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Feb 19 22:14
• gallbladder with gangrene *catered* multiple gallstones
+ ?
Sat Feb 23 11:38:29 2019 ?
Surgical findings are as follows: The gallbladder was cocooned in omental cake which after separation of the gallbladder revealed the presence of distended gangrenous cholecystitis with a necrotic fundus. The contents of the gallbladder was purulent bile commensurate with the diagnosis of empyema of the gallbladder with gangrene __________ multiple gallstones as seen on the ultrasound. Cystic duct and cystic artery anatomy was normal.
** • listen for: gangrene, craters, and multiple gallstones + sm
Sat Feb 23 12:59:44 2019 sm
link
**** • Thanks so much - !
Sat Feb 23 14:04:02 2019 !


• dissection to avoid any *energy delivery* in the vicinity of the duodenum.
+ sm
Sat Feb 23 11:34:45 2019 sm
A fixed area medially over the neck of the gallbladder was attached to the duodenum which required EndoShears dissection to avoid any ________ in the vicinity of the duodenum. The fundus of the gallbladder was then aspirated with an aspiration needle to allow grasping of the fundus and rotation of the gallbladder towards the right shoulder.
** • energy delivery is correct - nm
Sat Feb 23 13:00:00 2019 nm

**** • Thank you! - =
Sat Feb 23 14:04:13 2019 =


• Upon examination in plastic surgery clinic, discussion with the patien ...
+ wav
Fri Feb 22 23:11:12 2019 wav
Upon examination in plastic surgery clinic, discussion with the patient involved incision placement for lower abdominal incision or a combination of midline vertical with lower abdominal incision, panniculectomy. The patient understood the difference in the scar appearance and also the difference in addressing excess skin and subcutaneous tissue with _____, elected to undergo _____ approach for her panniculectomy. All risks, benefits, and alternatives were discussed.
** • fleur de lis approach (see link) check to see if it is capped or not + Questyr
Sat Feb 23 01:38:47 2019 Questyr
link
**** • Apparently it is not capped. - Q
Sat Feb 23 01:39:30 2019 Q

****** • BTW, this is #2 - Q
Sat Feb 23 01:40:17 2019 Q

******** • Also I would start a new sentence at "Elected to" - Q
Sat Feb 23 01:41:23 2019 Q

** • I can't get #2 - poi
Fri Feb 22 23:27:56 2019 poi

** • 1. two approaches - poi
Fri Feb 22 23:21:06 2019 poi

**** • Thanks a lot. - guy
Fri Feb 22 23:28:56 2019 guy


• Preoperative Diagnosis: OBESITY, STATUS POST _____ WEIGHT LOSS. ...
+ wav
Fri Feb 22 22:44:08 2019 wav
Preoperative Diagnosis:
OBESITY, STATUS POST _____ WEIGHT LOSS.

Procedure:
PANNICULECTOMY.

** • significant (WAG) - poi
Fri Feb 22 23:01:03 2019 poi

**** • Thanks a lot. - guy
Fri Feb 22 23:05:15 2019 guy


• We then incised the skin transversely just proximal to the antecubital ...
+ wav
Fri Feb 22 20:50:36 2019 wav
We then incised the skin transversely just proximal to the antecubital fossa using #15 blade scalpel. Sharp and electrocautery dissection were used to isolate out cephalic vein. This _____ several centimeters both proximally and distally. Care was taken to create two skin flaps going proximally and distally to aid in mobilization of the vein.
** • never mind. Thanks to anyone who tried. - guy
Fri Feb 22 21:06:05 2019 guy


• The patient is a 63-year-old gentleman with a significant past medical ...
+ wav
Fri Feb 22 20:25:00 2019 wav
The patient is a 63-year-old gentleman with a significant past medical history including hypertension, HIV, hepatitis C, chronic kidney disease, diabetes mellitus _____ intravenous drug use, lung cancer, and he was referred to vascular surgery for worsening kidney disease, proteinuria, and likely requiring longterm hemodialysis access.
** • former intravenous drug use - poi
Fri Feb 22 20:26:28 2019 poi

**** • Thanks a lot. - guy
Fri Feb 22 20:48:30 2019 guy


• The patient is a 63-year-old gentleman with a significant past medical ...
+ mp3
Fri Feb 22 19:33:57 2019 mp3
The patient is a 63-year-old gentleman with a significant past medical history including hypertension, HIV, hepatitis C, chronic kidney disease, diabetes mellitus from intravenous drug use, lung cancer, and he was referred to vascular surgery for worsening kidney disease, proteinuria, and likely requiring longterm hemodialysis access. All material risks, benefits, and alternatives to arteriovenous fistula, _____ informed consent was obtained and he agreed to proceed with surgery.
** • proximal graft _?_ was explained to the patient and informed - poi
Fri Feb 22 19:49:40 2019 poi

**** • thanks a lot. - guy
Fri Feb 22 20:09:25 2019 guy


• IMPLANTS: No. SPECIMENS: No. TOTAL FLUIDS: _____ of I ...
+ wav
Fri Feb 22 19:25:14 2019 wav
IMPLANTS: No.

SPECIMENS: No.

TOTAL FLUIDS: _____ of IVF.

URINE OUTPUT: The patient made approximately 850 cc of urine.

** • 600?? - poi
Fri Feb 22 19:56:41 2019 poi

**** • thanks a lot. - guy
Fri Feb 22 20:09:10 2019 guy


• Preoperative Diagnosis: END-STAGE RENAL DISEASE REQUIRING HEMODIALY ...
+ wav
Fri Feb 22 19:11:33 2019 wav
Preoperative Diagnosis:
END-STAGE RENAL DISEASE REQUIRING HEMODIALYSIS.

Procedure:
RIGHT BRACHIOCEPHALIC FISTULA CREATION.

FINDINGS: Large side branch from the cephalic vein which had _____ and branch ligated.
** • counter incision? - poi
Fri Feb 22 19:14:07 2019 poi

**** • onelook shows that to be one word - p n l k g f
Fri Feb 22 19:15:11 2019 p n l k g f

****** • Thanks a lot. - guy
Fri Feb 22 19:21:11 2019 guy


• Preoperative Diagnosis: RADIATION-INDUCED CARIES. Procedure: ...
+ wav
Fri Feb 22 18:40:09 2019 wav
Preoperative Diagnosis:
RADIATION-INDUCED CARIES.

Procedure:
EXTRACTION OF TEETH #1 THROUGH #6, #8, #9, #11 THROUGH #16, AND #27 THROUGH #32.

The tube was then secured in place using tape and the patient was turned over to the oral surgery service. The patient was prepped and draped in a normal sterile fashion. A moist _____ pack was placed in the patients posterior oropharynx after copious suctioning
** • got it. thanks. + guy
Fri Feb 22 18:44:19 2019 guy
vaginal

• The osteotomy was fixated with a single 24 mm 3.0 cancellous screw ori ...
+ mp3
Fri Feb 22 18:03:15 2019 mp3
The osteotomy was fixated with a single 24 mm 3.0 cancellous screw oriented from distal dorsal to plantar proximal. The correction obtained by the surgery was evaluated intraoperatively. Hallux range of motion was noted to be greater than 65 degrees dorsiflexion with the foot _____. Attention was directed to the capsule which was then closed with 3-0 Vicryl suture. The subcutaneous layer was closed with 4-0 Vicryl suture. Skin was closed with 4-0 nylon suture. Attention was directed to the second digit of the right foot for contracture as well as the distal and proximal interphalangeal joint was noted
** • loaded and not loaded - poi
Fri Feb 22 18:06:46 2019 poi

**** • ... + g o g g d g
Fri Feb 22 18:39:53 2019 g o g g d g

**** • Thanks a lot. - guy
Fri Feb 22 18:09:14 2019 guy


• The medial and lateral collateral ligaments of the first metatarsophal ...
+ mp3
Fri Feb 22 17:56:47 2019 mp3
The medial and lateral collateral ligaments of the first metatarsophalangeal joint were freed. A sagittal saw was used to resect the medial eminence. A 0.062 Kirschner guidewire was placed to guide the osteotomy. A chevron-shaped osteotomy was performed at the distal first metatarsophalangeal joint. A dorsal _____ bone was removed from the dorsal aspect of the chevron with a sagittal saw.
** • rectangle of - poi
Fri Feb 22 18:01:42 2019 poi

**** • Thanks a lot. - guy
Fri Feb 22 18:02:36 2019 guy


• Preoperative Diagnosis: RIGHT FOOT HALLUX LIMITUS AND SECOND DIGIT ...
+ wav
Fri Feb 22 17:41:50 2019 wav
Preoperative Diagnosis:
RIGHT FOOT HALLUX LIMITUS AND SECOND DIGIT HAMMERTOE.

Procedures:
1. RIGHT _____ BUNIONECTOMY.
2. RIGHT FOOT _____ WITH SCREW FIXATION AND SECOND DIGIT ARTHROPLASTY.

** • 1. foot?? 2. ___ plate with ?? - sorry-poi
Fri Feb 22 18:05:06 2019 sorry-poi

**** • Not even sure about plate..check the rest of report - poi
Fri Feb 22 18:06:26 2019 poi

**** • Thanks a lot. bad audio there - guy
Fri Feb 22 18:05:28 2019 guy


• symphysis pubis fracture of inferior symphysis pubis *s/l light* subacute lucency
+ sm
Fri Feb 22 07:22:20 2019 sm
4. Minimally malunited fracture through the mid aspect of inferior symphysis pubis on the right, _________ subacute lucency on that level.
** • It really sounds more like "like subacute lucency" ?? - OP
Fri Feb 22 07:26:14 2019 OP

**** • ? likely subacute - nm
Fri Feb 22 10:40:11 2019 nm

****** • Has to be. Thanks. :) - OP
Fri Feb 22 15:03:14 2019 OP


• Even after administration of the glucose, the patient was noted to con ...
+ mp3
Fri Feb 22 01:59:26 2019 mp3
Even after administration of the glucose, the patient was noted to continue to make excellent urine, had received 4 liters of crystalloid; however, at this time, based on the ABG had climbing lactate values starting from 3.5 to 4.7 to 5 and above. At this time, after discussion with both Anesthesia attending, consulting Anesthesia attending, and the plastic surgical attending, Dr. Flores, was present and _____ this decision was made that given the patients hemodynamic instability that likely she would need additional neurologic and cardiovascular evaluation as well as potentially would not be safe to proceed with a long anticipated free flap case.
** • see message + Q
Fri Feb 22 02:32:53 2019 Q
There are problems with this sentence beyond the fact that it is a run-on sentence. Where she speaks about "after discussion with both".....there are listed more than two physicians.

Also I think she is referring to the person she is calling Anesthesia Attending (as in 'the attending physician for the anesthesia department) and when used like this, I would be included to cap both words (I'm thinking this under the 'personification' rule).

And if that logic holds, then it would also be Consulting Anesthesia Attending and Plastic Surgical Attending.

At this time, after discussion with both Anesthesia attending, consulting Anesthesia attending, and the plastic surgical attending, Dr. Flores, was present and _____ this decision was made that given the patients hemodynamic instability that likely she would need additional neurologic and cardiovascular evaluation as well as potentially would not be safe to proceed with a long anticipated free flap case.
**** • Thanks for the correction. - guy
Fri Feb 22 04:14:47 2019 guy

**** • typo...I would be inclined (not included) - Q
Fri Feb 22 02:33:36 2019 Q

** • since - Questyr
Fri Feb 22 02:21:56 2019 Questyr

**** • Thanks a lot. - guy
Fri Feb 22 02:28:37 2019 guy


• Preoperative Diagnosis: BILATERAL BREAST CANCER AND BREAST CANCER G ...
+ wav
Fri Feb 22 01:45:11 2019 wav
Preoperative Diagnosis:
BILATERAL BREAST CANCER AND BREAST CANCER GENE 1 MUTATION.

Procedure:
BILATERAL TOTAL MASTECTOMIES BY BREAST SURGERY FOLLOWED BY ELEVATION OF BILATERAL DEEP INFERIOR EPIGASTRIC PERFORATOR FLAPS AND DELAY AND PLACEMENT OF BILATERAL TISSUE EXPANDERS BY PLASTIC SURGERY.

The anterior rectus sheath fascia was incised carefully near the fascial rents where the perforators exited the rectus. These perforators were then traced down to the deep inferior epigastric perforator main source, the DIEA and DIEV. The DIEA and DIEV were then traced down to its source in the external iliac and the groin and careful dissection was performed to clip and hemostase branches coming off of the main _____.
** • What I hear is "drag" ....but I should point out that that usage is slang - Questyr
Fri Feb 22 02:21:24 2019 Questyr

**** • Thanks a lot. - guy
Fri Feb 22 02:28:32 2019 guy


• The final PATH on the left breast was consistent with DCIS and it was ...
+ wav
Thu Feb 21 23:12:39 2019 wav
The final PATH on the left breast was consistent with DCIS and it was noted that there was DCIS within a fraction of a millimeter of the superior margin. At this point in time, given the patients known history of BRCA mutation and consent for potential persistent _____ was made to proceed with bilateral total mastectomy at this time. The patient also met with the plastic surgery team who had planned on immediate reconstruction with DIEP flaps after bilateral mastectomy.
** • NOTE: It should be "mastectomy. At this time the patient also met - Questyr
Fri Feb 22 00:19:45 2019 Questyr

**** • disagree - poi
Fri Feb 22 00:50:56 2019 poi

****** • the mastectomy is being done "at this time" - poi
Fri Feb 22 00:52:38 2019 poi

******** • I still think I am correct. There is a solid pause after the + Questyr
Fri Feb 22 01:12:21 2019 Questyr
word mastectomy AND the term "At this time" also fits with meeting the plastic surgery team AND he already said "At this point in time" at the beginning of the 'mastectomy' sentence.
********** • BTW I am not 'yelling' when I capped my 'and's'...I just used them to separate my points - Q
Fri Feb 22 01:15:27 2019 Q

************ • Thanks for the opinion Q. I never felt you will ever yell at me or anybody..lol - guy
Fri Feb 22 01:47:13 2019 guy

************ • if you listen again, what is left out is "the patient HAS met" + poi
Fri Feb 22 01:22:26 2019 poi
I agree there is a pause, but a pause does not always mean "period"....plus the fact that guy does only OP notes.

************** • I agree that 'has' was not show, but the sentence of "At + Q
Fri Feb 22 01:30:20 2019 Q
this time the patient also has met with the plastic surgery team etc" still works. I also agree that a pause does not necessarily mean there must be an end to the sentence, but given that he started the previous sentence with "At this point in time", that there was the pause, and that it makes sense with the next sentence, I feel ending the sentence at mastectomy is justified. Obviously neither of us can prove our opinion so this is the best we can do for guy....give our opinion and our reason(s) why and move on.
**************** • Just didn't want my not commenting to lead guy to believe your + poi
Fri Feb 22 01:38:07 2019 poi
opinion was necessarily correct either, so wanted to add MY opinion. It wouldn't be the first or last time a doctor has said something redundant...but as you said, moving on.
**************** • oops typo..shown (not show) - Q
Fri Feb 22 01:30:43 2019 Q

** • concern for .....disease within the left breast, a decision - poi
Thu Feb 21 23:26:43 2019 poi

**** • Thanks a lot. Thanks for the correction. - guy
Thu Feb 21 23:30:40 2019 guy


• Preoperative Diagnosis: BREAST CANCER ANTIGEN MUTATION. Proc ...
+ wav
Thu Feb 21 23:00:35 2019 wav
Preoperative Diagnosis:
BREAST CANCER ANTIGEN MUTATION.

Procedure:
BILATERAL TOTAL MASTECTOMY.

This is a 57-year-old BRCA-positive patient with a history of right breast cancer in 2013 followed by chemoradiation, now status post left lumpectomy and sentinel lymph node biopsy for _____ cancer that initially presented with palpable mass.
** • interval? - poi
Thu Feb 21 23:02:53 2019 poi

**** • Interval breast cancer is a term given to cancers detected/presenting ... + info
Thu Feb 21 23:03:29 2019 info
Interval breast cancer is a term given to cancers detected/presenting within 12 months after a mammographic screening in which findings are considered normal 2.
****** • Thanks a lot. Thanks for the info. - guy
Thu Feb 21 23:05:44 2019 guy


• Revision arthroplasty, see message
+ CO MT
Thu Feb 21 19:53:01 2019 CO MT
"the tibia was impacted in a hybrid technique with the short press-fit *Eskalith* stem."

SR put in Eskalith and that's all I can hear now. Actually sounds more like "esk-L-F" I tried Googling SLF, no good

Thanks in advance
** • He said it again later. It's Aesculap (added for future generations of searchers) - CO MT
Thu Feb 21 20:00:17 2019 CO MT


• Sputum Gram stain and _________ and fungal culture
+ mp3 posted
Thu Feb 21 19:50:15 2019 mp3 posted
I am hearing CNS. What would that be?
** • C and S (culture and sensitivity) - CO MT
Thu Feb 21 19:53:26 2019 CO MT

**** • ... + d a d c p e
Thu Feb 21 23:00:20 2019 d a d c p e

**** • Thanks! - mp3 posted
Thu Feb 21 19:59:09 2019 mp3 posted


• I would recommend concurrent s/l*i-ther-ser-load-er* a 5-fluorouracil based chemother
+ SM
Thu Feb 21 13:48:19 2019 SM
would recommend standard fractionated pelvic radiotherapy, a dose of 45 to 50 Gy to the pelvis followed by a 5 to 9 Gy boost to the primary tumor site. I would recommend concurrent s/l*i-ther-ser-load-er* a 5-fluorouracil based chemotherapy to be delivered with pelvic radiotherapy. I did explain to the patient the rationale for treatment. Pelvic radiotherapy would likely improve his pain as well as decrease the severity of his bleeding.
** • either Xeloda or a ? - p o l i j c
Thu Feb 21 14:43:52 2019 p o l i j c


• Preoperative Diagnosis: MANDIBULAR SYMPHYSIS FRACTURE, LEFT MANDIBU ...
+ wav
Thu Feb 21 08:57:26 2019 wav
Preoperative Diagnosis:
MANDIBULAR SYMPHYSIS FRACTURE, LEFT MANDIBULAR CONDYLAR FRACTURE.

Procedure:
OPEN REDUCTION AND INTERNAL FIXATION OF MANDIBULAR SYMPHYSIS FRACTURE AS WELL AS OPEN REDUCTION AND INTERNAL FIXATION OF LEFT CONDYLAR FRACTURE, EXTRACTION OF TOOTH #4.

The mucosal incision was closed using 3-0 Vicryl sutures in a continuous locking fashion to obtain a watertight seal. The patients plate was kept in maxillomandibular fixation and attention was then turned to the left condylar fracture. All intraoral instruments were changed as well as the _____ changed adequate gloves. The incision was marked inferior to the _____. A 3.5 cm incision was marked out. Approximately 3 cc of 1% lidocaine with 1:100,000 units of epinephrine were infiltrated in subcutaneous plane.
** • First blank - surgeons performing the procedure - p o l i j c
Thu Feb 21 09:47:43 2019 p o l i j c


• Preoperative Diagnosis: LEFT ANTERIOR CRUCIATE LIGAMENT TEAR, LEFT ...
+ wav
Thu Feb 21 03:44:40 2019 wav
Preoperative Diagnosis:
LEFT ANTERIOR CRUCIATE LIGAMENT TEAR, LEFT LATERAL MENISCUS TEAR.

Procedures:
1. LEFT ACL RECONSTRUCTION.
2. PARTIAL LEFT LATERAL MENISCECTOMY.
3. PARTIAL LEFT MEDIAL MENISCECTOMY.

To further augment the tibial repair, a 4.7 mm SwiveLock anchor was inserted into the anterior tibial cortex approximately 2 cm distal to the tibial tunnel and the suture that had been passed to the tendon was anchored into the tibia. All passing sutures were cut. The wound was thoroughly irrigated. The Lachman test was performed and the graft was noted to be appropriately tensioned and the tibia had been _____ translation.
** • never mind. Thanks to anyone who tried. - guy
Thu Feb 21 03:55:14 2019 guy


• Protamine was administered and the patient was monitored for adverse r ...
+ wav
Thu Feb 21 02:14:10 2019 wav
Protamine was administered and the patient was monitored for adverse reaction. Coagulopathy was assessed and hemostasis secured. The operating field was slowly ____ any bleeding. Once adequate hemostasis was achieved, the sternum was closed with a total of eight stainless steel sternal wires.
** • inspected for - Questyr
Thu Feb 21 02:14:52 2019 Questyr

**** • Thanks a lot. - guy-
Thu Feb 21 02:17:13 2019 guy-


• Guy repost the WAV that starts with The aortic valve and sinus Valsalva was also aneu
- Questyr
Thu Feb 21 02:09:33 2019 Questyr

** • Guy, it's "sinus of Valsalva" - fyi
Thu Feb 21 11:44:48 2019 fyi

** • I'm wondering if the word "button" was in there someplace as I wasn't + Q
Thu Feb 21 02:10:38 2019 Q
really sure what I was hearing.
**** • Thanks a lot. - guy
Thu Feb 21 02:10:52 2019 guy


• Then, 25 mm SJM HP mechanical conduit was chosen. The total of 15 of ...
+ wav
Thu Feb 21 01:59:19 2019 wav
Then, 25 mm SJM HP mechanical conduit was chosen. The total of 15 of 2-0 pledgeted sutures were placed with _____ technique. All sutures were through the conduit cuff, the valve conduit was seated to aortic annulus. Sutures were tied down. Next, left mid coronary _____ and right mid coronary _____ were reimplanted to the graft with 5-0 Prolene sutures. We then gave cardioplegia to the graft, then checked any leaking
** • I'm still working on #1 - Q
Thu Feb 21 02:02:37 2019 Q

**** • everting mattress - Q
Thu Feb 21 02:06:35 2019 Q

****** • see link + Q
Thu Feb 21 02:07:09 2019 Q
link
** • #2 and #3 are both "button" (see link) + Questyr
Thu Feb 21 02:02:19 2019 Questyr
link
**** • Thanks a lot. Thanks for the correction. - guy
Thu Feb 21 02:10:40 2019 guy


• The aortic valve and sinus Valsalva was also aneurysmal, so we decided ...
+ wav
Thu Feb 21 01:44:10 2019 wav
The aortic valve and sinus Valsalva was also aneurysmal, so we decided to resect. Both coronary ostia _____ created. Then, 25 mm SJM HP mechanical conduit was chosen.
** • I THINK he somewhat repeats himself himself a bit and says "Both + Questyr
Thu Feb 21 01:50:15 2019 Questyr
coronary ostia, both of them were created."
**** • Thanks a lot. - guy
Thu Feb 21 01:54:23 2019 guy


• The ascending aorta was resected to just superior to the sinotubular j ...
+ mp3
Thu Feb 21 01:38:33 2019 mp3
The ascending aorta was resected to just superior to the sinotubular junction we visualized of the right and left coronary ostia. There was large tear in the aortic root. The tear went to the left main coronary ostia; however, the left coronary artery was not dissected. We _____ with 5-0 Prolene sutures to approximate the layers. The aortic valve and sinus Valsalva was also aneurysmal, so we decided to resect.
** • Now I hear "We put in a couple of 5-0 Prolene etc" - Q
Thu Feb 21 01:48:43 2019 Q

**** • Thanks a lot. - guy
Thu Feb 21 01:54:29 2019 guy

** • Sorry, I can't get it. - Questyr
Thu Feb 21 01:43:45 2019 Questyr

**** • Thanks for the effort. - guy
Thu Feb 21 01:44:25 2019 guy


• Preoperative Diagnosis: ACUTE STANFORD TYPE A AORTIC DISSECTION, AO ...
+ wav
Thu Feb 21 01:02:59 2019 wav
Preoperative Diagnosis:
ACUTE STANFORD TYPE A AORTIC DISSECTION, AORTIC ROOT ANEURYSM, MODERATE-TO-SEVERE ACUTE AORTIC VALVE REGURGITATION.

Procedure:
BENTALL PROCEDURE WITH 25 MM SJM HP MECHANICAL VALVE VALSALVA COMPOSITE GRAFT, CORONARY ARTERY REIMPLANTATION, REPAIR OF LEFT MAIN CORONARY OSTIA.

There was moderate-to-severe aortic valve regurgitation. The A-lines were placed in the bilateral radial artery. The chest was entered via standard median sternotomy. The heart was exposed, and the ascending aorta was inspected and showed some hematoma _____. There was _____ pericardial effusion. Aortic root was dilated, about 5 cm dilator.
** • #1 "in the _____________ "#2 I just hear "There was pericardial effusion." - Questyr
Thu Feb 21 01:40:50 2019 Questyr

**** • Thanks a lot. - guy
Thu Feb 21 01:43:36 2019 guy


• Preoperative Diagnosis: RIGHT BREAST NIPPLE DISCHARGE. Proce ...
+ wav
Wed Feb 20 23:38:52 2019 wav
Preoperative Diagnosis:
RIGHT BREAST NIPPLE DISCHARGE.

Procedure:
RIGHT BREAST TOTAL DUCT EXCISION.

This is a 37-year-old female, status post right total duct excision in May of 2018 with final pathology consistent with a focus of _____. The patient was _____ with persistent and spontaneous right nipple discharge, unchanged after surgery, and underwent bilateral diagnostic mammography, right ultrasound, and bilateral breast MRI without _____. The patient was then scheduled for right total duct re-excision and possible partial wedge nipple excision.
** • 1. intraductal papilloma 2. was seen in our clinic? 3. correlate - poi
Wed Feb 20 23:42:17 2019 poi

**** • ?? any correlate?? - poi
Wed Feb 20 23:45:01 2019 poi

**** • not sure about #3, but what I hear - poi
Wed Feb 20 23:44:20 2019 poi

****** • Thanks a lot. - guy
Thu Feb 21 00:14:54 2019 guy


• I discussed the surgery with the mother and discussed the risks and be ...
+ mp3
Wed Feb 20 22:59:49 2019 mp3
I discussed the surgery with the mother and discussed the risks and benefits with the mother, including limb swelling and inability to achieve _____ correction. I solicited and answered questions and informed consent was obtained.
** • Sorry, I can't get it. - Questyr
Wed Feb 20 23:07:05 2019 Questyr

** • complete correction? - poi
Wed Feb 20 23:06:49 2019 poi

**** • ... + g d i g b m
Wed Feb 20 23:38:58 2019 g d i g b m

**** • Thanks a lot everybody - guy
Wed Feb 20 23:15:39 2019 guy


• The patient is a 15-year-old female with a leg length discrepancy and ...
+ wav
Wed Feb 20 22:55:07 2019 wav
The patient is a 15-year-old female with a leg length discrepancy and bony deformity of the sacrum. She has an underlying diagnosis of VACTERL syndrome. She will need future surgery to correct the deformity in her spine and achieving overall correction of balance. I discussed elective epiphysiodesis of the right distal femur and proximal tibia to help equalize her leg lengths. Imaging demonstrates that her _____ completely closed.
** • ???physes are not??? - Questyr
Wed Feb 20 23:05:22 2019 Questyr

**** • Thanks a lot. - guy
Wed Feb 20 23:05:51 2019 guy


• Preoperative Diagnosis: HYPERPARATHYROIDISM. Procedure: E ...
+ wav
Wed Feb 20 22:30:11 2019 wav
Preoperative Diagnosis:
HYPERPARATHYROIDISM.

Procedure:
EXCISION OF LEFT INFERIOR PARATHYROID ADENOMA.

The patient was then prepped and draped in the usual fashion. An incision was made, and subplatysmal flaps were elevated. The left thyroid lobe was then mobilized, and reflected medially. On manual palpation of the left paratracheal space, a small, firm, and mobile mass was felt and suspicious for parathyroid adenoma. The mass was carefully dissected, was noted to have a _____ appearance with some brown/tan appearance to it, concerning for adenoma.
** • shotty - poi
Wed Feb 20 22:32:13 2019 poi

**** • Thanks a lot. - guy
Wed Feb 20 22:33:09 2019 guy


• doorframe one word here?
+ guy
Wed Feb 20 21:22:19 2019 guy
male who presented to the emergency room with a right thumb laceration after punching a doorframe.
** • did you check a dictionary? - poi
Wed Feb 20 21:23:12 2019 poi

**** • what's that? - lol
Wed Feb 20 21:35:56 2019 lol

**** • no. using two words. thanks - guy
Wed Feb 20 21:24:22 2019 guy

****** • Guy, one of the white boxes at the top of the Word Board page is called Onelook. If you + Questyr
Wed Feb 20 22:36:40 2019 Questyr
type in doorframe you will get hits from multiple dictionaries all showing it is one word.

• Using a 4-0 FiberWire, a modified Kessler core suture was placed in a ...
+ wav
Wed Feb 20 21:16:14 2019 wav
Using a 4-0 FiberWire, a modified Kessler core suture was placed in a two-strand repair fashion and this was buttressed by a horizontal mattress stitch again using a 4-0 FiberWire suture. A ____ epitendinous suture repair was then performed on the dorsal surface of the extensor pollicis longus tendon using a 6-0 Prolene suture.
** • Silfverskiold (not sure how it should be pronounced, but I think this is what she means) - poi
Wed Feb 20 21:21:50 2019 poi

**** • Thanks a lot. - guy
Wed Feb 20 21:22:30 2019 guy


• General endotracheal anesthesia was induced without incident. A time- ...
+ mp3
Wed Feb 20 19:02:05 2019 mp3
General endotracheal anesthesia was induced without incident. A time-out was performed. Bronchoscope was placed into the endotracheal tube which initially encountered abundant amount of thick mucous secretions. These were aspirated out and then the distal trachea and proximal mainstem _____ carina were visualized and patent.
** • ??? and proximal??? - Questyr
Wed Feb 20 19:08:46 2019 Questyr

**** • Thanks a lot. - guy
Wed Feb 20 19:09:10 2019 guy


• Preoperative Diagnosis: RIGHT HYDROPNEUMOTHORAX. He was then ...
+ wav
Wed Feb 20 18:49:39 2019 wav
Preoperative Diagnosis:
RIGHT HYDROPNEUMOTHORAX.

He was then seen back in the emergency room at some point few weeks later with his lung collapsed and the thoracic surgery service was not consulted regarding this. He came back in on this admission with shortness of breath and difficulty breathing and as X-ray shows that his lung was a large hydropneumothorax, _____ Pleur-evac on water seal and the lung came up small amount; however, CAT scan demonstrated that there could be some endobronchial reason for the lung not fully expanding.
** • His Pleurx (PleurX) was placed on - poi
Wed Feb 20 18:56:38 2019 poi

**** • Thanks a lot. - guy
Wed Feb 20 19:02:26 2019 guy


• Once we were satisfied with the apposition, the remainder of the iliac ...
+ wav
Wed Feb 20 18:11:51 2019 wav
Once we were satisfied with the apposition, the remainder of the iliac branch component was deployed successfully. At this time, over the Rosen wire we placed an _____ balloon and we ballooned the two components of the iliac branched system together and then we performed an angiogram through the sheath to confirm that there was adequate deployment of the system, which there appeared to be with brisk flow to the initial and external iliac arteries.
** • I realize it's too late, but 2 things: 1) I would question whether + Questyr
Wed Feb 20 19:13:43 2019 Questyr
it really was "two components of the iliac branch (not branched) system. 2) I would question "initial and external iliac arteries". Off the top of my head, initial doesn't sound right.
** • Atlas - poi
Wed Feb 20 18:38:45 2019 poi

**** • Thanks a lot. - guy
Wed Feb 20 18:49:24 2019 guy

** • never mind. Thanks to anyone who tried. - guy
Wed Feb 20 18:30:10 2019 guy


• At this point in the procedure, we introduced the iliac branch compone ...
+ mp3
Wed Feb 20 18:02:17 2019 mp3
At this point in the procedure, we introduced the iliac branch component on the patients right side over the right side of Lunderquist wire and placed the Glidewire through the branch component on the _____ instructions for use. This was advanced just proximal to the level of the iliac bifurcation.
** • got it. thanks. + guy
Wed Feb 20 18:06:00 2019 guy
the Gore device according to


• Preoperative Diagnosis: RIGHT COMMON ILIAC AND INFRARENAL AORTIC AN ...
+ wav
Wed Feb 20 17:51:05 2019 wav
Preoperative Diagnosis:
RIGHT COMMON ILIAC AND INFRARENAL AORTIC ANEURYSMS.

Procedure:
ENDOVASCULAR REPAIR OF RIGHT COMMON ILIAC ARTERY ANEURYSM AS WELL AS INFRARENAL AORTIC ANEURYSMS WITH AN AORTIC ENDOPROSTHESIS AND BRANCHED ILIAC DEVICE ON THE PATIENTS RIGHT SIDE.

One was placed in approximately at the 10 oclock position, the other was placed approximately at the 2 oclock position according to instructions for use. The sutures were then _____ off medially and laterally. We then turned our attention to the right side where we serially dilated up the sheath on the right side from a 5-French sheath.
** • controlled with the rubber?? __ and placed off (might want to check the instructions for + WAG-poi
Wed Feb 20 18:08:37 2019 WAG-poi
use)
**** • Thanks a lot. - guy
Wed Feb 20 18:09:47 2019 guy


• The patient is a woman with previous lumbar fusion, now presents with ...
+ mp3
Wed Feb 20 16:17:24 2019 mp3
The patient is a woman with previous lumbar fusion, now presents with _________ at L4-5, brought to the operating room for bilateral facet injections
** • adjacent-level disease - taco
Wed Feb 20 16:26:07 2019 taco

**** • Thanks, taco!! - mp3
Wed Feb 20 16:41:09 2019 mp3


• unclear word pls sm
+ abcdefg
Wed Feb 20 13:26:30 2019 abcdefg
patient with possible hernia. Doc dictates on examination: He appears to have a right inguinal hernia which is moderate sized, soft and easily reducible. However, in the supine position under ___ he appears to have a firm mass within the spermatic cord, itself. question: it sounds like he's saying either abduction or adduction... any thoughts, please? thanks
** • NOTE: "itself" is a reflexive intensive pronoun and should not have a comma (see link) + Questyr
Wed Feb 20 13:59:07 2019 Questyr
link
**** • thank you - abcdefg
Wed Feb 20 14:12:30 2019 abcdefg

**** • You'll need to peruse several of the hits to get the full explanation - Q
Wed Feb 20 13:59:59 2019 Q

** • I think it could be either - fwiw-poi
Wed Feb 20 13:51:58 2019 fwiw-poi

**** • If the pt is supine, I believe it has to be adduction. - Toward the midline.
Wed Feb 20 21:02:14 2019 Toward the midline.

****** • why? Please explain what supine has to do with anything? What is being + poi
Wed Feb 20 21:18:48 2019 poi
abducted or adducted?
******** • movement toward the midline can only be accomplished with adduction if you're supine - nm
Thu Feb 21 11:47:52 2019 nm

******** • google does show more hits for adduction, just trying to understand the logic. I + poi
Wed Feb 20 21:27:16 2019 poi
was actually thinking the hernia mass was being abducted or adducted and it seemed that could go either way.
**** • thank you, all! - abcdefg
Wed Feb 20 14:13:15 2019 abcdefg

** • if it is one or the other, I believe adduction would make the most sense. - mt
Wed Feb 20 13:27:51 2019 mt

**** • thanks - abcdefg
Wed Feb 20 14:13:28 2019 abcdefg


• I have recommended that he can ___ ultrasound and electrical stimulation
+ mp3
Wed Feb 20 11:12:24 2019 mp3
She is scheduled to be evaluated by her chiropractor and I have recommended that he can ___ ultrasound and electrical stimulation along with exercises.
** • have an - nm
Wed Feb 20 11:28:46 2019 nm

** • ???have??? - Questyr
Wed Feb 20 11:19:07 2019 Questyr

**** • thanks a lot - op (feeling stupid)
Wed Feb 20 11:42:16 2019 op (feeling stupid)


• Pt with knee pain.
+ sm please
Wed Feb 20 09:44:04 2019 sm please
He is status post arthroscopy and continues to have medial-sided pain and clicking. There was an articular cartilage defect seen at surgery, but no other details are given to me.

Dx: Status post left knee arthroscopy with likely s/l oh-kruh-nel-uh-sis with some early cartilage damage, medial femoral condyle.
** • I think he is saying ochronosis. Ty! + OP
Wed Feb 20 09:49:15 2019 OP
x

• The tibial bone was then removed. We then used a spacer to verify our ...
+ mp3
Wed Feb 20 08:55:38 2019 mp3
The tibial bone was then removed. We then used a spacer to verify our flexion and extension gaps and an alignment rod was placed and the spacer to check overall alignment _____. We then pinned the distal femoral condyle resection guide and used an oscillating
** • which we were pleased with. - l j a o o d
Wed Feb 20 10:10:51 2019 l j a o o d

** • alignment, which we were pleased with. - maybe?
Wed Feb 20 09:36:42 2019 maybe?

**** • Thanks a lot everybody - guy
Wed Feb 20 17:52:04 2019 guy

** • once we were _____??? - not much help-poi
Wed Feb 20 09:12:19 2019 not much help-poi

**** • Thanks a lot. - guy
Wed Feb 20 09:12:58 2019 guy

** • never mind. Thanks to anyone who tried. - guy
Wed Feb 20 09:11:40 2019 guy




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