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Dec 11 03:51
• Preoperative Diagnosis: LEFT HIP INTERTROCHANTERIC FRACTURE. ...
+ wav
Thu Dec 13 18:42:57 2018 wav
Preoperative Diagnosis:
LEFT HIP INTERTROCHANTERIC FRACTURE.

Procedure:
LEFT HIP SHORT CEPHALOMEDULLARY NAIL.

This is a 77-year-old female with no significant past medical history other than a large mass growing out of her left lower back, who on the day of presentation was at the train station. She was _____ and someone knocked her over onto her left side, immediate onset of pain and inability to bear weight.
** • trying to tip a musician - Questyr
Thu Dec 13 18:52:27 2018 Questyr

**** • Thanks a lot. - guy
Thu Dec 13 18:56:32 2018 guy


• "Cold" leakage
+ ms
Thu Dec 13 12:53:02 2018 ms
"Cold" leakage after bowel movements. Is the word "cold" right?
** • I don't know what that would mean. "Stool" leakage makes better sense. What's the context? - taco
Thu Dec 13 13:00:49 2018 taco

**** • Yes I think the doctor meant to say "stool" leakage and said c ... + h m o c b k
Thu Dec 13 13:13:43 2018 h m o c b k
Yes I think the doctor meant to say "stool" leakage and said cold instead. Thks
****** • I betcha Dr. probably said "stool" and you heard "cold." Maybe he said fecal. + sm
Thu Dec 13 17:01:22 2018 sm
Either way, always give the full sentence, one before and one after. At least.

• ught to place possible addition of *ViaNase* to breakup loculated effusion
+ ?
Thu Dec 13 09:24:17 2018 ?
Blood work shows nothing yet, it has been drawn now. CBC: Electrolytes, liver panel, sedimentation rate, vancomycin tough. He said when he was off vancomycin, fevers returned. ID consult is planned. Procalcitonin level is planned. CT of the chest was planned. I reviewed with Dr. Durban, remaining to have IR being involved for pigtail catheter placement, ought to place possible addition of ViaNase to breakup loculated effusion. We will continue cefepime and vancomycin, we dosed at 6 p.m. this evening and follow along. Blood work will be reviewed as well as imaging studies including CT of the chest.
** • ...catheter placement, alteplase, possible addition of Dnase to break up loculated... - nm
Thu Dec 13 10:38:40 2018 nm

**** • ty - !
Thu Dec 13 15:10:43 2018 !

** • You have a typo--vancomycin tough should be trough - isgal
Thu Dec 13 09:39:07 2018 isgal

**** • ty - -
Thu Dec 13 09:47:37 2018 -


• We then docked the robot. We began the case by incising the peritoneu ...
+ wav
Thu Dec 13 05:57:33 2018 wav
We then docked the robot. We began the case by incising the peritoneum in the pouch of Douglas. Vas deferens on both sides were identified and traced along the length _____ using a combination of sharp dissection and monopolar shears. The vessels overlying the seminal vesicles were ligated bilaterally using bipolar cautery.
** • got it. thanks. + guy
Thu Dec 13 06:30:25 2018 guy
along the length of the tips of the seminal vesicles (i think)

• A proximally referencing smooth wire was then placed from lateral to m ...
+ wav
Thu Dec 13 01:05:36 2018 wav
A proximally referencing smooth wire was then placed from lateral to medial, just below the level of the joint line anterior to the fibula head. This was confirmed fluoroscopically to be parallel to the joint. Using offset _____ this was then secured to the 5/8 ring and attention was turned to the distal fixation
** • never mind. Thanks to anyone who tried. - guy
Thu Dec 13 01:40:44 2018 guy


• is or are?
+ c d g k c k
Thu Dec 13 01:02:25 2018 c d g k c k
This along with the degree of generation at L5-S1 and Xs clinical complaints *is/are* highly suggestive of mechanical instability related to his work-related injury
** • "This" is the singular subject so use "is" rather than "are." A couple of commas helps + make it clear - sm
Thu Dec 13 04:40:40 2018 make it clear - sm
This, along with the degree of degeneration at L5-S1 and Xs clinical complaints, is highly suggestive of mechanical instability related to his work-related injury
**** • Thanks. This is what I did, but I wanted someone else's opinion on it. - op
Thu Dec 13 04:51:59 2018 op

** • *degeneration - correction
Thu Dec 13 01:04:54 2018 correction


• I do think it is very likely that the L5-S1 level is ____ the source of his pain
+ mp3
Thu Dec 13 00:21:44 2018 mp3
With the findings of a spondylolysis, I do think it is very likely that the L5-S1 level is ____ the source of his pain but that a minimally invasive L5-S1 fusion would likely eliminate the pain in its entirety with a high success rate.
** • not only the source... - poi
Thu Dec 13 00:24:44 2018 poi

**** • ... - thanks
Thu Dec 13 00:59:59 2018 thanks


• Preoperative Diagnosis: LEFT TIBIA FRACTURE INFECTED NONUNION. ...
+ wav
Thu Dec 13 00:18:12 2018 wav
Preoperative Diagnosis:
LEFT TIBIA FRACTURE INFECTED NONUNION.

Procedures:
1. LEFT TIBIA SINUS TRACT EXCISION.
2. REMOVAL OF HARDWARE, LEFT TIBIAL NAIL AND INTERLOCKING SCREWS.
3. IRRIGATION AND DEBRIDEMENT, LEFT TIBIA.
4. CEMENT IMPLANTATION.
5. SPATIAL FRAME APPLICATION.
6. FIBULA OSTEOTOMY.

IMPLANTS: DePuy Synthes multiaxial correction system;
1. A 5.8 proximal ring and full distal ring.
2. _____ x6.
3. Transfixion wires x4 proximally.
4. The 5 mm half-pins distally x4.

** • Could he be saying "quick connect struts"??? - Q
Thu Dec 13 00:33:23 2018 Q

** • I am finding "quick adjust struts", just not sure that is what I hear + link
Thu Dec 13 00:23:23 2018 link
link
**** • Wonder if he's saying "quick and naked struts times 6" (see link) + Q
Thu Dec 13 00:28:03 2018 Q
link
****** • Oops...meant this as a standalone post, not a response to yours..sorry - Q
Thu Dec 13 00:28:44 2018 Q

******** • Nevermind...don't think it's naked - Q
Thu Dec 13 00:30:37 2018 Q

** • NOTE: DePuy's website indicates it is 5/8 (not 5.8) (see link) + Questyr
Thu Dec 13 00:22:27 2018 Questyr
link
** • I think #1 is 5/8 proximal ring - poi
Thu Dec 13 00:20:26 2018 poi

**** • Thanks a lot everybody - guy
Thu Dec 13 00:30:59 2018 guy


• The endocervical canal was closed with #0 Vicryl sutures. A tumor imp ...
+ wav
Wed Dec 12 23:42:48 2018 wav
The endocervical canal was closed with #0 Vicryl sutures. A tumor implant on the bladder peritoneum was then elevated, separated away from the underlying peritoneum and removed using the Bovie. Similarly, additional tumor _____ posterior cul-de-sac were elevated, separated from the surrounding peritoneum.
** • got it. thanks. + guy
Wed Dec 12 23:47:42 2018 guy
involved in the

• strips would fall off on their own after surgery and they should not b ...
+ mp3
Wed Dec 12 22:12:54 2018 mp3
strips would fall off on their own after surgery and they should not be removed. The patient was given _____ instructions to return for a postop follow-up appointment
** • bos 3 - hyphenated form (follow-up) is still acceptable when used as an adjective. - fwiw
Wed Dec 12 22:38:22 2018 fwiw

** • also s/b followup (no hyphen as it is adjectival form..only verb has hyphen) - Q
Wed Dec 12 22:17:59 2018 Q

** • ???explicit??? - Questyr
Wed Dec 12 22:17:28 2018 Questyr

**** • Thanks a lot. Thanks for the correction. - guy
Wed Dec 12 22:18:29 2018 guy


• Preoperative Diagnosis: DORSAL RIGHT WRIST GANGLION CYST. Pr ...
+ wav
Wed Dec 12 22:09:06 2018 wav
Preoperative Diagnosis:
DORSAL RIGHT WRIST GANGLION CYST.

Procedure:
RIGHT WRIST TENOSYNOVECTOMY.

POSTOPERATIVE INSTRUCTIONS: The patient was instructed to keep this right wrist Ace, Kling, 4 x 4 gauze in place for 48 hours postoperatively and not to shower and to keep this entire dressing dry and intact. The patient was instructed that the _____ strips would fall off on their own after surgery and they should not be removed.
** • ???___ Steri-strips??? - Questyr
Wed Dec 12 22:14:58 2018 Questyr

**** • ???___ Steri-Strips??? - Q
Wed Dec 12 22:15:32 2018 Q

****** • ???___ gauze Steri-Strips??? - Q
Wed Dec 12 22:20:29 2018 Q

******** • Thanks a lot. can it be "fresh" - guy
Wed Dec 12 22:22:29 2018 guy

********** • Possibly...my ears are just not good enough to say for sure. - Q
Wed Dec 12 22:24:54 2018 Q

************ • Thanks.. - guy
Wed Dec 12 22:58:11 2018 guy

**** • Thanks a lot. - guy
Wed Dec 12 22:15:19 2018 guy


• Preoperative Diagnosis: A 40-YEAR-OLD GRAVIDA 5, PARA 1-2-1-2 AT 37 ...
+ wav
Wed Dec 12 20:34:12 2018 wav
Preoperative Diagnosis:
A 40-YEAR-OLD GRAVIDA 5, PARA 1-2-1-2 AT 37 WEEKS AND 2 DAYS WITH OLIGOHYDRAMNIOS, UNDESIRED PERMANENT STERILIZATION.

Procedure:
TERTIARY CESAREAN SECTION WITH SINGLE-LAYER UTERINE CLOSURE VIA PFANNENSTIEL SKIN INCISION WITH BILATERAL TUBAL LIGATION VIA POMEROY METHOD.

Attention was then turned to the fallopian tube and ligated using two free ties via Pomeroy method _____ create a window at the mesosalpinx _____ fallopian tube approximately 3 cm _____ and sent to pathology. The same procedure was done on the right side.
** • #3. and both excised (that's all I can get) - poi
Wed Dec 12 20:46:02 2018 poi

**** • Thanks a lot. - guy
Wed Dec 12 20:50:35 2018 guy

****** • never mind. Thanks to anyone who tried. - guy
Wed Dec 12 20:53:04 2018 guy


• Pressure bandage was placed and fundal pressure was applied to express ...
+ wav
Wed Dec 12 19:22:35 2018 wav
Pressure bandage was placed and fundal pressure was applied to express clots. Ins and outs as noted. Needle, instrument, and lap sponge counts correct x3. The procedure was without complications. The patient was taken to the recovery room in stable condition with the infant _____.
** • in her arms? - poi
Wed Dec 12 19:26:21 2018 poi

**** • Thanks a lot. - guy-
Wed Dec 12 19:28:23 2018 guy-

** • got it. thanks. + guy
Wed Dec 12 19:26:11 2018 guy
with the infant in the arm

• Preoperative Diagnosis: A 32-YEAR-OLD GRAVIDA 6, PARA 4-0-1-4 AT 39 ...
+ wav
Wed Dec 12 19:04:09 2018 wav
Preoperative Diagnosis:
A 32-YEAR-OLD GRAVIDA 6, PARA 4-0-1-4 AT 39 WEEKS AND 4 DAYS WITH CONGENITAL HUMAN IMMUNODEFICIENCY VIRUS, VIRAL LOAD UNDETECTABLE, AND CHRONIC HYPERTENSION FOR QUATERNARY REPEAT CESAREAN SECTION AND LEVONORGESTREL INTRAUTERINE DEVICE PLACEMENT.

Procedure:
A LOW-FLAP TRANSVERSE CESAREAN SECTION WITH SINGLE-LAYER UTERINE CLOSURE VIA PFANNENSTIEL SKIN INCISION AND LEVONORGESTREL INTRAUTERINE DEVICE PLACEMENT.

DISPOSITION: Stable to labor room with _____.
** • infant in arms - poi
Wed Dec 12 19:30:19 2018 poi

**** • Thanks a lot. - guy
Wed Dec 12 19:31:29 2018 guy

** • antibiotic, no anticoagulation and no ________. - Questyr
Wed Dec 12 19:11:24 2018 Questyr

** • _____ arm??? - poi
Wed Dec 12 19:08:01 2018 poi

**** • Thanks a lot everybody - guy
Wed Dec 12 19:14:43 2018 guy


• The patient underwent an uneventful induction of general endotracheal ...
+ wav
Wed Dec 12 18:24:51 2018 wav
The patient underwent an uneventful induction of general endotracheal anesthesia by the Anesthesia team. Surgical time-out was performed in accordance with the hospital policy. The dressings were taken down. The wound was examined and found to be stable _____ ICU. The abdomen was prepped and draped in a sterile standard fashion using Betadine.
** • from what was seen in the ICU? - poi
Wed Dec 12 18:28:02 2018 poi

**** • Thanks a lot. - guy
Wed Dec 12 18:29:23 2018 guy


• The patient was brought to the operating room and transferred to the o ...
+ mp3
Wed Dec 12 18:21:11 2018 mp3
The patient was brought to the operating room and transferred to the operating room table in a supine position. Sequential compression devices were not applied given the patient has bilateral _____ bilateral lower extremities.
** • can't get this one. - sorry
Wed Dec 12 18:24:27 2018 sorry

**** • Thanks for the effort. - guy
Wed Dec 12 18:25:05 2018 guy

****** • never mind. Thanks to anyone who tried. - guy
Wed Dec 12 18:32:16 2018 guy


• The patient is a 53-year-old male, status post getting hit by a car ap ...
+ wav
Wed Dec 12 18:15:13 2018 wav
The patient is a 53-year-old male, status post getting hit by a car approximately two weeks ago _____ abdomen which was closed; however, he had a bile leak.
** • pinned over the abdomen?? - poi
Wed Dec 12 18:22:27 2018 poi

**** • Thanks a lot. - guy
Wed Dec 12 18:24:36 2018 guy


• Preoperative Diagnosis: ABDOMINAL WALL DEHISCENCE. Procedure ...
+ wav
Wed Dec 12 18:09:16 2018 wav
Preoperative Diagnosis:
ABDOMINAL WALL DEHISCENCE.

Procedure:
IRRIGATION AND DEBRIDEMENT _____ PLACEMENT OF MIDLINE ABDOMINAL WOUND.

** • sounds like evacuation of... - billybob
Wed Dec 12 18:12:23 2018 billybob

**** • Thanks a lot. - guy
Wed Dec 12 18:15:00 2018 guy


• S/l "Fainting" colitis. Fainting could ocur with colitis, but is this
- correct?
Wed Dec 12 17:55:01 2018 correct?

** • it would help to have complete sentences, but check out this link + link
Wed Dec 12 18:05:25 2018 link
link
**** • It was just part of a list of illnesses. Thanks for the link. I think MD really dictated - fainting colitis.
Wed Dec 12 18:47:35 2018 fainting colitis.

****** • That last could have been helpful. - nm
Thu Dec 13 10:52:19 2018 nm


• Stable to valgus and varus stress at 0 and 25 degrees. Negative _______ test
+ sm
Wed Dec 12 13:37:14 2018 sm
Examination under anesthesia was performed showing positive McMurray's sign again medially. Range of motion was 0 to 140 degrees. Negative pivot shift, 1A Lachman, negative anterior and posterior drawer. Stable to valgus and varus stress at 0 and 25 degrees. Negative __________ test.

Standard medial and lateral portals were marked out. Then, 0.25% Marcaine with epinephrine was injected into the portal sites and then 10 cc into the joint itself. An incision was made laterally and the arthroscope was introduced into the joint. Utilizing a spinal needle, the medial portal was established.
** • Dial test? - nm
Wed Dec 12 17:42:54 2018 nm

** • Whoops - thought i put a sound like. S/l bowel - -
Wed Dec 12 13:44:56 2018 -

**** • flagging - -
Wed Dec 12 15:26:50 2018 -


• Does this need commas?
+ tia
Wed Dec 12 12:31:28 2018 tia
The right shoulder shows chronic degeneration of the superior anterior and inferior labrum.
** • Actually it is 2 locations (see link)...the shoulder has an + Questyr
Wed Dec 12 19:18:50 2018 Questyr
anterior and a posterior side and, on each side, there would be a superior (top) section and an inferior (bottom) section ...so this is describing the findings on the anterior side both superiorly and inferiorly.
**** • The LABRUM has a superior (top), anterior (front), and inferior (bottom) - fwiw
Wed Dec 12 22:55:37 2018 fwiw

****** • I did state that the (see message) + Questyr
Thu Dec 13 00:40:19 2018 Questyr
labrum has a superior and inferior location and the link shows an image as such. But the point I was trying to make was that by saying "anterior" the doctor was indicating the superior location on the anterior side of the should AND the inferior location on the anterior side, thus two locations both being on the anterior side for this patient. At least that's how I interpret the sentence.
******** • oops...typo s/b shoulder (not should) in the message - Q
Thu Dec 13 00:41:33 2018 Q

********** • not sure how you interpret that the labrum has 2 superiors and 2 infer ... + fwiw
Thu Dec 13 01:08:32 2018 fwiw
not sure how you interpret that the labrum has 2 superiors and 2 inferiors. Your link showed a picture of the shoulder. I didn't need to see a picture to know there is an anterior and posterior side of the body. I did NOT see a picture showing an anterior superior, posterior superior, anterior inferior and posterior inferior labrum. If you look at a circle or egg shape (like the labrum) there will be a front (anterior), back (posterior), top (superior), bottom (inferior)
************ • (see message and link) + Q
Thu Dec 13 13:00:09 2018 Q
The shoulder is on the side (lateral) of the body. The glenoid cavity is on the side (lateral) of the body. The labrum is a "cartilage ring around the glenoid." Because the glenoid cavity is on the lateral side of the body half of the labral cartilage ring is on the anterior side of the body and half is on the posterior side of the body. And each side of the body (anterior and posterior) has a top and a bottom (superior and inferior). For instance, "A Bankart lesion is an injury of the anterior (inferior) glenoid labrum of the shoulder". It is true you "did NOT see a picture showing an anterior superior, posterior superior, anterior inferior and posterior inferior labrum" as they are merely directional words like north, south, east, west, top, bottom. One can talk about the top of the labrum (superior), one can be more specific and talk about the top front of the labrum (superior anterior). I note the quote I gave about the Bankart lesion chose to put the "i
************** • When you click on the link you have to wait a bit for it to pull up the specific + Q
Thu Dec 13 13:05:17 2018 Q
image that contains the "cartilage ring" quote.
**************** • link + link
Thu Dec 13 15:52:39 2018 link
link
****************** • This link shows label and image of "anterior superior labral tear", but I + Q
Thu Dec 13 18:45:25 2018 Q
do understand the point you are making too.
******************** • My link didn't work so I'm pasting the address to see + Q
Thu Dec 13 18:49:02 2018 Q
if you can get to the image that way.

https://www.google.com/search?q=labrum+superior+inferior+anterior+posterior&tbm=isch&tbs=rimg:CR5lvzJWfMNKIjgixzZUO5n4QuPqM-YIOWG7ZMe5GBLkJEZliWLwtQMRonn-kCzEsUHIbIeqS4pIxp2v-J8aAh7XkSoSCSLHNlQ7mfhCETY2fcytPMzSKhIJ4-oz5gg5YbsRZIsHzObH52sqEglkx7kYEuQkRhF3xCI1wAIreyoSCWWJYvC1AxGiEU5Up2h_1l6V-KhIJef6QLMSxQcgRnZN1nXBm2DwqEglsh6pLikjGnRGlI_1GQ9yjM1CoSCa_14nxoCHteREbXSJrLCvAhx&tbo=u&sa=X&ved=2ahUKEwi9576O_J3fAhXMJjQIHUSVDaEQ9C96BAgBEBg&biw=1185&bih=557&dpr=1.35#imgrc=3b8dmsdaq1atKM:&spf=1544744188909
********************** • Yes ...the pasted address onto a google tab does bring up + Q
Thu Dec 13 18:51:50 2018 Q
the image and the "anterior superior labral tear" is shown and labeled on the drawing.
**************** • link + link
Thu Dec 13 15:50:37 2018 link
link
****************** • ignore link. They are not working. - link
Thu Dec 13 15:53:28 2018 link

******************** • the first one worked. - fwiw
Thu Dec 13 15:55:59 2018 fwiw

********************** • The first one worked for me. - Q
Thu Dec 13 18:54:14 2018 Q

** • I would have. Three different locations. - fwiw
Wed Dec 12 17:39:15 2018 fwiw

** • No. ... + nm
Wed Dec 12 16:29:03 2018 nm
No.
**** • ... - thanks
Wed Dec 12 16:32:00 2018 thanks


• n Zosyn and daptomycin for a *V wreck* with a nasogastric tube
+ ?
Wed Dec 12 08:50:20 2018 ?
On postoperative day #4, she was noted to be diuresing well, on Zosyn and daptomycin for ______ with a nasogastric tube in place and a colostomy was viable, but without function. Neurology consultation was obtained and a suspected multifactorial metabolic toxic infectious ________ was suspected. CT of the head was negative and therefore a CVA was felt to be unlikely. On postoperative day #7, all drains were serosanguineous and we were still awaiting colostomy function. The patient had remained intubated since surgery. NG tube feeds were started at 10 cc an hour on postoperative day #8, 05/01/2018. She was off pressors, but remained on ventilator. The wound was opened and on 05/05/2018, removed packing. She was felt to have developed pneumonia and was treated with antibiotics.
** • "vancomycin-resistant Enterococcus gallinarum (VREg) and E. casseliflavus (VREc)" - billybob
Wed Dec 12 12:05:30 2018 billybob

**** • ahhh - thanks
Wed Dec 12 13:44:31 2018 thanks

** • vancomycin-resistant enterococci (VRE) would fit. maybe adding a C for -coccus? - taco
Wed Dec 12 09:06:45 2018 taco

**** • ty - -
Wed Dec 12 09:15:58 2018 -


• Procedure: OPEN REDUCTION AND INTERNAL FIXATION OF RIGHT MANDIBULAR ...
+ wav
Wed Dec 12 08:16:08 2018 wav
Procedure:
OPEN REDUCTION AND INTERNAL FIXATION OF RIGHT MANDIBULAR BODY FRACTURE, PLACEMENT OF MAXILLARY AND MANDIBULAR ARCH BARS.

FINDINGS: Lingually _____ proximal mandibular segment.
** • not really sure but s/l : + k d i e m n
Wed Dec 12 08:29:04 2018 k d i e m n
Stable?

**** • Thanks a lot. - guy
Wed Dec 12 08:38:27 2018 guy


• not sure which way to expand BNP. B-type or brain natriuretic peptide?
+ nm
Wed Dec 12 08:14:29 2018 nm
s
** • either or - k d i e m n
Wed Dec 12 08:26:47 2018 k d i e m n

**** • thanks + nm
Wed Dec 12 08:47:51 2018 nm
x

• Preoperative Diagnosis: GLAUCOMA OF THE LEFT EYE. Procedure: ...
+ wav
Tue Dec 11 23:32:35 2018 wav
Preoperative Diagnosis:
GLAUCOMA OF THE LEFT EYE.

Procedure:
TRABECULECTOMY WITH MITOMYCIN C OF THE LEFT EYE.

The patient would like to reduce her drops burden and therefore elected to proceed with surgery in the left eye. In addition, the intraocular pressure is running greater than _____ which ideally would run 10; therefore, she elected to proceed with trabeculectomy of the left eye.
** • target - Questyr
Tue Dec 11 23:41:59 2018 Questyr

**** • Thanks a lot. - guy
Tue Dec 11 23:46:44 2018 guy


• Preoperative Diagnosis: RIGHT FOURTH AND FIFTH METACARPAL FRACTURES ...
+ wav
Tue Dec 11 22:44:16 2018 wav
Preoperative Diagnosis:
RIGHT FOURTH AND FIFTH METACARPAL FRACTURES.

Procedure:
OPEN REDUCTION AND INTERNAL FIXATION OF RIGHT FOURTH AND FIFTH METACARPAL FRACTURES.

At the end of the case, all sponge and needle counts were correct. The patient tolerated the procedure well, was aroused from sedation, taken to PACU in good condition _____ out his IV with a plan to follow up in clinic to stay **mobilized** for two weeks, after which he will be **immobilized**.
** • to get out his IV? I would think it should be immobilzed then mobilized. - fwiw-poi
Tue Dec 11 22:48:14 2018 fwiw-poi

**** • Thanks a lot. Thanks for the correction. - guy
Tue Dec 11 22:48:35 2018 guy


• Procedure: SEPTOPLASTY AND BILATERAL INFERIOR TURBINOPLASTY. ...
+ wav
Tue Dec 11 21:17:42 2018 wav
Procedure:
SEPTOPLASTY AND BILATERAL INFERIOR TURBINOPLASTY.

She has failed a trial of maximal medical treatment and therefore was counseled on the surgical options for managing nasal congestion. All risks, benefits, and alternatives were discussed and the patient was _____ prior to the procedure.
** • formally consented. - billybob
Tue Dec 11 21:27:01 2018 billybob

**** • Thanks a lot. - guy
Tue Dec 11 21:30:17 2018 guy


• Preoperative Diagnosis: STAGE 2A SQUAMOUS CELL CERVICAL CANCER, STA ...
+ wav
Tue Dec 11 20:42:21 2018 wav
Preoperative Diagnosis:
STAGE 2A SQUAMOUS CELL CERVICAL CANCER, STATUS POST CHEMORADIATION.

Procedure:
EXAM UNDER ANESTHESIA, TANDEM AND OVOID PLACEMENT.

The anterior lips of the cervix were grasped with a single-tooth tenaculum. The uterine sound was introduced and the uterus was sounded to 8 cm. Under ultrasound guidance, the tandem was then introduced to _____ 6 cm and the ovoid were attached to the tandem by radiation oncology.
** • sounds more like a stutter and changed her mind? - k d i e m n
Tue Dec 11 20:53:37 2018 k d i e m n

**** • Thanks a lot. - guy
Tue Dec 11 21:18:09 2018 guy

** • never mind. Thanks to anyone who tried. - guy
Tue Dec 11 20:51:36 2018 guy


• Preoperative Diagnosis: LEFT DEGENERATIVE PRIMARY HIP OSTEOARTHRITI ...
+ wav
Tue Dec 11 18:23:36 2018 wav
Preoperative Diagnosis:
LEFT DEGENERATIVE PRIMARY HIP OSTEOARTHRITIS.

Procedure:
LEFT TOTAL HIP ARTHROPLASTY WITH COMPUTER NAVIGATION ASSISTANCE USING INTELLIJOINT.

We then performed an inferior capsular release and placed a cobra retractor along the inferior margin of the acetabulum and this Gelpi retractor was placed into the joint capsule superiorly. We then removed the labrum and contents of the _____ fossa and proceeded to ream in sequential fashion to the above size component.
** • condylar - poi
Tue Dec 11 18:34:45 2018 poi

**** • condyloid joint - poi
Tue Dec 11 18:35:40 2018 poi

****** • geez...condyloid fossa - poi
Tue Dec 11 18:36:09 2018 poi

**** • Thanks a lot. - guy
Tue Dec 11 18:34:57 2018 guy


• "Patient has had Shingrix and *vennar 13* vaccines"
+ CO MT
Tue Dec 11 17:45:50 2018 CO MT
I've heard of Prevnar 13, I clearly don't hear that here. Any ideas?
** • He's got to be mispronouncing Prevnar (grossly), but I'm blanking it - CO MT
Tue Dec 11 17:51:21 2018 CO MT


• Hearing test: s/l "A sting" was done and these responses seem accurate and reliable.
+ sm - tia
Tue Dec 11 11:13:49 2018 sm - tia
she has a downward sloping neurosensory hearing loss with pure tone responses to as low as 50 and 60 dB at 6000 and 8000 Hz respectively. This was rechecked by the audiologist. _____[s/l A sting] was done and these responses seem accurate and reliable.
** • I found a "lactic acid sting test (LAST)" - could that be it? - taco
Tue Dec 11 11:16:03 2018 taco

**** • I don't feel that it fits with the hearing test that I can find - thanks though! - op
Tue Dec 11 11:38:06 2018 op

****** • Maybe Stenger - k d i e m n
Tue Dec 11 12:42:49 2018 k d i e m n

******** • yes! that is it. Thank you! - op
Tue Dec 11 12:55:24 2018 op


• Millon Clinical Multiaxial Inventory-III testing (ESL)
+ sm
Tue Dec 11 10:02:31 2018 sm
examinee displayed avoidant, negativistic, schizoid and paranoid traits. Testing pointed towards major depression and possible anxiety disorder. Most notable is his indifference to the actions and feelings of others. Also s/l saline are his broad-based social anxiety and fearful guardedness. Also s/l "will give" attention in his lack of s/l motoric and ami tive expressiveness.
** • Can you hear: Also, with inattention...(?) + sm/link
Tue Dec 11 10:32:06 2018 sm/link
"Also worthy of attention are her deficits in motoric and emotive expressiveness....Her speech may be slow and monotonous, characterized by an absence of affect and by obscurities that may signify either inattentiveness or failure to grasp the emotional dimensions of communication."
** • motoric and emotive expressiveness + link
Tue Dec 11 10:23:47 2018 link
link
** • saline = salient? - poi
Tue Dec 11 10:11:20 2018 poi

**** • thank you all for your help - much appreciated
Tue Dec 11 10:55:10 2018 much appreciated


• Preoperative Diagnosis: BENIGN PROSTATIC HYPERTROPHY. Proced ...
+ wav
Mon Dec 10 22:12:03 2018 wav
Preoperative Diagnosis:
BENIGN PROSTATIC HYPERTROPHY.

Procedure:
TRANSURETHRAL RESECTION OF THE PROSTATE.

FINDINGS: Prostatic regrowth from previous _____. Normal urethra and bladder seen. Wide open channel at the end of the resection.
** • got it. thanks. + guy
Mon Dec 10 22:29:24 2018 guy
strip (i think)

• Preoperative Diagnosis: RIGHT PARIETAL ENHANCING NODULE WITH CYST. ...
+ wav
Mon Dec 10 19:28:23 2018 wav
Preoperative Diagnosis:
RIGHT PARIETAL ENHANCING NODULE WITH CYST.

Procedure:
RIGHT PARIETAL STEREOTACTIC NEEDLE BRAIN BIOPSY AND CYST DRAINAGE.

This is a 53-year-old male with a history of HIV on HAART therapy with a history of prior right parietal craniotomy for resection of intercranial mass with pathology being CNS lymphoma. He presents to the hospital with enlarging intracranial cyst and a residual enhancing _____ restricting nodule.
** • diffusion - nm
Tue Dec 11 11:18:44 2018 nm

** • Can't quite get it, but 3 lines above, should be "intra"cranial, (just got one brain) - mn
Mon Dec 10 19:58:49 2018 mn

** • sounds like infusion (cannot verify usage) - fwiw-poi
Mon Dec 10 19:58:24 2018 fwiw-poi

**** • I kind of hear "infusion restricting" but that just doesn't sound right. - mn
Mon Dec 10 20:00:09 2018 mn

****** • Thanks a lot everybody - guy
Mon Dec 10 20:30:33 2018 guy


• to ensure that there are no red flags of anemia or ___ etc.
- mp3
Mon Dec 10 14:29:50 2018 mp3

** • hypoalbuminemia, etc. - my guess
Mon Dec 10 15:01:41 2018 my guess

**** • ... - thanks
Mon Dec 10 15:21:15 2018 thanks


• colonscopy, s/l "tradoxogenic" sm plse
+ nm
Mon Dec 10 13:42:47 2018 nm
Secretions were obtained and sent for C. diff **and tra-doxo-genic coli** as well as cultlures and sensitivity.

He kind of runs that together, but best s/l I could get.

Thanks for any help.
** • got it - Enterotoxigenic coli - OP
Mon Dec 10 13:46:56 2018 OP


• There were no nail changes and no (s/l infasteal) tenderness.
+ ???
Mon Dec 10 12:31:38 2018 ???
Examination showed a right second proximal interphalangeal joint swelling and a the left second distal interphalangeal joint swelling. He had restricted neck movements but his modified Schober's lateral flexion was intact and his chest expansion was 3 cm. There were no nail changes and no (s/l infasteal) tenderness.
** • ? entheseal - nm
Mon Dec 10 13:43:51 2018 nm


• s/l Fios needle. Procedure is tubal ligation.
+ can't find
Mon Dec 10 12:15:19 2018 can't find
A small subumbilical incision was made and a 5 mm s/l Fios needle was passed under direct visualization with CO2 flowing. On entering the cavity, we checked for any sign of injury.
** • there is a Kii Fios First Entry system by Applied Medical for laparoscopy - if that helps - ltt
Mon Dec 10 12:33:50 2018 ltt

**** • Thanks a lot ! I did find that after I posted. - can't find
Mon Dec 10 12:37:50 2018 can't find


• horizontal-type tear from the posterior ____ of the body to the posterior horn.
+ mp3
Mon Dec 10 11:21:52 2018 mp3
There is decreased size of the medial meniscus consistent with his previous surgery with probable horizontal-type tear from the posterior ____ of the body to the posterior horn.
** • s/l posterior portion of the body to (body of the meniscus) - ltt
Mon Dec 10 11:30:04 2018 ltt

**** • ... - thanks
Mon Dec 10 11:31:54 2018 thanks


• As you know, he has been considered for "transcardiac valve replacement." Is this
+ tia
Mon Dec 10 03:02:19 2018 tia
okay? I'm unable to document it.
** • Check out TransCardiac Therapeutics + link
Mon Dec 10 17:10:30 2018 link
link
** • Check to see if you are really hearing "transaortic" - Questyr
Mon Dec 10 06:14:02 2018 Questyr

**** • He's saying "transcardiac" very clearly, though later he says the patient needs a TAVR. - op
Mon Dec 10 08:13:51 2018 op




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