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Mar 17 22:14
• At this time, using the LEEP, ___________ set on 50, taken to a depth ...
+ mp3
Wed Mar 29 09:07:17 2017 mp3
At this time, using the LEEP, ___________ set on 50, taken to a depth of about 1 cm and about 1-2 mm beyond the transformation zone.

• *pole* IV to RV coil
+ sm
Wed Mar 29 08:52:13 2017 sm
DEVICE MEASURE DATA: RA: P wave 2.1 mV, capture threshold of 0.75 V at 0.5 ms, impedance 380 ohms. RV: R wave 6.6 mV, capture threshold of 1 V of 0.5 ms, pacing impedance of 399 ohms, HVB impedance 40, HVX impedance 47. LV lead: Capture threshold 1.5 V at 0.4 ms (_____ IV to RV coil) and pacing impedance 437 ohms.

• followed by #3-0 _____ and #4-0 subcuticular _____ Dermabond
+ mp4
Wed Mar 29 08:48:08 2017 mp4
The pocket was closed with #2-0 Vicryl followed by #3-0 _____ and #4-0 subcuticular _____ Dermabond, Steri-Strips, sterile dressing, and compression dressing. The case was concluded.


• Final *pilgrim* was done
+ ?
Wed Mar 29 08:46:50 2017 ?
All pacing and sensing parameters were checked through the device and found to be excellent. Final _____ was done. The new device was placed in the pocket.
** • programming? - taco
Wed Mar 29 09:01:50 2017 taco


• The ______ LV lead and the
+ mp3
Wed Mar 29 08:44:26 2017 mp3
Pacing was subsequently checked here and found to be acceptable. The guide catheters and SafeSheath were then slowly removed using standard technique. The lead was sutured to the floor of the pocket using #0 Ethibond. The ______ LV lead and the previous lead implanted RV and RA leads were then placed into a new Medtronic biventricular defibrillator.
** • reimplanted ? - taco
Wed Mar 29 09:01:41 2017 taco


• antibiotic _____. Contrast AND left and _____ for reference during
+ wav
Wed Mar 29 08:35:29 2017 wav
The left chest was prepped and draped in usual sterile fashion. Lidocaine was given as a local anesthetic. Sedation and antibiotic _____. Contrast venogram of the left subclavian vein was done by injection of 10 cc of IV contrast into the left and _____ for reference during venipuncture. A 2-inch incision was made in the left pectoral area overlying defibrillator.

• s/l Y QRS
+ ok?
Wed Mar 29 08:21:16 2017 ok?
is a 74-year-old man with history of non-ischemic cardiomyopathy and chronic systolic heart failure, status post dual chamber defibrillator, with intraventricular conduction delay on ______ QRS.
** • and wide QRS (not Y) - taco
Wed Mar 29 09:00:21 2017 taco


• Since ______ is just distal to the ligament of Treitz
+ wav
Wed Mar 29 07:33:20 2017 wav
IMPRESSION AND PLAN: Abnormal jejunal loop which was noted on CT study about five months ago. The differential includes inflammatory bowel disease in neoplastic lesion like lymphoma. Since ______ is just distal to the ligament of Treitz, this can probably be reached with push enteroscopy using pediatric colonoscope. Keep well-hydrated. Limit her diet to clear liquids for now.
** • the area ? (the area ___ ?) - nnm
Wed Mar 29 07:54:01 2017 nnm

**** • thanks - -
Wed Mar 29 09:03:20 2017 -


• The table was turned 90 degree. The patient was prepped and draped in ...
+ mp3
Wed Mar 29 04:20:20 2017 mp3
The table was turned 90 degree. The patient was prepped and draped in the usual fashion. Pledgets containing 4% topical lidocaine and Afrin were inserted into each nasal cavity during _____. They were then removed and the nasal cavity was inspected. A large left-sided septal spur was seen about 3 cm posterior to the beginning of the quadrangular cartilage.
** • nevermind. bad dictator. - guy
Wed Mar 29 04:53:43 2017 guy


• Preoperative Diagnosis: FACIAL PAIN AND LEFT NASAL OBSTRUCTION. ...
+ wav
Wed Mar 29 04:12:46 2017 wav
Preoperative Diagnosis:
FACIAL PAIN AND LEFT NASAL OBSTRUCTION.

Procedure:
SEPTOPLASTY, RESECTION OF LEFT CONCHA BULLOSA, INFERIOR BILATERAL TURBINOPLASTY.

INDICATIONS FOR SURGERY: This is a 31-year-old female who is otherwise healthy that has multiple year long history of bilateral maxillary facial pain as well as nasal obstruction, left greater than right which has been refractory to _____. The patient underwent a CT scan which showed a large bony septal spur, contrast with no large size left concha bullosa. The right sinus disease was not present.
** • nevermind. - b b o m o l
Wed Mar 29 04:53:51 2017 b b o m o l


• Next, suction cautery was used to provide adequate hemostasis to the a ...
+ wav
Wed Mar 29 01:00:49 2017 wav
Next, suction cautery was used to provide adequate hemostasis to the adenoids. Of note, a roll of adenoids at Passavants ridge _____ to prevent velopharyngeal insufficiency. Once this was done, the adenoids were noted to have excellent hemostasis.
** • a row (not roll) - poi
Wed Mar 29 01:16:12 2017 poi

** • were left - poi
Wed Mar 29 01:15:52 2017 poi

**** • Thanks a lot. Thanks for the correction. - guy
Wed Mar 29 01:17:06 2017 guy


• Preoperative Diagnosis: SLEEP APNEA. Procedure: PARTIAL I ...
+ wav
Wed Mar 29 00:53:22 2017 wav
Preoperative Diagnosis:
SLEEP APNEA.

Procedure:
PARTIAL INTRACAPSULAR TONSILLECTOMY AND ADENOIDECTOMY.

The patient was brought to the operating room. General anesthesia was induced. The patient was intubated without incident. The patient was prepped and draped in the usual sterile fashion. Surgical time-out per protocol was obtained. First, a mouthgag retractor was placed in the mouth _____ to the lips, teeth, and gums. The patient was then placed in suspension onto the Mayo stand.
** • nevermind. - guy
Wed Mar 29 01:00:38 2017 guy


• Help! Word 2010 on PC keeps enlarging and shrinking
+ Thankful
Wed Mar 29 00:12:03 2017 Thankful
Randomly. Also top number row not typing all numbers. Happened very suddenly

** • Thanks everyone. Ended up switching keyboard out, but that was CRAZY! - OP
Wed Mar 29 00:51:09 2017 OP

** • maybe a ctrl, alt or function key stuck? try hitting each of them a couple of times - poi
Wed Mar 29 00:23:24 2017 poi

** • "not typing all numbers" sounds like a keyboard problem. - billybob
Wed Mar 29 00:18:17 2017 billybob


• Preoperative Diagnosis: CRITICAL RHEUMATIC MITRAL STENOSIS AND INSU ...
+ wav
Tue Mar 28 20:01:04 2017 wav
Preoperative Diagnosis:
CRITICAL RHEUMATIC MITRAL STENOSIS AND INSUFFICIENCY WITH PULMONARY HYPERTENSION, CARDIOMEGALY, AND CONGESTIVE HEART FAILURE.

Procedure:
MITRAL VALVE REPLACEMENT EMPLOYING EDWARDS PERICARDIAL TISSUE HEART VALVE, SIZE 25 MM, MODEL #7300TFX, SERIAL #5270680.

The pericardium was divided in the midline. The heart was considerably dilated and the right atrium and the right _____. Pursestring sutures were inserted and the patient was heparinized.
** • ventricle were enlarged - poi
Tue Mar 28 20:02:28 2017 poi

**** • Thanks a lot. - guy
Tue Mar 28 20:06:42 2017 guy


• The gas was allowed to flow out of the abdomen and three manual breath ...
+ mp3
Tue Mar 28 19:38:36 2017 mp3
The gas was allowed to flow out of the abdomen and three manual breaths were given to allow as much _____ to be discharged from the belly
** • CO2 - poi
Tue Mar 28 19:46:29 2017 poi

** • Sorry, I can't get it. - Questyr
Tue Mar 28 19:42:07 2017 Questyr

**** • Thanks a lot everybody - guy
Tue Mar 28 19:50:59 2017 guy


• The ovary as well as the fallopian tube were excised from the pelvis, ...
+ mp3
Tue Mar 28 19:21:07 2017 mp3
The ovary as well as the fallopian tube were excised from the pelvis, the tube all the way to the cornua. The specimen was removed with a #10 bag Bovie _____ remaining intact. Careful survey of the entire abdomen revealed findings as above
** • I hear "#10 bag through the ____ port, remaining intact." - Questyr
Tue Mar 28 19:36:00 2017 Questyr

**** • Thanks a lot. - guy
Tue Mar 28 19:37:56 2017 guy


• At this point in time, the adhesions of the cyst to the anterior abdom ...
+ wav
Tue Mar 28 19:19:51 2017 wav
At this point in time, the adhesions of the cyst to the anterior abdominal wall were ligated with LigaSure and the attention was then turned to the IP and to the ureter. The right ureter was _____; therefore, the IP was grasped with LigaSure and ligated and cut.
** • I hear "was seen, and when this _____ peristalsed; therefore," - Questyr
Tue Mar 28 19:38:14 2017 Questyr

**** • ???tube??? - Q
Tue Mar 28 19:38:32 2017 Q

****** • Thanks a lot. - guy
Tue Mar 28 19:51:12 2017 guy


• Two additional ports were placed, one on the left and one on the right ...
+ mp3
Tue Mar 28 19:05:53 2017 mp3
Two additional ports were placed, one on the left and one on the right lateral aspects of the abdominal wall. _____ 5-mm port, findings as above. An attempt was made with monopolar scissors to separate the cyst wall from the ovarian tissue. The cyst however ruptured and yellow pus-like mucinous material was protruding from the cyst
** • got it. thanks. + guy
Tue Mar 28 19:19:33 2017 guy
They were both

• The 10/12 trocar was then placed directly into the abdominal cavity. ...
+ mp3
Tue Mar 28 18:53:13 2017 mp3
The 10/12 trocar was then placed directly into the abdominal cavity. With the #10 camera, direct visualization was confirmed and abdomen was insufflated with appropriate flow of volume of CO2. Prior to placing the 11/12 trocar, the fascial layer had been tagged and _____ #0 Vicryl attached to the fascial layer where attached to the 10/11 trocar. Two additional ports were placed, one on the left and one on the right
** • those....were (not where) attached ? - poi
Tue Mar 28 19:01:54 2017 poi

**** • Thanks a lot. - guy
Tue Mar 28 19:03:25 2017 guy


• Attention was then turned to the abdomen where approximately a 1.5 cm ...
+ wav
Tue Mar 28 18:47:36 2017 wav
Attention was then turned to the abdomen where approximately a 1.5 cm skin incision was made in the umbilicus _____ Allison and tonsil as well as _____ were used to dissect down to the fascia. The fascia was grasped with tonsils and entered via direct visualization with Mayo scissors. Continued dissection down to the peritoneum was continued. The peritoneum was again tented up with tonsils and the abdominal cavity was entered under direct visualization with sharp dissection 3:57
** • at the umbilicus. w_____ pickups? 2? Adson's - poi
Tue Mar 28 19:06:45 2017 poi

**** • Thanks a lot. - guy
Tue Mar 28 19:09:12 2017 guy


• Preoperative Diagnosis: RIGHT ADNEXAL MASS. Procedure: LA ...
+ wav
Tue Mar 28 18:32:36 2017 wav
Preoperative Diagnosis:
RIGHT ADNEXAL MASS.

Procedure:
LAPAROSCOPIC RIGHT SALPINGO-OOPHORECTOMY, ABDOMINAL WASHINGS, AND _____ BIOPSY.

** • peritoneal biopsy - poi
Tue Mar 28 18:45:16 2017 poi

**** • Thanks a lot. - guy
Tue Mar 28 18:47:20 2017 guy


• A trial jigging system was used to orient the patella and drill just medial on the sm
+ wav :)
Tue Mar 28 15:31:15 2017 wav :)
patella _____ patellar tracking. Osteophytes were removed with a large rongeur.
** • jig system...drilled just medial on the patella. Patellar tracking osteophytes - poi
Tue Mar 28 15:50:40 2017 poi

**** • Thannks poi. - :)
Tue Mar 28 16:16:58 2017 :)


• I will have _____ care come and reassess patient today for appropriateness for sm
+ wav :)
Tue Mar 28 14:41:59 2017 wav :)
hospice in the nursing facility.
** • palliative care? - poi
Tue Mar 28 14:50:26 2017 poi

**** • Yes! Thanks poi. - :)
Tue Mar 28 14:50:42 2017 :)


• s/l eludant (very clear). We irrigated and suction until our eludant was clear.
- MM
Tue Mar 28 12:41:31 2017 MM

** • We irrigated and suctioned until all purulence was clear. - nm
Tue Mar 28 23:49:11 2017 nm

** • effluent? (guessing for archives) - :)
Tue Mar 28 21:16:35 2017 :)

** • eluate? - poi
Tue Mar 28 12:55:54 2017 poi

** • eluant? - nm
Tue Mar 28 12:54:16 2017 nm

**** • Appreciate both your help, don't think either fit, more to do with chemistry? flagged - MM
Tue Mar 28 12:59:51 2017 MM


• have recommended use of Acapella device ________ and depending
- mp3 posted
Tue Mar 28 12:31:51 2017 mp3 posted

** • given while awake? - nm
Tue Mar 28 12:50:07 2017 nm

**** • thanks for suggestion - OP
Tue Mar 28 13:29:40 2017 OP


• polypharmacy overdose. Also _____ allergies Bactrim
+ mp3
Tue Mar 28 11:24:03 2017 mp3
DIAGNOSES:
Axis I: Major depression, severe, rule out bipolar disorder I versus II, mixed versus depressed severe with suicidal features.
Axis II: Borderline personality traits versus disorder.
Axis III: Status post polypharmacy overdose. Also _____ allergies Bactrim, doxycycline, sulfa antibiotics and Z-Pak.

** • [also in a subheading] - taco
Tue Mar 28 11:27:44 2017 taco

**** • thanks - -
Tue Mar 28 11:48:05 2017 -


• present status post ______ by overdose.
+ wav
Tue Mar 28 11:16:03 2017 wav
MENTAL STATUS EXAMINATION: The patient appears her stated age, labile, guarded, irritable, minimal eye contact. Describes her mood as fine. Affect was irritable and labile. Thought process was guarded. Suicidality and suicide potential present status post ______ by overdose. Denies any homicidal ideas, intent or plan. Cognition and memory is intact. Alert and oriented to time, place and person. Insight and judgment limited to impaired.

I know what I think it SHOULD be but I can't hear it.
** • a serious attempt - taco
Tue Mar 28 11:18:30 2017 taco

**** • ah ha - thanks!
Tue Mar 28 11:24:29 2017 thanks!


• OB/GYN mumbling a report of vacuum-assisted delivery of baby
+ RMT
Tue Mar 28 11:01:02 2017 RMT
On delivery of the body, the shoulder remained s/l arrested and with no lateral traction. She was brought down head but brought in McRoberts and then suprapubic pressure and s/l Whitsker maneuver in order to reduce shoulder dystocia.

This is a very mumbly American doctor. He makes me want to pull all of my hair out!
** • Ughhhhh!!! Wood's screw maneuver!!!!~nm - RMT
Tue Mar 28 11:06:31 2017 RMT

**** • Or maybe Wood-Screw maneuver per FP Notebook`nm - RMT
Tue Mar 28 11:09:11 2017 RMT


• markings for rotation of the knee _____. The ____ vacuum fashion
+ wav
Tue Mar 28 08:11:21 2017 wav
The patella was cut with patellar cutting jig, removing 7 mm bone and replacing with 32 button making appropriate holes. Holes were made in the femur and the tibia after markings for rotation of the knee _____. The ____ vacuum fashion. The bony surface thoroughly irrigated and dried, and components were cemented first the tibia, then the femur, and then the patella, excess cement removed, knee held in extension and cement hardened.
** • #2 The nail was connected? - wag
Tue Mar 28 10:13:32 2017 wag

** • of rotation were in the files. can't get the next blank, sorry - k p e c i h
Tue Mar 28 08:35:58 2017 k p e c i h


• tibia and dilated for a 3.0 posterior _____ in neutral varus and valgus
+ mp4
Tue Mar 28 08:04:34 2017 mp4
The distal femur was then entered with intramedullary guide system, cut with a 6-degree valgus and a 9 mm cut with intercondylar notch alignment for the rotation, sizing it to a 5N. The appropriate cuts and sulcus cut were made.

The tibia was then cut using computerized navigation to screw to the tibia and dilated for a 3.0 posterior _____ in neutral varus and valgus. Approximately 6 mm was removed off the lateral tibial plateau site plus perpendicular to the tibia.
** • slope - k p e c i h
Tue Mar 28 08:35:01 2017 k p e c i h

**** • ty - -
Tue Mar 28 08:45:53 2017 -

** • Correction made + sm
Tue Mar 28 08:06:58 2017 sm
The distal femur was then entered with intramedullary guide system, cut with a 6-degree valgus and a 9 mm cut with intercondylar notch alignment for the rotation, sizing it to a 5N. The appropriate cuts and sulcus cut were made.

The tibia was then cut using computerized navigation to screw to the tibia and dialed in for a 3.0 posterior _____ in neutral varus and valgus. Approximately 6 mm was removed off the lateral tibial plateau site plus perpendicular to the tibia. The flexion-extension gap was equalized at 7 mm and trial implants were put in place.

• IMPLANTS USED: *J & J* Attune, size 5N for the femur, 5 for tibia, 32 mm patella.
- ?
Tue Mar 28 08:01:26 2017 ?

** • Johnson & Johnson - nm
Tue Mar 28 08:51:34 2017 nm


• drawn and a #6 ______ was placed without difficulties
+ mp3
Tue Mar 28 07:54:23 2017 mp3
Strap muscles were divided and retracted laterally and the second endotracheal ring space was chosen and scored. Under direct vision, endotracheal tube was drawn and a #6 ______ was placed without difficulties. At this case, his head and neck were re-prepped and with the use of a marking pen, a margin was chosen around the patients carcinoma which was involving his upper lip as well as nasal region more so on the right side.
** • Shiley - isgal
Tue Mar 28 08:01:46 2017 isgal

**** • ty - nm
Tue Mar 28 08:04:54 2017 nm


• well as open ______ procedure to the patellar tendon of the _____ to prevent
+ wav
Tue Mar 28 07:31:24 2017 wav
Using the previous anterior midline incision, sharp dissection was then performed down to the fascia. Medial peripatellar arthrotomy was performed and clear tinged synovial fluid was appreciated and sent for culture that did not look infectious in etiology. A complete synovectomy was performed. Medial release was performed, as well as open ______ procedure to the patellar tendon of the _____ to prevent any further extensor mechanism injury. After complete synovectomy was performed, the soft tissue was cleared from the extensor mechanism.
** • not sure about #2 but I think it's off the, not of the - isgal
Tue Mar 28 08:01:23 2017 isgal

** • #1 as well as a banana peel procedure? - isgal
Tue Mar 28 08:00:13 2017 isgal

**** • thank you - !
Tue Mar 28 08:04:12 2017 !

** • I hear old wav - isgal
Tue Mar 28 07:32:12 2017 isgal

**** • added - again
Tue Mar 28 07:55:40 2017 again


• Pediatric cardiologist dictates that 22-month-old wants to play hockey.
- is this ok?
Tue Mar 28 05:50:48 2017 is this ok?

** • ... - never mind
Tue Mar 28 07:40:23 2017 never mind


• The sac was dissected to the internal ring where it was ligated with a ...
+ wav
Tue Mar 28 02:47:43 2017 wav
The sac was dissected to the internal ring where it was ligated with a 3-0 Vicryl and suture ligated with a 4-0 Vicryl. The excess sac was excised. Attention was then directed to the right thigh where a similar 1 cm incision was made and the dissection was carried as on the initial side. A small hernia sac was also _____ coming from the external ring and this was dissected down and the attachments were dissected into the internal ring.
** • found here - nnm
Tue Mar 28 03:56:31 2017 nnm

**** • Thanks a lot. - guy
Tue Mar 28 04:22:55 2017 guy

** • nevermind. - guy
Tue Mar 28 02:54:00 2017 guy


• INDICATIONS: The patient is a 76-year-old male who previously in a mo ...
+ wav
Tue Mar 28 01:56:56 2017 wav
INDICATIONS: The patient is a 76-year-old male who previously in a month transferred to the hospital for a chronic subdural hematoma causing small amount of mass effect. At that time, the patient was elected to be observed ultimately when going to rehab but was found to have a neurological decline today as per his daughter and his caring physicians and physiatrist and new non-con head CT showed progression in size of the subdural hematoma with multiple loculations which was not amenable to bedside _____ placement. Thus, a conversation was had with the daughter about his new right-sided increasing chronic subdural with increasing midline shift and a mass effect on the brain.
** • SEPS (Subdural Evacuating Port System) - poi
Tue Mar 28 02:00:16 2017 poi

**** • Thanks a lot. - guy
Tue Mar 28 02:01:45 2017 guy


• Preoperative Diagnosis: TRAUMATIC BRAIN INJURY, STATUS POST HEMICRA ...
+ wav
Mon Mar 27 21:32:24 2017 wav
Preoperative Diagnosis:
TRAUMATIC BRAIN INJURY, STATUS POST HEMICRANIECTOMY.

Procedure:
RIGHT-SIDED CRANIOPLASTY.

The scalp flap was reflected anteriorly with dissection being carried out superficial to his temporalis muscle. Bone edges were identified circumferentially around his incision, except at the anteroinferiormost point where the pedicle of the temporalis was. Hemostasis was obtained using bipolar and monopolar cautery and a prebent Stryker titanium cranial mesh was placed over the defect _____ cut an appropriate sized piece. This was done so and screwed into place with Stryker cranial plate screws.
** • to be able to - what I hear
Mon Mar 27 21:39:16 2017 what I hear

**** • Thanks a lot. - guy
Mon Mar 27 21:42:47 2017 guy


• Preoperative Diagnosis: RIGHT HIP OSTEONECROSIS. Procedure: ...
+ wav
Mon Mar 27 19:36:03 2017 wav
Preoperative Diagnosis:
RIGHT HIP OSTEONECROSIS.

Procedure:
RIGHT TOTAL HIP ARTHROPLASTY.

The fascia was incised to the length of the incision and the interval between the gluteus maximus and TFL (tensor fascia lata). The gluteus maximus fascia was temporally split with blunt dissection. Electrocautery was used during _____ portion of the case to maintain hemostasis. The soft tissue superficial to the short external rotators were peeled from the posterior aspect of the greater trochanter to allow for identification of the piriform stem.
** • stumbles over "this" - poi
Mon Mar 27 19:42:13 2017 poi

**** • Thanks a lot. - guy-wag
Mon Mar 27 19:43:36 2017 guy-wag

****** • sorry about wag. auto text entry. - guy
Mon Mar 27 21:33:00 2017 guy


• sentence look okay? I'm assuming it's a type of knife?
+ tia
Mon Mar 27 18:07:24 2017 tia
The paracentesis diamond on a 300 micron setting was then used to create a 300 micron temporal paracentesis.
** • no need to assume + see link
Mon Mar 27 20:03:46 2017 see link
link

• over the last 1 year include _____ and constipation with rectal bleeding....
+ mp3 posted
Mon Mar 27 17:26:26 2017 mp3 posted
He has not had a prior colon exam. Symptoms over the last 1 year include _____ and constipation with rectal bleeding and .....
** • include intermittent - nm
Mon Mar 27 17:32:41 2017 nm

**** • Thanks a lot. - mp3 posted
Mon Mar 27 17:33:45 2017 mp3 posted


• Malleolus fracture, s/l cow-sill, pls sm for context
+ MM
Mon Mar 27 15:23:46 2017 MM
The fracture was a proximal transverse fracture. There was some **cowsill** that had flipped into the anterior-most portion of the fracture. This was removed from the fracture site.
** • callus here? - poi
Mon Mar 27 21:08:14 2017 poi


• A "Jamieson" clamp (cannot verify?)
+ tia
Mon Mar 27 14:31:42 2017 tia
The muscle was held in a muscle hook and check ligament attachments were freed. A "Jamieson" clamp was placed so that a 8 mm resection could be affected.

I found a few hits for Jameson... am I missing something?
** • just off the top of my head, wondering if it could be "adjacent" - mm
Mon Mar 27 15:24:55 2017 mm

**** • definitely Jaimeson but thank you! - op
Mon Mar 27 17:58:59 2017 op


• C-section findings: Cord s/l popped out following uterine incision. Sound odd?
- NT
Mon Mar 27 13:27:59 2017 NT

** • I don't think so. They opened the uterus, and there was the cord. - k p e c i h
Mon Mar 27 13:42:32 2017 k p e c i h


• POSTOP DX: Esophagitis with incidental **fare-etz** of Barrett metaplasia sm
+ mt
Mon Mar 27 12:46:53 2017 mt
does not sound like "appearance", really sounds like it starts with an F and rhymes with ferrets.
** • I will go out on a limb and say Barrett's appearance of Barrett metaplasia - k p e c i h
Mon Mar 27 13:03:37 2017 k p e c i h

**** • thanks, I agree - mt
Mon Mar 27 13:28:40 2017 mt


• He has also had __ since the age of 16, which is most likely hereditary
+ WAV
Mon Mar 27 12:40:00 2017 WAV
for the investigation of abnormal liver function tests in the setting of travelling overseas. He has also had __ since the age of 16, which is most likely hereditary
** • clubbing? - taco
Mon Mar 27 13:08:39 2017 taco


• using 3-0 PDS and the ____ using 3-0 PDS
+ mp3
Mon Mar 27 11:20:31 2017 mp3
platysma off the skin and the neck. At this point again, the neck was resuspended to the mastoid and concha using 3-0 PDS and the ____ using 3-0 PDS as well.

Excess skin was excised. Skin was reapproximated using 4-0 PDS and once again was closed in similar fashion, staples superiorly and posteriorly, plain gut behind the ear along the lobule and a mixture of 6-0 Prolene interrupted running along the tragal area and along the lobule anteriorly.
** • SMAS flap was resuspended - poi
Mon Mar 27 11:24:11 2017 poi

**** • thanks - !
Mon Mar 27 11:27:27 2017 !


• the skin ______ flap was carefully elevated and removed subsequently dividing ______
+ wav
Mon Mar 27 11:15:31 2017 wav
We were able to subsequently incise along the natural skin crease, upper bleph skin crease. A lower incision was made, upper incision was made and the skin ______ flap was carefully elevated and removed subsequently dividing ______ muscles. A small strap was removed using Bovie hemocautery in a low setting of 15.
** • a skin-only flap? - poi
Mon Mar 27 11:26:53 2017 poi

** • 1. skin-only flap - isgal
Mon Mar 27 11:26:06 2017 isgal

** • 2. orbicularis - poi
Mon Mar 27 11:25:22 2017 poi

**** • Thank you very much - !
Mon Mar 27 11:27:21 2017 !


• Once again, a ______ incision was carefully made.
+ mp4
Mon Mar 27 10:46:04 2017 mp4
A plain gut was used around the lobule and a 6-0 in an interrupted fashion Prolene was used along the tragal area. No significant complication was noted on this.

Subsequently, attention was paid to the left side. Once again, a ______ incision was carefully made. We were able to carefully dissect the subcutaneous plane initially and subsequently once identifying the location of the deep plane, we were able to carefully incised and identify the deep plane itself.
** • face-lift-type - poi
Mon Mar 27 10:56:41 2017 poi

**** • thank you - -
Mon Mar 27 11:12:33 2017 -


• and the _____ flap superoposteriorly. Once it was resuspended, _____ approximately
+ mp3
Mon Mar 27 10:44:48 2017 mp3
Subsequent to this, we were able to carefully go in a supraplatysmal plane in the neck to free up all the soft tissue attachment to the skin to the underlying platysma, and subsequently using 3-0 PDS, we were able to re-stent the platysma posteriorly and the _____ flap superoposteriorly. Once it was resuspended, _____ approximately 1 cc was placed for optimal hemostasis and the incision line was closed using 4-0 PDS and staples superiorly and posteriorly.
** • 1. SMAS - poi
Mon Mar 27 10:57:21 2017 poi

**** • thank you - -
Mon Mar 27 11:12:28 2017 -


• The deep plane was ______ itself and was carefully
+ wav
Mon Mar 27 10:43:12 2017 wav
The deep plane was subsequently entered along the line drawn from the zygomatic major incision point to the angle of mandible using a 10-blade. Once the deep plane was carefully entered, we were able to elevate anteriorly along the deep plane. The deep plane was ______ itself and was carefully then subsequently released off of the overlying skin along the jaw line to help the jaw line aesthetics. Ultimately, we were able to carefully inferiorly identify the platysma and a subplatysmal dissection carefully was performed for approximately 1 cm.
** • corrected to: The SMAS itself - poi
Mon Mar 27 10:56:05 2017 poi

**** • thank you - !
Mon Mar 27 11:12:21 2017 !


• Me or I?
+ RMT
Sun Mar 26 09:24:29 2017 RMT
The dictator is dictating a clipped sentence:

CONSENT
Administrative consent with intensivist and myself.

Myself is wrong, but I don't know if this should be me or I. If I were to make it a complete sentence and add a verb, I'm thinking 'I' would be the correct pronoun here: Administrative consent was given by intensivist and I. If I take away the intensivist, I gave administrative consent (me gave administrative consent wouldn't be grammatically correct). Am I correct in this reasoning?

I pride myself at being pretty good at grammar generally, but here lately, I feel as though I'm slipping.

** • me. with me, not with I. Or in your example, given by me, not given by I. - isgal
Sun Mar 26 11:23:42 2017 isgal

**** • Thank you, isgal! ~ nm - RMT
Sun Mar 26 12:22:44 2017 RMT


• This is a 32-year-old male with a history of a gunshot wound to the ri ...
+ mp3
Sun Mar 26 05:34:21 2017 mp3
This is a 32-year-old male with a history of a gunshot wound to the right distal tibial _____ in Virginia in XXXX. His course was complicated by recurrent infections after
** • as in back in Virginia - k p e c i h
Sun Mar 26 06:16:47 2017 k p e c i h

** • back - k p e c i h
Sun Mar 26 06:15:52 2017 k p e c i h

**** • Thanks a lot. - guy
Sun Mar 26 06:37:26 2017 guy


• Preoperative Diagnosis: A 32-YEAR-OLD GRAVIDA 2, PARA 0-1-0-0 AT 38 ...
+ wav
Sun Mar 26 05:05:56 2017 wav
Preoperative Diagnosis:
A 32-YEAR-OLD GRAVIDA 2, PARA 0-1-0-0 AT 38-3/7 WEEKS BASED ON A DATES AND _____ FOR PRIMARY CESAREAN SECTION FOR NONREASSURING FETAL HEART TRACING, REMOTE FROM DELIVERY.

Procedure:
A PRIMARY LOW-FLAP TRANSVERSE CESAREAN SECTION VIA PFANNENSTIEL SKIN INCISION, DOUBLE-LAYER UTERINE CLOSURE.



• preop dx for C-section: "Term preterm rupture of membranes" sm pls
+ mt
Sat Mar 25 15:14:14 2017 mt
cannot tell if the doc stumbling and correcting term to preterm OR if "term preterm" is correct.
** • forgot to say, 38 weeks 4 days gestation. - m
Sat Mar 25 15:22:05 2017 m

**** • "term premature" and "term prelabor" in archives. - billybob
Sat Mar 25 17:17:55 2017 billybob

**** • 38 weeks would be term. Preterm premature rupture of membranes is ROM prior to 37 weeks + fwiw
Sat Mar 25 16:06:27 2017 fwiw
.

• Plastic surgery was called to the operating room. They evaluated his ...
+ wav
Sat Mar 25 07:21:59 2017 wav
Plastic surgery was called to the operating room. They evaluated his perforator flap and then determined that the best way to elevate it would be on the medial border and then also curved incision just distal to the flap location. Using careful technique, the flap was elevated minimizing damage or trauma to the area. The membrane was preserved that was created in the setting of the antibiotic spacer. The _____ was dissected by orthopedics at this point and separated with a central slit. The cement spacer was evaluated on fluoroscopic images.
** • think he's just stumbling over "membrane" - nnm
Sat Mar 25 08:17:40 2017 nnm

**** • Thanks a lot. - guy
Sun Mar 26 05:09:34 2017 guy

** • nevermind. - guy
Sat Mar 25 07:41:04 2017 guy


• Preoperative Diagnosis: RIGHT TIBIAL DISTAL THIRD NONUNION, STATUS ...
+ mp3
Sat Mar 25 07:14:55 2017 mp3
Preoperative Diagnosis:
RIGHT TIBIAL DISTAL THIRD NONUNION, STATUS POST SOME ANTIBIOTIC CEMENT SPACER.

Procedures:
1. REMOVAL OF CEMENT SPACER WITH PLASTICS ASSISTANCE FOR FLAP ELEVATION.
2. ILIAC CREST BONE GRAFT.
3. ILIAC CREST BONE GRAFTING OF THE BONE VOID.
4. CLOSURE OF SLAP WITH PLASTICS ASSISTANCE.

Since then, he has been following closely in the Outpatient Fracture Clinic. He had ESR and CRP done two weeks prior to the indicated surgery which showed that his _____ within normal limits and he was indicated for final stage of two-stage _____ procedure. The patient was explained the risks and benefits in full details. He assented to the procedure.
** • nevermind. - guy
Sat Mar 25 07:41:30 2017 guy


• Preoperative Diagnosis: INFERIOR RHEGMATOGENOUS RETINAL DETACHMENT, ...
+ wav
Sat Mar 25 06:22:40 2017 wav
Preoperative Diagnosis:
INFERIOR RHEGMATOGENOUS RETINAL DETACHMENT, RIGHT EYE.

Procedure:
REPAIR OF RETINAL DETACHMENT WITH SCLERAL BUCKLE ENCIRCLING BAND, SCLEROTOMY, CRYOTHERAPY, RIGHT EYE.

A Leica microscope with BIOM visualization system was then used to examine the retina. The retinal detachment was visualized by inserting using a trocar cannula at 25-gauge _____ at 6 oclock. Then, using a BIOM microscope and a scleral depressor, the retina was inspected 360-degrees and this inferior pathology was visualized.
** • cannula, a 25-guage chandelier (I didnt research that but it is what he is saying) - k p e c i h
Sat Mar 25 07:08:17 2017 k p e c i h

**** • Thanks a lot. - guy
Sat Mar 25 07:15:41 2017 guy


• Tooth #M: Facial composite. Tooth #N: Facial composite. Tooth ...
+ wav
Fri Mar 24 22:11:10 2017 wav
Tooth #M: Facial composite.
Tooth #N: Facial composite.
Tooth #O: Within normal limits.
Tooth #P: Within normal limits.
Tooth #Q: Within normal limits.
Tooth #R: Facial _____.
Tooth #S: Stainless steel crown.
Tooth #T: Pulpotomy and stainless steel crown.

** • immunization?? I did find some verification of its use, not a lot - poi
Fri Mar 24 22:25:57 2017 poi

**** • from what I can find, fluoride varnish is considered tooth immunization - fwiw-poi
Fri Mar 24 22:38:12 2017 fwiw-poi

****** • Thanks for the info. - guy
Sat Mar 25 06:23:14 2017 guy

**** • Thanks a lot. - guy
Fri Mar 24 22:26:16 2017 guy


• CHIEF COMPLAINT: "I ____ understand what's going on with my liver ...
+ mp3, pie
Fri Mar 24 21:05:50 2017 mp3, pie
CHIEF COMPLAINT: "I ____ understand what's going on with my liver."
** • send on now. thanks to any who tried. - pie
Fri Mar 24 21:31:34 2017 pie

** • have swelling and _____? - poi
Fri Mar 24 21:31:28 2017 poi

**** • can't?? - poi
Fri Mar 24 21:31:47 2017 poi

****** • not sure. she does say this later: + pie
Fri Mar 24 21:33:16 2017 pie
The patient reports that he is frustrated with the lack of understanding of what is going on with his liver.

She's just getting a big old blank there. Big mess in the PE too, not worth spending more time on.

Thanks for trying! :)
******** • I did add "can't" before understand, at least. thanks again. :) - pie
Fri Mar 24 21:34:26 2017 pie


• cardiology consultation/___ consultation
- wav :)
Fri Mar 24 19:14:30 2017 wav :)

** • valve clinic? - poi
Fri Mar 24 21:37:30 2017 poi


• REVIEW OF SYSTEMS: ______
- :) wav
Fri Mar 24 18:27:07 2017 :) wav




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