SUN
Mon Aug 29 04:47:46 2016 SUN
How can it be explained that doctor is right?

**** • I would think it is up to the doctor to do his/her own explaining. - Questyr
Mon Aug 29 13:42:12 2016 Questyr

****** • I think the OP wanted an explanation that this makes sense to be sure she's hearing right. + AP
Mon Aug 29 13:58:17 2016 AP
I could be wrong.
** • normal diastolic dysfunction + sun
Mon Aug 29 04:40:34 2016 sun
I do understand there are 6000 hits, for example......

Diastolic function grade was reported in all subjects in the cohort. The majority of subjects had Grade I (mild) diastolic dysfunction at baseline; (n = 135, 87.7 %). Five percent of the cohort had normal diastolic dysfunction at the initial onset of the study observation period (n = 7).

Can it be explained in a simple way?

** • There are over 6000 hits on Google, several in medical journals. Also the general rule sm + :)
Mon Aug 29 04:23:53 2016 :)
for the EF is if you have a percentage you do 60%-65%.

• Lethargy, falls and __________ .
- :) wav
Mon Aug 29 02:30:09 2016 :) wav


• The patient also had a very high blood pressure at presentation, which has sm
+ :) wav
Mon Aug 29 00:50:21 2016 :) wav
improved after patient being on sedative medications including propofol and __________ .

is he saying and and ocet or and Endocet.

• The patient has a history of heavy alcohol intake and the patient has, __________ sm
+ wav :)
Mon Aug 29 00:33:22 2016 wav :)
since his last discharge, has been trying to cut down on his alcohol intake.

• History has been obtained from the __________ obtained from the ER physician.
- wav ;)
Mon Aug 29 00:24:03 2016 wav ;)

** • If he was just changing his mind as to what he said, then I + Questyr
Mon Aug 29 00:28:26 2016 Questyr
think he wanted to end up with "sign-out"
**** • got it. Sign out received. Thanks. - :)
Mon Aug 29 00:31:46 2016 :)


• An awl was then used for entry point on the femur. The femur was then ...
+ wav
Sun Aug 28 23:28:50 2016 wav
An awl was then used for entry point on the femur. The femur was then drilled for the entry point _____ jig was then placed. Distal femoral cut was then made. Femoral sizer was then used. The sizer was based on right side of line and was made parallel to it as the lateral condyle was hypoplastic
** • R U sure doc said "sizer was based"...just seems he might have said "placed" - Questyr
Sun Aug 28 23:59:01 2016 Questyr

** • 5 degrees valgus right. - billybob
Sun Aug 28 23:46:24 2016 billybob

** • nevermind. - guy
Sun Aug 28 23:45:55 2016 guy


• The patient is a 68-year-old female with a history of bilateral valgus ...
+ wav
Sun Aug 28 23:17:34 2016 wav
The patient is a 68-year-old female with a history of bilateral valgus knees, _____ lateral compartment disease in her right knee, status post left total knee arthroplasty in 2011 which she is very happy about.
** • knees and severe lateral - Questyr
Sun Aug 28 23:20:15 2016 Questyr

**** • Thanks a lot. - guy
Sun Aug 28 23:21:05 2016 guy


• some type of scan used to help in diagnosis of parkinson's
- s/l deltamine
Sun Aug 28 13:47:49 2016 s/l deltamine

** • dopamine? - taco
Sun Aug 28 17:00:02 2016 taco


• Oncology
+ b o h b c p
Sun Aug 28 11:26:21 2016 b o h b c p
A PET scan concerning for progression of disease reported in the PET scan with a 4.7 cm x 4 cm mass with an SUV max of 12.66 "letting" the distal small bowel loops in the right anterior pelvis.
** • 12.6 distending? - Oasis
Sun Aug 28 12:26:26 2016 Oasis


• knee rehab scooter or a *migo* or**mego*?
- j b k m b e
Sat Aug 27 10:14:40 2016 j b k m b e

** • never mind found Amigo - j b k m b e
Sat Aug 27 10:17:11 2016 j b k m b e


• Preoperative Diagnosis: RECTAL MASS. Procedure: EXAM UNDE ...
+ wav
Sat Aug 27 02:15:01 2016 wav
Preoperative Diagnosis:
RECTAL MASS.

Procedure:
EXAM UNDER ANESTHESIA WITH FLEXIBLE SIGMOIDOSCOPY.

FINDINGS: External, none. _____ 5 cm from anal verge _____ 6 cm from anal verge.
** • DRE mass.........and poor sphincter tone. Sigmoidoscopy mass - nm
Sat Aug 27 07:15:38 2016 nm

**** • Thanks a lot. - guy
Sat Aug 27 23:17:52 2016 guy


• The patient was then prepped and draped in the usual sterile fashion. ...
+ wav
Sat Aug 27 01:41:36 2016 wav
The patient was then prepped and draped in the usual sterile fashion. An eyelid speculum was placed to retract the eyelid _____. Using a 0.12 mm forceps _____, two paracenteses were created with an MVR blade at the 7 oclock and 1 clock positions.
** • got it. thanks. + guy
Sat Aug 27 01:49:08 2016 guy
An eyelid speculum was placed to retract the eyelid back. Using a 0.12 mm forceps to stabilize the globe, two paracenteses were created with an MVR blade at the 7 oclock and 1 clock positions

• When the distal interlocking screw was removed from the nail, purulent ...
+ wav
Sat Aug 27 00:59:43 2016 wav
When the distal interlocking screw was removed from the nail, purulent fluid drained freely from the wound. This fluid was sampled and sent for culture. Using the extraction _____ in the proximal tip of the nail, the nail was removed.
** • bolt - poi
Sat Aug 27 01:18:07 2016 poi

**** • Thanks a lot. - guy
Sat Aug 27 01:29:29 2016 guy


• Differential includes CNS versus arrhythmia versus s/l*Fago syndrome* vs dehydration
- Pls help
Sat Aug 27 00:49:34 2016 Pls help

** • ???vagal??? (see link)....see what you think + Questyr
Sat Aug 27 00:55:27 2016 Questyr
link
**** • yes it is ....thank you - g c o o h o
Sat Aug 27 00:59:52 2016 g c o o h o


• The cord was clamped x2 and cut. The infant was handed to the waiting ...
+ wav
Sat Aug 27 00:25:24 2016 wav
The cord was clamped x2 and cut. The infant was handed to the waiting pediatricians. Twin Bs _____ was palpated and noted to be _____. The amniotomy was performed with clear fluid and infant B was delivered in vertex position.
** • 1. presenting part ..2. vertex - poi
Sat Aug 27 00:30:42 2016 poi

**** • Thanks a lot. - guy
Sat Aug 27 00:32:01 2016 guy


• Procedure: TERTIARY LOW-FLAP TRANSVERSE REPEAT CESAREAN SECTION WIT ...
+ mp3
Sat Aug 27 00:03:41 2016 mp3
Procedure:
TERTIARY LOW-FLAP TRANSVERSE REPEAT CESAREAN SECTION WITH SINGLE-LAYER UTERINE CLOSURE VIA PFANNENSTIEL SKIN INCISION WITH _____ IUD PLACEMENT.

** • Liletta - nm
Sat Aug 27 07:31:26 2016 nm

** • no luck here either...sorry - poi
Sat Aug 27 00:24:27 2016 poi

**** • Thanks for the effort. - guy
Sat Aug 27 00:25:05 2016 guy


• Preoperative Diagnosis: A 33-YEAR-OLD GRAVIDA 3, PARA 2-0-0-2 AT 30 ...
+ wav
Sat Aug 27 00:02:15 2016 wav
Preoperative Diagnosis:
A 33-YEAR-OLD GRAVIDA 3, PARA 2-0-0-2 AT 30 AND 0 WEEKS WITH GESTATIONAL DIABETES MELLITUS, INSULIN CONTROLLED, TYPE 1 _____ DICHORIONIC-DIAMNIOTIC TWINS _____ TERTIARY REPEAT CESAREAN SECTION.

** • #2 scheduled for? No clue on #1 - poi
Sat Aug 27 00:21:15 2016 poi

** • 38 not 30 - poi
Sat Aug 27 00:19:38 2016 poi

**** • Thanks a lot. Thanks for the correction. - guy
Sat Aug 27 00:22:02 2016 guy


• Further dissection carried down using low current Bovie cautery until the lamina sm
+ wav :)
Fri Aug 26 23:02:28 2016 wav :)
L5 and S1 was fully _____ exposed.
** • Could he be saying "until the laminae of the L5 and S1 nerve roots were exposed." ??? - Questyr
Fri Aug 26 23:10:46 2016 Questyr

**** • yes when I relistened that was what he said. He is stumbling over a lot of this report. - :)
Fri Aug 26 23:15:12 2016 :)

**** • Even if he may have said lamina...you would need the plural the way the + Q
Fri Aug 26 23:11:51 2016 Q
sentence is constructed if he said what I think I heard.

• Edema __________ . She has significant lower extremity edema.
- wav :)
Fri Aug 26 22:07:03 2016 wav :)

** • does he usually give punctuation? WAG - Edema (colon) - poi
Fri Aug 26 22:16:57 2016 poi

**** • no he does not say this on everything. it sounds to me like he is saying including sm + :)
Fri Aug 26 22:19:26 2016 :)
the following but that really does not make sense.

****** • sorry, I don't hear that. My other thought was *in groin* - poi
Fri Aug 26 22:35:44 2016 poi

******** • I have already sent several in with blanks on that. I am going to get some feedback sm + :)
Fri Aug 26 23:01:53 2016 :)
and find out what the heck he is saying. Thanks for trying.

• With good exposure, we then opened up the peritoneum overlying the bla ...
+ wav
Fri Aug 26 21:48:55 2016 wav
With good exposure, we then opened up the peritoneum overlying the bladder and identified our urachus. With a Kocher clamp and a Kelly clamp placed _____ bluntly transected using Metzenbaum scissors. Also, to allow for further exposure, we transected the left medial ligament in a similar fashion.
** • this then was - poi
Fri Aug 26 21:58:05 2016 poi

**** • Thanks a lot. - guy
Fri Aug 26 21:58:37 2016 guy


• The patient is a 69-year-old gentleman with workup for microhematuria. ...
+ wav
Fri Aug 26 21:36:44 2016 wav
The patient is a 69-year-old gentleman with workup for microhematuria. The patient had a CT urogram which was concerning for a urachal cyst, possible adenocarcinoma, had cystoscopy performed, negative for any _____ findings other than dimpling at the level of the dome consistent with a urachal cyst.
** • suspicious - poi
Fri Aug 26 21:44:00 2016 poi

**** • Thanks a lot. - guy
Fri Aug 26 21:45:47 2016 guy


• After the consent was confirmed in the preoperative holding area, the ...
+ mp3
Fri Aug 26 20:54:43 2016 mp3
After the consent was confirmed in the preoperative holding area, the patient was brought into the operating room. The patient was placed in a supine position and general anesthesia was administered. _____ preoperative antibiotics were also administered. After the patient was intubated, a time-out was performed with all members of the operating team to confirm the patients identity and the laterality of the procedure. The patient was then prepped and draped in the usual sterile fashion and placed in a dorsal lithotomy position.
** • nevermind. - guy
Fri Aug 26 21:38:57 2016 guy


• The patient presented to emergency department on 08/26/16 with severe ...
+ wav
Fri Aug 26 20:42:05 2016 wav
The patient presented to emergency department on 08/26/16 with severe right-sided abdominal pain after stent removal. CT scan revealed _____. Due to pain and _____ decision was made to proceed with _____ and ureteral stent placement.
** • diagnostic biopsy #3 - nm
Fri Aug 26 21:09:54 2016 nm

** • periureteral collection, unable to rule out urinoma #1 - nm
Fri Aug 26 21:08:29 2016 nm

**** • Thanks a lot. - guy
Fri Aug 26 21:22:55 2016 guy


• The patient is a 52-year-old man with a history of nephrolithiasis wit ...
+ mp3
Fri Aug 26 20:37:54 2016 mp3
The patient is a 52-year-old man with a history of nephrolithiasis with outside hospital _____. The patient presented to emergency department on 08/26/16 with severe right-sided abdominal pain after stent removal.
** • interventions - nm
Fri Aug 26 20:49:34 2016 nm

**** • Thanks a lot. - guy
Fri Aug 26 20:53:31 2016 guy


• Preoperative Diagnosis: URETERAL OBSTRUCTION, RIGHT. Procedu ...
+ wav
Fri Aug 26 20:29:18 2016 wav
Preoperative Diagnosis:
URETERAL OBSTRUCTION, RIGHT.

Procedure:
CYSTOSCOPY, RIGHT RETROGRADE PYELOGRAM, URETERAL STENT PLACEMENT.

FINDINGS: _____ hydronephrosis. _____ ureteral stent.

SPECIMENS: None.

** • 1. No extravasation on retrograde pyelogram or... - poi
Fri Aug 26 20:31:07 2016 poi

**** • I can't get #2 - poi
Fri Aug 26 20:32:12 2016 poi

****** • Thanks a lot. - guy
Fri Aug 26 20:33:12 2016 guy


• INTRAOPERATIVE FINDINGS: 1. Intercartilaginous incision performed ...
+ wav
Fri Aug 26 19:32:17 2016 wav
INTRAOPERATIVE FINDINGS:
1. Intercartilaginous incision performed bilaterally.
2. Dorsal hump reduction with Rubin osteotome followed by rasping.
3. Minimal cartilaginous dorsal reduction.
4. Excision of bilateral soft tissue over supratip.
5. Placement of fascia/soft tissue over the dorsum.
6. Inferior turbinate reduction.
7. _____ reduction with 6.0 cutting bur.

** • Pogonion. Thanks to poi. - guy
Fri Aug 26 19:46:34 2016 guy

** • pogonion - The most anterior point of the chin on the mandible in the midline. Also called + poi
Fri Aug 26 19:46:24 2016 poi
mental point
**** • good solve, poi - t
Fri Aug 26 19:48:44 2016 t

****** • Thanks I was coming up blank looking in the nose, but guy threw me the chin clue + poi
Fri Aug 26 19:52:29 2016 poi
on facebook messenger and tada! Good teamwork :)
******** • you were looking in whose nose? - haha
Sat Aug 27 10:11:20 2016 haha

**** • Thanks a lot. - guy
Fri Aug 26 19:46:49 2016 guy


• This is adjusted with silver nitrate with resolution. He has no other ...
+ mp3
Fri Aug 26 19:28:42 2016 mp3
This is adjusted with silver nitrate with resolution. He has no other medical problems and no _____. On exam, the patient was noted to have a significant dorsal hump and a widened upper third; however, the nose was noted to be straight.
** • toxic habits - poi
Fri Aug 26 19:29:50 2016 poi

**** • Thanks a lot. - guy
Fri Aug 26 19:30:47 2016 guy


• Preoperative Diagnosis: HISTORY OF NASAL BONE FRACTURES, EXTERNAL N ...
+ wav
Fri Aug 26 19:19:32 2016 wav
Preoperative Diagnosis:
HISTORY OF NASAL BONE FRACTURES, EXTERNAL NASAL DEFORMITY, OVER-PROJECTION OF _____.

Procedure:
ENDONASAL RHINOPLASTY, BILATERAL REDUCTION OF INFERIOR TURBINATES AND _____ REDUCTION.

** • pogonion - poi
Fri Aug 26 19:45:19 2016 poi

**** • never heard that word before - I like it! - t
Fri Aug 26 19:47:24 2016 t

**** • Thanks a lot. You saved me 4 blanks. - guy
Fri Aug 26 19:46:06 2016 guy

****** • totally new word for me! - poi
Fri Aug 26 19:46:46 2016 poi


• Preoperative Diagnosis: BILATERAL _____ ULCERATIONS. Procedu ...
+ wav
Fri Aug 26 18:55:37 2016 wav
Preoperative Diagnosis:
BILATERAL _____ ULCERATIONS.

Procedure:
BILATERAL WOUND DEBRIDEMENT WITH AMNIOTIC ALLOGRAFT PLACEMENT, IRRIGATION AND WOUND VACUUM PLACEMENT ON THE RIGHT FOOT.


** • pedal - taco
Fri Aug 26 18:57:33 2016 taco

**** • Thanks a lot. - guy
Fri Aug 26 18:59:51 2016 guy


• with nausea, vomiting, diarrhea, some s/l chicken feelings, and dizziness. TIA!
+ hmm?
Fri Aug 26 17:59:54 2016 hmm?
Patient with dehydration and UTI.

The patient presents to the clinic with nausea, vomiting, diarrhea, some _____, and dizziness.
** • Thanks for the suggestions. Not clear to me, so flagging and moving on. - OP
Fri Aug 26 18:38:19 2016 OP

** • shaky/shaking? - nm
Fri Aug 26 18:33:30 2016 nm

** • chilling? - Oasis
Fri Aug 26 18:02:17 2016 Oasis


• Depo, depo (lower case), or depot? Thanks!
+ tlh
Fri Aug 26 15:45:58 2016 tlh
I have suggested to her today that we place some intralesional triamcinolone into the lesion. She understands that this will be a ______[s/l depo] drug that will work for approximately 2 months after we place it.
** • ... + b l k h p o
Fri Aug 26 19:32:27 2016 b l k h p o

** • depot (generic) - taco
Fri Aug 26 17:18:14 2016 taco


• help with "index pregnancy" sm pls
+ mt
Fri Aug 26 12:51:33 2016 mt
First baby was delivered by emergency cesarean section for cephalopelvic disproportion, baby weighing about 4.5 kg. Index pregnancy she had requested elective repeat cesarean section.

Doc speaks as though "Index pregnancy" is the beginning of next sentence, but doesn't index refer to the first pregnancy? How could she request repeat C-section for a first pregnancy. So confused.
** • Maybe "In this pregnancy, " ??? - b k l o l i
Fri Aug 26 13:07:03 2016 b k l o l i

**** • exactly what I was thinking... - t
Fri Aug 26 13:15:58 2016 t

** • flagged - mt
Fri Aug 26 13:01:22 2016 mt


• all soft tissue _____ for the rotator cuff repair.
+ wav
Fri Aug 26 10:09:09 2016 wav
taken back to the level of the superior AC ligament, which was identified and maintained throughout this entire case. The entire distal clavicle excision was visualized to ensure there was no bony bridge between the distal clavicle and medial acromial facet. Attention was then turned back to the bursal side of the rotator cuff where all remaining bursal tissues were removed. The small full-thickness rotator cuff tear was debrided back to a stable rim. The greater tuberosity was cleared of all soft tissue _____ for the rotator cuff repair.
** • to prepare for? - taco
Fri Aug 26 10:16:57 2016 taco

**** • ty - -
Fri Aug 26 10:18:44 2016 -


• Internal rotation *sick sickle* level
+ sm
Fri Aug 26 08:27:39 2016 sm
PHYSICAL EXAMINATION:
RIGHT SHOULDER: Shows pain to palpation of the anterior portal.

RANGE OF MOTION:
(normal range in a)
Forward flexion (170) 60
Abduction with forearm in neutral 45
Internal rotation ____ level
External rotation 20/40


** • C6? - b k l o l i
Fri Aug 26 08:49:47 2016 b k l o l i

**** • or thoracic 6? (to account for the "sick") (internal rotation is to a vertebral level) - taco
Fri Aug 26 09:04:57 2016 taco

****** • I like yours better. C6 would make ya sort of a contortionist me thinks. - b k l o l i
Fri Aug 26 09:09:22 2016 b k l o l i

******** • thank - you
Fri Aug 26 10:09:42 2016 you


• continue using a cane to diminish ________ on left side
+ mp4
Fri Aug 26 08:24:40 2016 mp4
ASSESSMENT & PLAN:
The patient is status-post motor vehicle accident, sustaining a left knee sprain.
MRI evidence of a healing fracture of the lateral tibial plateau and patellofemoral joint arthrosis. We discussed an injection of steroids in the left knee at this point to alleviate symptoms and the patient agreed to proceed. Under sterile condition, the left knee suprapatellar area was marked laterally. Betadine was used to sterilize the area of injection. 5 ccs of lidocaine 1% were mixed with 1 cc of Depo-Medrol 40 mg, and the whole content was introduced with a 22 gauge needle from lateral to medial inside the knee. The patient tolerated the procedure well and had no complications.
Continue physical therapy.
She will also continue using a cane to diminish ________ on left side.
She has been reassured that her left knee fracture at this point has been healing perfectly.
She will follow up with us in four weeks.


• enlargement due to *pretty* changes of the
+ sm
Fri Aug 26 08:22:10 2016 sm
PHYSICAL EXAMINATION:
LEFT KNEE:
Shows mild enlargement due to *pretty* changes of the patella.
There is a strong positive patella compression test.
There is a positive grind test.
Palpation of the medial joint line is painful.
Quad strength is 4+/5.

** • arthritic? - nm
Fri Aug 26 08:41:12 2016 nm

**** • thanks - -
Fri Aug 26 08:44:42 2016 -


• had marked ______ prostatic hypertrophy
+ mp3
Fri Aug 26 08:16:31 2016 mp3
A #21 cystoscope was inserted. The urethra was visualized in its entirety. There is no evidence of stones, stricture or tumor seen. The prostatic fossa was entered and he had marked ______ prostatic hypertrophy with easy friability and bleeding. The bladder was entered and examined with both 37 degree lenses and no evidence of stone, tumor or foreign bodies were identified.
** • trilobar - nm
Fri Aug 26 08:25:21 2016 nm

**** • thanks - -
Fri Aug 26 08:29:20 2016 -


• control of her fasting _______ postprandial
+ wav
Fri Aug 26 08:07:59 2016 wav
She presents today for evaluation of her blood sugars which show overall good control of her fasting _______ postprandial. She does have sporadic elevations. However, with particular food choices, she has a better understanding and will make the choices going forward.
** • and 2-hour - nm
Fri Aug 26 08:24:54 2016 nm

**** • ty - -
Fri Aug 26 08:31:33 2016 -


• The patient also __________ history of __________ .
- wav :)
Fri Aug 26 04:53:06 2016 wav :)

** • also comes with? - wag
Fri Aug 26 07:27:54 2016 wag

** • micturia so we will do a bladder scan ____ to rule out obstructive uropathy. - b k l o l i
Fri Aug 26 07:01:57 2016 b k l o l i

**** • i think it is hematuria, not micturia - b k l o l i
Fri Aug 26 07:02:29 2016 b k l o l i


• The patient has nonspecific left-sided __________ chest pain.
- wav :)
Fri Aug 26 04:37:54 2016 wav :)

** • gotit. - :)
Fri Aug 26 04:53:28 2016 :)


• Pelvis ultrasound shows a __________ vascular 6.3 cm mass in the anterior ______, sm
+ wav :)
Fri Aug 26 03:22:37 2016 wav :)
presumably a large fibroid, but further clinical evaluation necessary __________ intervention in order to excluded malignancy.
** • heterogenous ... uterine fundus ... given interval change in order to... - m i f c c m
Fri Aug 26 04:30:00 2016 m i f c c m

**** • Thanks so much. - :)
Fri Aug 26 04:36:42 2016 :)


• SKIN: The patient has __________ discoloration, has pallor positive.
- :) wav
Fri Aug 26 03:08:47 2016 :) wav

** • Your WAV not there. - Questyr
Fri Aug 26 03:12:17 2016 Questyr

**** • it will not even load that page for me. - :)
Fri Aug 26 03:15:42 2016 :)

****** • it's there now. - :)
Fri Aug 26 03:18:21 2016 :)

******** • ???underlying??? - Questyr
Fri Aug 26 03:18:49 2016 Questyr

********** • Thanks. I thought that's what I was hearing. - :)
Fri Aug 26 03:21:01 2016 :)


• Care was taken not to expose this. A back cut was made in the left po ...
+ wav
Fri Aug 26 02:17:52 2016 wav
Care was taken not to expose this. A back cut was made in the left postauricular region to allow for a medial rotation of the posterior muscle flap. This was approximately 6 cm in length. The galea was scored in a hash mark pattern to allow for advancement in rotation at 1 cm intervals. A similar back cut was made in the vertex region to allow for anterior rotation of the remaining scalp tissue. _____ was also scored in a hash mark pattern. Meticulous hemostasis was then obtained.
** • sorry it is too late but I think it is galea incision. - :)
Fri Aug 26 02:41:57 2016 :)

**** • You may be right with galea (or galeal), but I don't think + Q
Fri Aug 26 02:47:39 2016 Q
incision....(because you can score the galea, but not an incision). Can it be galeal region? or galea region?
****** • Galea incisions used a standard blade tip, set on coagulating mode, with power of 20 W sm + :)
Fri Aug 26 02:50:57 2016 :)
and 1 MHz pulse-modulated waveform.
******** • You are right though that is not incision. She is saying galea region but sm + :)
Fri Aug 26 02:53:13 2016 :)
I think she is saying something between galea and region.
********** • Thanks a lot. i was hearing region also. - guy
Fri Aug 26 02:59:47 2016 guy

********** • Me too, but I can't make it out. - Q
Fri Aug 26 02:54:42 2016 Q

************ • it just bugs me to get that close and not figure it all out. LOL - :)
Fri Aug 26 02:56:13 2016 :)

************** • Fluff + Q
Fri Aug 26 02:58:05 2016 Q
Over the years I learned to let that go because often as not it turned out to be a misspeak by the doc.
** • nevermind. - guy
Fri Aug 26 02:23:07 2016 guy

**** • What was the answer? - Questyr
Fri Aug 26 02:26:53 2016 Questyr




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