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Feb 19 22:20
• He has not been aggresive or combative. He _____ spent most of the evening in the sm
+ wav :)
Mon Feb 20 12:41:29 2017 wav :)
day room.
** • was able to? - wag-poi
Mon Feb 20 12:49:52 2017 wag-poi

**** • was able to spend - poi
Mon Feb 20 12:58:53 2017 poi

****** • Thanks poi. Appreciate you. - :)
Mon Feb 20 13:01:07 2017 :)


• postoperative pain management. *Permanent* x-rays were obtained
+ sm
Mon Feb 20 12:37:28 2017 sm
At this point of the procedure, 20 cc of 0.5% Marcaine was placed as a radial nerve block for postoperative pain management. *Permanent* x-rays were obtained confirming excellent alignment of the first CMC joint with interposition bolus in place and excellent position of the MP joint with screw arthrodesis present.

** • I think meaning regular x-rays as opposed to interoperative fluoroscopy? (poi would know - better'n me, taco)
Mon Feb 20 12:39:31 2017 better'n me, taco)

**** • sounds like a good explanation to me :) - poi
Mon Feb 20 12:47:46 2017 poi

****** • thank you - !
Mon Feb 20 13:00:39 2017 !


• secured in place with the *lock it*
+ ?
Mon Feb 20 09:43:37 2017 ?
The proximal mesh was cut to size and pulled through the mesh arms and secured in place with the *lock it* . The midline of the proximal portion was secured to the cardinal ligament with #2-0 Vicryl. The wound was copiously irrigated.
** • seems to be an abandoned trademark Lock-It + poi-link
Mon Feb 20 12:19:36 2017 poi-link
link

• mesh was pulled slightly *on more* tension - pretty clear just seems like a weird way
+ to say
Mon Feb 20 09:32:47 2017 to say
There were no bladder injuries. The ureteral orifices were in a normal anatomical position, effluxing clear yellow urine. There was no injury to the urethra. The mesh was pulled slightly *on more* tension to achieve no incontinence upon removing the cystoscope. The mesh was placed flush over the mid urethra.
** • nm - -
Mon Feb 20 12:37:10 2017 -


• The distal mesh was _____. The proximal mesh AND place with the *lock it*.
+ wav
Mon Feb 20 09:26:23 2017 wav
Care was taken not to injure the neurovascular bundle. The distal mesh was _____. The proximal mesh was cut to size and pulled through the mesh arms and secured in place with the *lock it*. The midline of the proximal portion was secured to the cardinal ligament with 2-0 Vicryl.
** • She corrected herself - isgal
Mon Feb 20 09:39:35 2017 isgal

**** • ty - -
Mon Feb 20 09:43:49 2017 -


• leaving through _____1.5 cm caudal strut
+ wav
Mon Feb 20 08:28:51 2017 wav
A left Killian incision was made with #15 blade. Submucous dissection of the mucoperichondrium and mucoperiosteum was performed from anterior to posterior. Incision was made leaving through _____1.5 cm caudal strut and right mucoperichondrial and mucoperiosteal flap elevated from anterior to posterior.
** • Got it: through the septal cartilage leaving a - nm
Mon Feb 20 08:42:16 2017 nm


• Preoperative Diagnosis: A 32-YEAR-OLD GRAVIDA 1, PARA 0 AT 41-1/7 W ...
+ wav
Sun Feb 19 23:11:30 2017 wav
Preoperative Diagnosis:
A 32-YEAR-OLD GRAVIDA 1, PARA 0 AT 41-1/7 WEEKS WITH GESTATIONAL THROMBOCYTOPENIA AND ASTHMA, ADMITTED FOR LATE-TERM INDUCTION OF LABOR WITH _____ COURSE COMPLICATED BY CHORIOAMNIONITIS OR PRIMARY CESAREAN SECTION FOR NONREASSURING FETAL HEART TONES.


** • antepartum - nnm
Mon Feb 20 03:05:08 2017 nnm

** • nevermind + guy
Sun Feb 19 23:26:27 2017 guy
INTRAPARTUM

• Preoperative Diagnosis: A 36-YEAR-OLD GRAVIDA 3, PARA 1-0-1-1 AT 41 ...
+ wav
Sun Feb 19 22:43:20 2017 wav
Preoperative Diagnosis:
A 36-YEAR-OLD GRAVIDA 3, PARA 1-0-1-1 AT 41 WEEKS AND 1 DAY, UNDERGOING _____ INDUCTION, NONREASSURING FETAL HEART TRACING GOING SECONDARY TO _____ CESAREAN SECTION.

Procedure:
REPEAT LOW TRANSVERSE C-SECTION WITH SINGLE-LAYER CLOSURE VIA PFANNENSTIEL SKIN INCISION.

** • 1. late term 2. repeat - poi
Sun Feb 19 22:53:39 2017 poi

**** • Thanks a lot. - guy
Sun Feb 19 22:55:48 2017 guy


• volar vomer was taken to use for graft _______ changes
+ mp3
Sun Feb 19 17:41:41 2017 mp3
. A rectangular strip of cartilage just anterior to the vomer was taken to use in the future as a graft. Additionally, a small piece of volar vomer was taken to use for graft _______ changes. Surgical changes are a previous septoplasty.
** • ... - mp3 deleted
Sun Feb 19 18:23:41 2017 mp3 deleted


• Hydrochlorothiazide, atorvastatin, glipizide, __________, baclofen
- mp4 posted
Sun Feb 19 14:43:46 2017 mp4 posted

** • levocetirizine?? - nm
Sun Feb 19 15:16:03 2017 nm

**** • Thanks nm - OP
Sun Feb 19 15:46:44 2017 OP


• Omeprazole, atorvastatin, fluoxetine, _______, metformin,
- mp3 posted
Sun Feb 19 13:59:13 2017 mp3 posted


• For this reason, most recently he was admitted on 02/16/17 after comin ...
+ wav
Sat Feb 18 22:23:29 2017 wav
For this reason, most recently he was admitted on 02/16/17 after coming to the emergency room in respiratory distress with increasing stridor in the context of his preexisting 7-0 cuffless Portex tube, not sitting properly. On examination in the emergency room, there was firm, white tissue at the interface between _____ and the native airway that prohibited small trach tubes to be passed.
** • got it. thanks. + guy
Sat Feb 18 22:29:28 2017 guy
stoma.

• COPD: Continue Breo, Ellipta, s/l Dalares..
- OldMT
Sat Feb 18 17:38:31 2017 OldMT

** • DALIRESP (roflumilast) - taco
Sat Feb 18 18:38:09 2017 taco


• Need help with word please...
+ p a a l g d
Sat Feb 18 16:59:27 2017 p a a l g d
He is talking about total hip arthroplasty components and he says,

"The components are well placed with good s/l *spot-wells* holding the stem in place."
** • spot welds - nm
Sat Feb 18 17:13:35 2017 nm

**** • Thank you! :) - p a a l g d
Sat Feb 18 17:14:01 2017 p a a l g d


• Is "marked" what you hear? Thanks.
+ mp3
Sat Feb 18 15:08:59 2017 mp3
Under microscopic visualization using suction irrigation, a wax curette as well as alligator, the marked wax impaction was removed.
** • I think it is. Thanks - mp3 deleted
Sat Feb 18 15:28:57 2017 mp3 deleted


• The Afrin-soaked pledget was removed and again similar to the right si ...
+ mp3
Sat Feb 18 10:24:31 2017 mp3
The Afrin-soaked pledget was removed and again similar to the right side, we cauterized the inferior-anterior aspect of the ethmoid cavity using suction Bovie. A mini Propel stent was placed _____ middle turbinate medialized and the nasopharynx and nasal cavity were then suctioned. We then again turned our attention to the right side
** • nevermind. - k e j p a m
Sat Feb 18 10:54:14 2017 k e j p a m


• Preoperative Diagnosis: CHRONIC RHINOSINUSITIS WITH NASAL POLYPOSIS ...
+ wav
Sat Feb 18 09:55:09 2017 wav
Preoperative Diagnosis:
CHRONIC RHINOSINUSITIS WITH NASAL POLYPOSIS.

Procedures:
1. BILATERAL ENDOSCOPIC SINUS SURGERY.
2. BILATERAL MAXILLARY ANTROSTOMY.
3. BILATERAL TOTAL ETHMOIDECTOMY.
4. BILATERAL FRONTAL SINUSOTOMY.

We then began our block by injecting approximately 2 cc of 1% lidocaine with 1:100,000 epinephrine into the crista ethmoidalis _____ palatine block. An additional 2 cc of 1% lidocaine to 1:100,000 epinephrine was then injected in overlying mucosa over the nasolacrimal convexity. We visualized the polyps within the middle meatus and a microdebrider was used to take this down
** • nevermind. - k e j p a m
Sat Feb 18 10:54:22 2017 k e j p a m


• We began the case by making a 3-cm incision at the center of the later ...
+ mp3
Fri Feb 17 23:17:57 2017 mp3
We began the case by making a 3-cm incision at the center of the lateral rectus, the rectus muscle two fingers breadth below the costal margin and _____ Veress needle; however, likely related to the inflammation of her muscles. The facial planes were very thick and appeared destroyed.
** • facial planes or fascial planes? - e h p h c i
Sat Feb 18 07:30:10 2017 e h p h c i

**** • Thanks a lot. - guy
Sat Feb 18 08:54:14 2017 guy

** • nevermind. - guy
Fri Feb 17 23:46:44 2017 guy


• Preoperative Diagnosis: LEFT RENAL MASS X2. Procedure: LA ...
+ wav
Fri Feb 17 23:03:57 2017 wav
Preoperative Diagnosis:
LEFT RENAL MASS X2.

Procedure:
LAPAROSCOPIC LEFT RADICAL NEPHRECTOMY.

INDICATIONS FOR PROCEDURE: This is a 43-year-old female with a history of _____ meningitis complicated by subsequent deafness who presented to an outside hospital with difficulty breathing, was found to have polymyositis requiring intubation that improved with steroid use.
** • nevermind. - guy
Fri Feb 17 23:46:37 2017 guy


• The inferior margin of the pannus thus was incised and elevated up to ...
+ wav
Fri Feb 17 22:13:29 2017 wav
The inferior margin of the pannus thus was incised and elevated up to the umbilicus. Percutaneous fascial anchoring sutures for the laparoscopic mesh were protected and preserved _____ laterally.
** • I hear "and elevation laterally" but it doesn't work grammatically and + Questyr
Fri Feb 17 22:55:50 2017 Questyr
I'm not sure what he's TRYING to say so I can't be of real help...sorry.
**** • Thanks a lot. + guy
Fri Feb 17 22:57:17 2017 guy
can it be "on" elevation?

• GU: His tamsulosin was discontinued but his s/l vabrirserc was continued.
+ mt
Fri Feb 17 20:00:51 2017 mt
very thick accent.
** • Too late to help but maybe it was Viberzi? ~nm - RMT
Sun Feb 19 11:21:24 2017 RMT


• Preoperative Diagnosis: 25-YEAR-OLD GRAVIDA 2, PARA 1-0-1-1 AT 40-4 ...
+ wav
Fri Feb 17 19:18:53 2017 wav
Preoperative Diagnosis:
25-YEAR-OLD GRAVIDA 2, PARA 1-0-1-1 AT 40-4, FAILED INDUCTION OF LABOR FOR OLIGOHYDRAMNIOS WITH ARREST AT 3 CM _____ 24 HOURS FOR SECONDARY REPEAT CESAREAN SECTION.

Procedure:
SECONDARY REPEAT CESAREAN SECTION VIA PFANNENSTIEL SKIN INCISION, LOW-TRANSVERSE UTERINE INCISION, SINGLE LAYER CLOSURE.

** • despite AROM and oxytocin for - poi
Fri Feb 17 19:39:26 2017 poi

**** • max pitocin? (not oxytocin) - poi
Fri Feb 17 19:40:31 2017 poi

****** • Thanks a lot. - guy
Fri Feb 17 19:46:26 2017 guy


• ....in its entirety to the promontory. ___ space was noted...
+ mp3
Fri Feb 17 18:03:07 2017 mp3
Examination of ears:

In essence, the tympanic membrane, although scarred was adhered almost in its entirety to the promontory. ___ space was noted.


** • I think I hear "____ pyramidal space was noted" (see link showing + Questyr
Fri Feb 17 18:46:20 2017 Questyr
google hits about pyramidal space). Not sure if he's saying "no pyramidal space" or "___?___ pyramidal space"
**** • One of the hits shows pictures of the pyramidal eminence and further + Q
Fri Feb 17 18:49:36 2017 Q
down the pages of the pyramidal space
****** • Thank you so much, Q. - mp3
Fri Feb 17 19:06:45 2017 mp3

** • no mp3 there - poi
Fri Feb 17 18:16:44 2017 poi

**** • Thanks for letting me know. It should be there now. - mp3
Fri Feb 17 18:23:45 2017 mp3

****** • The space is 'middle ear' space. But I can't - mp3
Fri Feb 17 18:30:50 2017 mp3

******** • ....make out what's before it. - mp3
Fri Feb 17 18:31:10 2017 mp3

******** • ....make out what's before it. - mp3
Fri Feb 17 18:31:09 2017 mp3


• MEDICATIONS: None at present other than OCPs, which she is on _________
- mp3 posted
Fri Feb 17 17:31:06 2017 mp3 posted

** • ..which she is on for acne. Thanks - mp3 posted
Fri Feb 17 18:01:03 2017 mp3 posted


• full 6 weeks, but ______ more aggressively
+ wav
Fri Feb 17 17:27:58 2017 wav
in the sling for 6 weeks postoperatively and rehab her with a small rotator cuff repair protocol. She will keep in the sling for the full 6 weeks, but ______ more aggressively. I will see her back in a week to take out stitches and start formal therapy, orsooner if there is a problem or issue.
** • more her more - poi
Fri Feb 17 18:15:48 2017 poi

**** • move her more - oops-poi
Fri Feb 17 18:16:34 2017 oops-poi

****** • thanks - -
Fri Feb 17 19:47:08 2017 -


• remaining debris and ______. All instrumentation
+ mp4
Fri Feb 17 16:44:21 2017 mp4
All remaining debris and ______. All instrumentation was then removed. The portal was reapproximated with #2 nylon suture. Sterile dressing and a sling was applied and the patient was awoken from anesthesia and taken to the recovery.
** • fluid were suctioned from the joint - nm
Fri Feb 17 17:10:09 2017 nm

**** • thnx - -
Fri Feb 17 17:27:40 2017 -


• impaired bony bed. _______ cut and repaired _______ and noted
+ mp3
Fri Feb 17 16:43:17 2017 mp3
The suture was then placed into a 4.75 Bio-SwiveLock with this employed at the lateral aspect of the footprint creating excellent and firm reapproximation of the tendon back to the previously impaired bony bed. _______ cut and repaired _______ and noted to have excellent stability.
** • Sutures were cut and the repair inspected from the bursal side - nm
Fri Feb 17 17:14:49 2017 nm

**** • ty - -
Fri Feb 17 17:25:31 2017 -


• to this creating a ______ configuration
+ wav
Fri Feb 17 16:41:45 2017 wav
It was felt that the best repair technique for this small tear would be a Rip-Stop technique. A piece of Arthrex FiberTape.was passed in an inverted mattress configuration and an Arthrex Rip-Stop stitches placed medially to this creating a ______ configuration.
** • "rip-stop" - nm
Fri Feb 17 17:06:59 2017 nm

**** • or maybe "rip-stop configuration" actually - nm
Fri Feb 17 17:07:38 2017 nm

****** • thanks - -
Fri Feb 17 17:24:18 2017 -


• was performed _______ subacromial decompression AND acromion __________ anterolateral
+ mp3
Fri Feb 17 15:28:57 2017 mp3
Once this was done, attention was directed to the subacromial space. A shaver was inserted and complete bursectomy was performed _______ subacromial decompression performed with an arthroscopic bur taking care to clear the type I acromion __________ anterolaterally. In the bursal side, a small full thickness tear was identified and again a shaver was used to debride the tissue to healthy and bleeding bone as well as a healthy rotator cuff tissue.
** • taking care to "create a" type 1 acromonion (not "clear the") - taco
Fri Feb 17 16:27:26 2017 taco

**** • thanks - -
Fri Feb 17 16:40:18 2017 -


• A _____ shaver was inserted and this appeared to be a healthy tissue __________ down
+ wav
Fri Feb 17 15:25:59 2017 wav
The subacromial portal was established and the area of high grade partial thickness tear measuring about a 1 cm in size was completed at full thickness. A _____ shaver was inserted and this appeared to be a healthy tissue __________ down to healthy and bleeding bone.
** • and "this was debrided" to healthy tissue (not "this appeared to be") - taco
Fri Feb 17 16:22:49 2017 taco

**** • ...and abrased to debride the the footprint down to healthy... - taco
Fri Feb 17 16:24:35 2017 taco

****** • ty - -
Fri Feb 17 16:39:08 2017 -


• shaver was inserted _______ back to stable base
+ mp4
Fri Feb 17 15:11:40 2017 mp4
Inspection superiorly revealed a partial thickness tear of the entirety of the supraspinatus, but there was one area in the midsubstance where it appeared to be high grade partial thickness. A shaver was inserted _______ back to stable base.
** • and this was (trimmed?) back to a stable base - taco
Fri Feb 17 15:24:16 2017 taco

**** • ty - -
Fri Feb 17 15:27:39 2017 -


• A posterior ______ portal was established.
+ mp3
Fri Feb 17 14:58:52 2017 mp3
At this point, the patient was placed in the lateral decubitus position. The left shoulder and upper extremity was sterilely prepped and draped in surgical fashion. A posterior ______ portal was established. Diagnostic arthroscopy of the left shoulder was performed. Charlotte had extensive fraying of the superior labrum without gross instability consistent with a type I SLAP tear.

• including nonsurgical ______ left shoulder arthroscopy.
+ wav
Fri Feb 17 14:57:37 2017 wav
is a 51-year-old female with a persistently symptomatic left shoulder high grade but partial thickness tear of the supraspinatus. After risks, benefits, and alternative treatment options including nonsurgical ______ left shoulder arthroscopy.
** • and no treatment were discussed, she was ____ (can't get that last part) - taco
Fri Feb 17 15:05:35 2017 taco

**** • thanks - -
Fri Feb 17 15:10:44 2017 -


• IMPLANTS: s/l koo day Arthrex 4.75 Bio-Corkscrew x1.
- nm
Fri Feb 17 14:44:34 2017 nm


• dental OP report. Preop DX: Carious **peri-annul** of tooth times one.
- mt
Fri Feb 17 13:27:09 2017 mt

** • something "enamel" maybe? peri-enamel? - twag
Fri Feb 17 13:36:58 2017 twag

**** • that seems likely, but he is going so fast, thank you - probably will flag - mt
Fri Feb 17 13:41:28 2017 mt

** • More: It is tooth #28 extraction. - mt
Fri Feb 17 13:30:07 2017 mt


• The patient, _____, has been having this right shoulder pain.
- wav :)
Fri Feb 17 11:28:38 2017 wav :)

** • Sent in. - :)
Fri Feb 17 12:00:06 2017 :)


• Therefore, at this point, ______. The wound
+ mp3
Fri Feb 17 10:04:23 2017 mp3
The decision was then now to place the blade through the plate as much of our reduction was also being held. As a fair amount of security, the plate fixation was being held with outer screw in the oblique hole. Therefore, at this point, ______. The wound was irrigated. Tagged sutures in the rotator cuff were repaired to the plate for a tuberosity repair.
** • (with all?) pathology (being/having been?) addressed - taco
Fri Feb 17 10:34:08 2017 taco


• These were measured with ______ confirmed with depth cage
+ wav
Fri Feb 17 10:02:19 2017 wav
However, there was a large amount of comminution and bone loss and this area was filled with Stryker HydroSet bone void filling cement. Once this was done and allowed to cure, the remainder of screws was placed. The more distal screws were placed bicortically as well. These were measured with ______ confirmed with depth cage confirmed via fluoroscopy.


** • measured with depth gauge, confirmed... - billybob
Fri Feb 17 10:20:39 2017 billybob

**** • thank - you
Fri Feb 17 10:37:17 2017 you


• guidance __________ 5 cm __________ needle into the area
+ mp4
Fri Feb 17 07:40:21 2017 mp4
The patient agreed to such. She had preoperative testing, medical clearance, all within acceptable limits. At the morning of surgery, she was seen in the ultrasound suite and under ultrasound guidance __________ 5 cm __________ needle into the area of the biopsy cavity adjacent to the clip and at the completion of that, the patient did go down to the holding unit after seeing anesthesia and having anesthesia concern and all questions were answered.
** • I inserted a 5 cm ... can't find "Hohmann" or "Homan" needle though, but that is what I - hear.
Fri Feb 17 07:55:59 2017 hear.

**** • It is Homer needle. - :)
Fri Feb 17 08:16:10 2017 :)

**** • thank you - !
Fri Feb 17 07:59:30 2017 !


• s/l *holeman* needle
+ sm
Fri Feb 17 07:37:54 2017 sm
PROCEDURE PREFORMED: Ultrasound localization with the 5 cm _______ needle to the left 1 oclock 4 cm from the nipple. The area of the clip and biopsy site with a left partial mastectomy and tissue advancement with the specimen x-ray showing the clip in the specimen.
** • Surgical Word Book lists a Homer localization needle - Questyr
Fri Feb 17 18:52:28 2017 Questyr

**** • Oh, I see someone answered on the thread above this one. - Q
Fri Feb 17 18:54:25 2017 Q


• sutured to the _____ pubic tubercle
+ wav
Fri Feb 17 07:30:44 2017 wav
. I then proceeded to open a Versatex 6 cm x 11 cm mesh. The mesh was soaked in antibiotic solution. The mesh was cut, so that it measured 1 cm x 4 inches. The mesh was sutured to the _____ pubic tubercle with #0 Ethibond stitch. That stitch was continued suturing left laterally to the inguinal ligament.
** • changed last sentence: continued suturing _____laterally to the inguinal ligame - left isn't correct
Fri Feb 17 07:32:14 2017 left isn't correct

**** • got this one: to the rest laterally, flagging the other - ty
Fri Feb 17 08:07:21 2017 ty


• Preoperative Diagnosis: LEFT RENAL MASS. Procedure: ROBOT ...
+ mp3
Fri Feb 17 07:11:43 2017 mp3
Preoperative Diagnosis:
LEFT RENAL MASS.

Procedure:
ROBOTIC-ASSISTED LEFT PARTIAL NEPHRECTOMY.

INDICATIONS FOR PROCEDURE: This is a 29-year-old female who was seen at the Bellevue Hospital in November for left pyelonephritis. Imaging at that time showed a 2 cm lower pole mass, uncertain if it _____ with the infection. Repeat imaging several months later in the absence of symptoms showed continued left lower pole 3 cm mass that did have a solid component and was concerning for RCC.
** • affiliated - nm
Fri Feb 17 07:19:27 2017 nm

**** • Thanks a lot. - guy
Fri Feb 17 07:20:59 2017 guy


• Capillary refill time was confirmed to bilateral hallux and found to b ...
+ wav
Fri Feb 17 06:12:24 2017 wav
Capillary refill time was confirmed to bilateral hallux and found to be intact. The _____ dressed with Betadine-soaked Adaptic, dry sterile gauze, Kling, and Ace dressing.

• The proximal nail fold was resected proximally with a skin hook, and t ...
+ wav
Fri Feb 17 05:56:35 2017 wav
The proximal nail fold was resected proximally with a skin hook, and the skin was resected off the underlying subcutaneous and nail matrix. _____ nail fold matrix was excised in toto. Curettage was utilized to confirm re-excision of the bone matrix.
** • Proximal? - isgal
Fri Feb 17 05:59:30 2017 isgal

**** • Thanks a lot. - guy
Fri Feb 17 06:00:55 2017 guy


• Preoperative Diagnosis: INGROWN NAIL, BILATERAL HALLUX. Proc ...
+ wav
Fri Feb 17 05:50:34 2017 wav
Preoperative Diagnosis:
INGROWN NAIL, BILATERAL HALLUX.

Procedure:
BILATERAL SHARP TOTAL MATRICECTOMY

PROCEDURE IN DETAIL: The patient was transferred from the preoperative area to the operating room and placed on the operating room table. A time-out was performed by the Anesthesia attending and surgical attending verifying the patients name, date of birth, medical record number, and surgical site. The Anesthesia team performed spinal anesthesia. The patient was then placed in a supine position. Bilateral feet were then prepped and draped in the usual sterile manner. _____ into the left hallux. A Penrose drain was secured around the left hallux.
** • Attention was directed to the ... - e h p h c i
Fri Feb 17 05:52:09 2017 e h p h c i

**** • Thanks a lot. - guy
Fri Feb 17 05:54:04 2017 guy


• While carrying out decompression at and around the left nerve root of ...
+ mp3
Fri Feb 17 05:17:30 2017 mp3
While carrying out decompression at and around the left nerve root of L1, part of the tumor was adherent to the axilla of the nerve root and the dura there which was torn and there was egress of spinal fluid which was quickly stopped with placement of Gelfoam. _____ curettes were used to further decompress the ventral epidural space and remove as much tumor as possible.
** • nevermind. + guy
Fri Feb 17 05:38:14 2017 guy
Down-going curettes

• PROCEDURE IN DETAIL: The patient was brought into the operating room ...
+ wav
Fri Feb 17 05:13:04 2017 wav
PROCEDURE IN DETAIL: The patient was brought into the operating room supine on a stretcher. All lines and monitors were placed by the Anesthesia team. General anesthesia and endotracheal intubation were performed by the Anesthesia team. The patient was then flipped prone on a Jackson table with a Wilson frame. The L1 level was localized _____ superiorly from deep pelvis. Also, the compression fracture at L1 was very easily visualized on lateral fluoroscopy.
** • by counting superiorly from *the* - nnm
Fri Feb 17 05:34:07 2017 nnm

**** • Thanks a lot. Thanks for the correction. - guy
Fri Feb 17 05:35:32 2017 guy


• INDICATIONS: The patient is a 57-year-old male who presented with bac ...
+ mp3
Fri Feb 17 04:30:43 2017 mp3
INDICATIONS: The patient is a 57-year-old male who presented with back pain as well as a four-day history of inability to void as well as some inability to _____ as well. However, the patient had been full strength and had full sensation in his legs as well. The patient received an MRI scan of his lumbar spine which showed a significant compression fracture at L1 with epidural disease.
** • defecate - nnm
Fri Feb 17 05:11:34 2017 nnm

**** • Thanks a lot. - guy
Fri Feb 17 05:12:50 2017 guy


• Preoperative Diagnosis: THORACOLUMBAR EPIDURAL TUMOR. Proced ...
+ wav
Fri Feb 17 04:23:28 2017 wav
Preoperative Diagnosis:
THORACOLUMBAR EPIDURAL TUMOR.

Procedure:
T12-L1 LAMINECTOMY, T12 TO L2 POSTEROLATERAL INSTRUMENTED FUSION, AND DECOMPRESSION AND RESECTION OF EPIDURAL TUMOR.

IMPLANTS: Medtronic Solera screws and titanium rods, _____ allograft.
** • as well as ? - nnm
Fri Feb 17 05:11:13 2017 nnm

**** • Thanks a lot. - guy
Fri Feb 17 05:12:40 2017 guy


• Instrument count, needle count, and sponge counts were correct x2. ...
+ wav
Fri Feb 17 04:02:25 2017 wav
Instrument count, needle count, and sponge counts were correct x2.

_____ I preformed surgery and was present for the entire operation.

** • nevermind. - guy
Fri Feb 17 04:23:12 2017 guy


• Preoperative Diagnosis: LEFT DISTAL FEMUR NONUNION. Procedur ...
+ wav
Fri Feb 17 01:43:27 2017 wav
Preoperative Diagnosis:
LEFT DISTAL FEMUR NONUNION.

Procedure:
LEFT DISTAL FEMUR REMOVAL OF HARDWARE, NONUNION REPAIR, AND RETROGRADE FEMORAL INTRAMEDULLARY NAIL.

Given that the nonunion did not appear to be chronically infected and cultures of the contralateral side did not grow any _____, we elected to leave these buried intraarticular screws.
** • I hear "any organism too deep" ? - isgal
Fri Feb 17 02:12:45 2017 isgal

**** • Thanks a lot. + guy
Fri Feb 17 02:13:57 2017 guy
can it be "to date" instead of "too deep"?
****** • could be. That would probably make more sense. - isgal
Fri Feb 17 02:18:02 2017 isgal

******** • Thanks a lot. - guy
Fri Feb 17 02:29:45 2017 guy


• POSTOPERATIVE PLAN: They will come back to clinic in approximately 10 ...
+ wav
Fri Feb 17 00:27:57 2017 wav
POSTOPERATIVE PLAN: They will come back to clinic in approximately 10 days or 2 weeks. We will inspect his wound. If all things look good, he will be placed into a thumb-spica cast for approximately one month. At that time, we will consider placing him back into his prefabricated thumb-spica splint that was made by occupational therapy _____.
** • to reduce swelling and _____?? - poi -sorry
Fri Feb 17 00:29:51 2017 poi -sorry

**** • due to swelling and condition allowing? - another wag - poi
Fri Feb 17 00:31:15 2017 another wag - poi

**** • condition allowing? - wag-poi
Fri Feb 17 00:30:29 2017 wag-poi

****** • Thanks a lot. - guy
Fri Feb 17 00:30:55 2017 guy


• Preoperative Diagnosis: RIGHT SCAPHOID PROXIMAL POLE NONUNION. ...
+ wav
Fri Feb 17 00:03:46 2017 wav
Preoperative Diagnosis:
RIGHT SCAPHOID PROXIMAL POLE NONUNION.

Procedure:
RIGHT PROXIMAL POLE SCAPHOID OPEN REDUCTION AND INTERNAL FIXATION.

PROCEDURE IN DETAIL: He was placed supine on the operating table and a regional block was performed by the Anesthesia team. All bony prominences were padded and checked. _____ were placed. At this time, the appropriate weight-based dose of antibiotics was administered.
** • nevermind. + guy
Fri Feb 17 00:22:40 2017 guy
Venodyne stockings

• On med list, doctor dictated "chlorhexidine 5 mL p.o. b.i.d." This is a
+ med question
Thu Feb 16 21:44:56 2017 med question
disinfectant used to disinfect skin and sterilize equipment. Should I flag this?
** • There is an oral rinse chlorhexidine gluconate (see link) I would + Questyr
Thu Feb 16 22:58:10 2017 Questyr
just give him what he said
**** • Thanks. We used to use chlorhexidine gluconate in the hospital to sterilize the rectal + op
Fri Feb 17 01:10:43 2017 op
thermometers between patients, so it's hard for me to imagine anyone putting it in their mouth!

• Preoperative Diagnosis: HISTORY OF TOTAL LARYNGECTOMY REQUIRING TRA ...
+ wav
Thu Feb 16 21:33:02 2017 wav
Preoperative Diagnosis:
HISTORY OF TOTAL LARYNGECTOMY REQUIRING TRANSESOPHAGEAL PUNCTURE.

Procedure:
TOTAL THYROIDECTOMY, TOTAL LARYNGECTOMY RIGHT LEVEL 2 THROUGH 4 SELECTIVE NECK DISSECTION, LEFT PARATRACHEAL LYMPH NODE DISSECTION, AND RIGHT PECTORALIS MYOFASCIAL FLAP.

The patient understood the concept of the laryngectomy as well as a _____ with a possibility for esophageal speech in the future.
** • aphonia - nm
Thu Feb 16 21:35:35 2017 nm

**** • Thanks a lot. - guy
Thu Feb 16 21:36:49 2017 guy


• This ultimately returned as papillary thyroid cancer, _____ with no ev ...
+ mp3
Thu Feb 16 21:25:26 2017 mp3
This ultimately returned as papillary thyroid cancer, _____ with no evidence of anaplastic tumor. Additionally, the patient was discussed at the head and neck multidisciplinary tumor board and ultimately recommendations
** • tall cell variant - nm
Thu Feb 16 21:32:11 2017 nm

**** • Thanks a lot. - guy
Thu Feb 16 21:33:22 2017 guy


• s/l incutaneous, Patient had an incutaneous ureterostomy
+ Me
Thu Feb 16 21:17:41 2017 Me
s/l incutaneous ureterostomy
** • end cutaneous? + poi - link
Thu Feb 16 22:00:38 2017 poi - link
link

• At that time, he was recommended for a total thyroidectomy in _____ co ...
+ wav
Thu Feb 16 21:15:52 2017 wav
At that time, he was recommended for a total thyroidectomy in _____ country of the Philippines, given a suspicion for cancer; however, the patient did not consent.
** • his home - nm
Thu Feb 16 21:29:53 2017 nm

**** • Thanks a lot. - guy
Thu Feb 16 21:30:49 2017 guy


• S/L dog frash screw size 2.0 X 16 mm
+ TYIA=)
Thu Feb 16 19:44:35 2017 TYIA=)
Podiatry / ortho

• Next, once the temporal horn was entered, the tumor was further dissec ...
+ mp3
Thu Feb 16 18:57:21 2017 mp3
Next, once the temporal horn was entered, the tumor was further dissected out from all the white matter around and was able to be removed en bloc and sent for permanent pathology. The _____ white matter and the ventricle were inspected and found not to have any other obvious tumor. Hemostasis was obtained with bipolar cautery and hemostatic agents.
** • walls of the? - poi
Thu Feb 16 18:59:40 2017 poi

**** • Thanks a lot. - guy
Thu Feb 16 19:01:24 2017 guy


• Next, three epidural tack-up stitches were placed throughout the perip ...
+ wav
Thu Feb 16 18:53:15 2017 wav
Next, three epidural tack-up stitches were placed throughout the periphery of the craniotomy and the dura was opened in a cruciate fashion anterior to a water _____ visualized both on the MRI as well as on the stereotaxis.
** • simple drain? vein? I don't know. I hear both. Sorry. - poi
Thu Feb 16 19:00:27 2017 poi

**** • Thanks a lot. - guy
Thu Feb 16 19:01:16 2017 guy


• Risks including infection, bleeding, stroke, coma, death, hemiparesis, ...
+ mp3
Thu Feb 16 18:49:43 2017 mp3
Risks including infection, bleeding, stroke, coma, death, hemiparesis, visual field defect, as well as problems with speech and _____, cardiopulmonary issues, and metabolic issues, and the patients family decided to proceed with the surgery and the patient agreed.
** • speech, ambulation, as well as medical comorbidities such as - poi
Thu Feb 16 18:55:41 2017 poi

**** • Thanks a lot. - guy
Thu Feb 16 18:56:52 2017 guy


• A discussion was had with the patient and his family that _____ serial ...
+ wav
Thu Feb 16 18:47:10 2017 wav
A discussion was had with the patient and his family that _____ serial imaging or removing to establish diagnosis and remove the tumor at this point and the patients family opted for removing the tumor. They were counseled on all the risks of the surgery.
** • the best way to manage this with the possibilities being watching - poi
Thu Feb 16 18:52:24 2017 poi

**** • Thanks a lot. - guy
Thu Feb 16 18:53:02 2017 guy


• This tumor was about 1.2 cm in size _____ a small nodule along the lat ...
+ mp3
Thu Feb 16 18:14:36 2017 mp3
This tumor was about 1.2 cm in size _____ a small nodule along the lateral edge of the right temporal horn.
** • size. There was? - poi
Thu Feb 16 18:45:40 2017 poi

**** • Thanks a lot. - guy
Thu Feb 16 18:46:59 2017 guy


• In the suprapubic site _________ ______ for later too.
+ mp3 posted
Thu Feb 16 17:49:00 2017 mp3 posted
An infraumbilical incision was made. The 12 mm port was inserted, the abdomen insufflated with CO2. Once this was completed, the above findings were noted. In the suprapubic site _________ ______ for later too.

** • was also placed to put a blunt manipulator through. - billybob
Thu Feb 16 17:58:30 2017 billybob

** • tried but no luck. sorry. - guy
Thu Feb 16 17:53:57 2017 guy

**** • Thank you both so much! - mp3 posted
Thu Feb 16 18:34:35 2017 mp3 posted


• Preoperative Diagnosis: RIGHT TEMPORAL BRAIN TUMOR. Procedur ...
+ wav
Thu Feb 16 17:46:12 2017 wav
Preoperative Diagnosis:
RIGHT TEMPORAL BRAIN TUMOR.

Procedure:
RIGHT TEMPORAL CRANIOTOMY FOR RESECTION OF TUMOR, FRAMELESS STEREOTAXY.

INDICATIONS: The patient is a 15-year-old male who had a syncopal episode _____ illness which was questionable for being a seizure which led to his getting a workup which found an incidental right temporal brain tumor that was enhancing.
** • tenative? - poi
Thu Feb 16 18:44:38 2017 poi

**** • Thanks a lot. - guy
Thu Feb 16 18:46:52 2017 guy


• In the suprapubic site _________ ______ for later too.
+ n a j f g k
Thu Feb 16 17:06:34 2017 n a j f g k
An infraumbilical incision was made. The 12 mm port was inserted, the abdomen insufflated with CO2. Once this was completed, the above findings were noted. In the suprapubic site _________ ______ for later too.


** • I forgot to mention that the mp3 is posted. - n a j f g k
Thu Feb 16 17:47:45 2017 n a j f g k

**** • ... + c d l b j p
Thu Feb 16 18:53:22 2017 c d l b j p


• This is a 7 yo boy with behavioral dysregulation and _____ dysfunction.
- :) wav
Thu Feb 16 14:24:08 2017 :) wav

** • executive - nnm
Thu Feb 16 14:26:23 2017 nnm

**** • thank you - :)
Thu Feb 16 14:29:46 2017 :)


• apostrophe required? "They were clamped with curved Masterson(')s."
- mt
Thu Feb 16 13:08:58 2017 mt




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