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Feb 15 15:52
• Toe wound: s/l soof-an-coal is to be applied to the edge of the callus. TIA!
- wound care?
Sat Feb 17 08:58:07 2018 wound care?

** • NM. Soothe and Cool - OP
Sat Feb 17 09:44:06 2018 OP


• Preoperative Diagnosis: RESPIRATORY FAILURE. Procedure: T ...
+ wav
Sat Feb 17 03:11:02 2018 wav
Preoperative Diagnosis:
RESPIRATORY FAILURE.

Procedure:
TRACHEOTOMY.

The patient is a 48-year-old female with multiple medical problems who has been critically ill in CCU for two weeks. Of note, he has HIV and HCV and his course was complicated by septic emboli to his brain and had a poor mental status in the recent past. At consultation on 02/13/18, recommended continuing care based on the patients current prognosis _____ **healthcare proxies in the assessment and recommendations at their E-mail, they recommended tracheostomy.** As such, the ENT team under two-physician consent agreed to proceed the trach procedure.
** • and the lack of health care proxies. - billybob
Sat Feb 17 07:59:46 2018 billybob


• The talus was noted to be anteriorly subluxed with respect to the tibi ...
+ mp3
Fri Feb 16 23:06:22 2018 mp3
The talus was noted to be anteriorly subluxed with respect to the tibial plafond and the external fixator was then under direct visualization and under fluoroscopic guidance _____ failed to yield sufficient reduction of the ankle joint, but did provide some _____ of the soft tissues to allow further mobilization of the fracture fragments.
** • 1. distracted. This failed to 2. release - poi
Fri Feb 16 23:14:42 2018 poi

**** • Thanks a lot. Thanks for the correction. - guy
Fri Feb 16 23:15:12 2018 guy


• Preoperative Diagnosis: LEFT PILON FRACTURE. Procedures: ...
+ wav
Fri Feb 16 22:49:20 2018 wav
Preoperative Diagnosis:
LEFT PILON FRACTURE.

Procedures:
1. OPEN REDUCTION AND INTERNAL FIXATION OF LEFT PILON FRACTURE.
2. EXTERNAL FIXATOR PLACEMENT, LEFT PILON FRACTURE.

This is an 18-year-old male who had a fall downstairs on 12/25/17, taken to Harlem Hospital where he underwent Ex-Fix on 12/27/17 and _____ was hospitalized there for approximately one month and _____ Bellevue Ortho and Ex-Fix was revised on 01/24/18. See that dictation.
** • 2. followed up - poi
Fri Feb 16 23:12:37 2018 poi

**** • follow up with - poi
Fri Feb 16 23:15:54 2018 poi

**** • Thanks a lot. - guy-
Fri Feb 16 23:15:02 2018 guy-


• Ventilatory Respiration
+ b o h b c p
Fri Feb 16 22:02:26 2018 b o h b c p
The PT had a "set or SEPs" ventilatory respiration of 11.


• Cervical prevertebral abscess
+ b o h b c p
Fri Feb 16 21:04:32 2018 b o h b c p
a flat JP drain was placed above the spine and the plate going inferiorly towards T2 to evacuate more of the purulent material. Clear fluid was seen. Then "valsalva" was performed and it was questionable whether this was CSF or not.
** • is this an op report? is the pt awake? - poi
Fri Feb 16 21:43:39 2018 poi

**** • IV sedation only - b o h b c p
Fri Feb 16 22:03:16 2018 b o h b c p

****** • then I think the pt could have performed the Valsalva maneuver + poi
Fri Feb 16 22:12:31 2018 poi
it is verifiable -- google info "A Valsalva maneuver may increase the flow of CSF and help with leak detection."
******** • Thank you! - b o h b c p
Fri Feb 16 22:12:57 2018 b o h b c p


• Cataract, left eye vitreous hemorrhage, and left eye proliferative diabetic
+ b o h b c p
Fri Feb 16 19:41:27 2018 b o h b c p
The lens was phacoemulsified with horizontal chop and "bowl" techniques.
** • I found bowl technique for cataracts. Google bowl and snail for cataracts. - sea
Fri Feb 16 20:49:33 2018 sea

**** • Thanks! - b o h b c p
Fri Feb 16 21:04:58 2018 b o h b c p


• The patient is a 20-year-old male with a longstanding history of nasal ...
+ wav
Fri Feb 16 18:02:47 2018 wav
The patient is a 20-year-old male with a longstanding history of nasal deformity and bilateral nasal congestion. The patient has had nasal congestion for quite some time, most prominently at night. The patient was also struck in the face seven years ago and feels that the external portion of his face has been different since that time. The patient is most concerned with the hump over his dorsum and feels that other people _____ for it and would like to change his external appearance as well. Based on the patients clinical findings and above concerns, the patient was deemed a good candidate for open septorhinoplasty with bilateral inferior turbinate reduction.
** • I hear: ....make fun of him for it - mn
Fri Feb 16 18:21:26 2018 mn

**** • Thanks a lot. - guy
Fri Feb 16 18:25:01 2018 guy


• Musculoskeletal Exam
+ b o h b c p
Fri Feb 16 16:31:16 2018 b o h b c p
On palpation, he has tenderness in the left lumbar paraspinals as well as PSIS, "Glut Meat", piriformis, greater trochanter and proximal ITB bands
** • gluteus medius? - guy
Fri Feb 16 16:35:59 2018 guy

**** • May be that but... + b o h b c p
Fri Feb 16 16:37:42 2018 b o h b c p
...could be the abbreviation being said?
****** • yeah. not listed in the book though. they coin their own all the time. - guy
Fri Feb 16 16:43:46 2018 guy


• Procedure: SECONDARY REPEAT CESAREAN SECTION VIA PFANNENSTIEL SKIN ...
+ wav
Fri Feb 16 16:18:15 2018 wav
Procedure:
SECONDARY REPEAT CESAREAN SECTION VIA PFANNENSTIEL SKIN INCISION WITH ONE-LAYER UTERINE CLOSURE, LYSIS OF ADHESIONS, BILATERAL TUBAL LIGATION VIA PARKLAND METHOD.

FINDINGS: Well-healed skin incision, subcuticular with dense adhesions to underlying fascia. Rectus muscle adherent to fascia, right size and thick adhesion between peritoneum, muscle and uterus. Female infant in ROA position at 07:37 p.m., Apgars 9 and 9, birthweight 3700 g. Amniotic fluid was clear. Uterus exteriorized _____ cut. Normal tubes and ovaries bilaterally. Excellent hemostasis after tubal ligation.
** • _____adhesions cut - poi
Fri Feb 16 16:35:05 2018 poi

**** • after ____ adhesions cut - poi
Fri Feb 16 16:35:56 2018 poi

****** • Thanks a lot. - guy
Fri Feb 16 16:36:10 2018 guy


• Procedure: BILATERAL BREAST REDUCTION. patient was taken to ...
+ wav
Fri Feb 16 15:44:24 2018 wav
Procedure:
BILATERAL BREAST REDUCTION.

patient was taken to the operating room and placed supine on the operating room table. SCD boots were initiated. In addition, 5000 units of subcu heparin were also given. General anesthesia was performed through endotracheal tube intubation. Then, 80 cc of solution C were used to infiltrate the breast with 40 cc going on each side. The _____ pedicle incision pattern was designed.
** • A superior medial - poi
Fri Feb 16 15:46:23 2018 poi

**** • Thanks a lot. - guy
Fri Feb 16 15:46:54 2018 guy


• Anterior and posterior labrum are intact, but s/l**shy-low* appearance.
+ SM
Fri Feb 16 15:37:00 2018 SM
The supraspinatus and infraspinatus are intact. Anterior and posterior labrum are intact, but s/l**shy-low* appearance.


** • shallow? - p o l i j c
Fri Feb 16 16:12:57 2018 p o l i j c


• Eye extruding buckle
+ b o h b c p
Fri Feb 16 15:28:36 2018 b o h b c p
The eye was noted to be normotensive with the intra-ocular pressure of approximately 18-20 mmHg approximately. The anterior chamber was formed and the lens was noted to be "cataractus", and there was some posterior synechiae as previously indicated.
** • cataractous - taco
Fri Feb 16 15:29:57 2018 taco

**** • Thank you! - b o h b c p
Fri Feb 16 15:37:31 2018 b o h b c p

****** • ... + m j c n m f
Fri Feb 16 18:02:55 2018 m j c n m f


• UPDRS motor score of 35 and a ___ score of 3.0. He also had a motor complication sco
+ WAV
Fri Feb 16 12:52:46 2018 WAV
He had a UPDRS motor score of 35 and a ___ score of 3.0. He also had a motor complication score of 13.
** • any guesses please!!?? Super long report! - HELP!
Fri Feb 16 13:00:39 2018 HELP!

**** • Hoehn and Yahr score - ff
Fri Feb 16 13:01:46 2018 ff


• he speaks limited English and I note that he speaks ___
+ WAV
Fri Feb 16 11:31:08 2018 WAV
It was rather difficult communicating with ** today given that he speaks limited English and I note that he speaks ___; however, there was no interpreter available today
** • I know that he speaks French (my guess). - billybob
Fri Feb 16 11:46:17 2018 billybob

**** • okay thank you both so much! - sc
Fri Feb 16 11:48:57 2018 sc

** • I thought I heard French, anyone else hear French? - ?
Fri Feb 16 11:43:42 2018 ?

** • Spanish? - poi
Fri Feb 16 11:38:00 2018 poi


• Plastic Surgery Note
+ NM
Fri Feb 16 08:39:26 2018 NM
The patient is having a facelift with submentoplasty, upper and lower lid blepharoplasty with autologous fat grafting.

My question is with the suture. S/L Labbe-like stitch (pronounced - Lob A). I have been unlucky with finding anything like this. Thanks in advance

Subcutaneous dissection was then carried out onto the face into the mobile SMAS and the cheek over the orbicularis and zygomaticus and down into the neck meeting up with the neck dissection, releasing the mandibular ligament under visualization. The SMAS plication was then performed using 3-0 Ethibond, first suture using a _____-like stitch and then further plicating superiorly the SMAS.
** • how about - sm + b o l b o m
Fri Feb 16 09:33:48 2018 b o l b o m
LABIAL SUTURE - A Suture between the Labium and Mentum saying lobia instead of labia maybe?
** • ? dissolvable stitch? i can't find anything beginning with an L. - b o l b o m
Fri Feb 16 08:57:23 2018 b o l b o m

**** • Thanks - but no - Very clear speaking doc. Definitely saying s/l lo ... + l m l k i a
Fri Feb 16 09:12:53 2018 l m l k i a
Thanks - but no - Very clear speaking doc. Definitely saying s/l lob-long A sound


****** • loop oblique stitch? - rj
Fri Feb 16 09:35:05 2018 rj

******** • I like this one too! - :)
Fri Feb 16 09:57:58 2018 :)

********** • Thanks for all of the suggestions - But I went ahead with an anomaly i ... + l m l k i a
Fri Feb 16 10:07:02 2018 l m l k i a
Thanks for all of the suggestions - But I went ahead with an anomaly in the report. I really appreciate the input

• Preoperative Diagnosis: LEFT ANTERIOR KNEE WOUND. Procedure: ...
+ wav
Thu Feb 15 23:25:22 2018 wav
Preoperative Diagnosis:
LEFT ANTERIOR KNEE WOUND.

Procedure:
LEFT ANTERIOR KNEE WOUND WASHOUT AND DEBRIDEMENT BY ORTHOPEDIC SURGERY AND COMPLEX CLOSURE BY PLASTIC SURGERY.

The patient is a 56-year-old gentleman with HIV who is status post a left quadratus reconstruction by orthopedic surgery in 01/25/18. He presented to the ER on 02/01/18 with a complaint of loosening of his cast which was reapplied per _____ and re-presented on 02/13/18 with a left anterior knee wound and area of dehiscence.
** • the notes and then - poi
Thu Feb 15 23:40:48 2018 poi

**** • Thanks a lot. - guy
Thu Feb 15 23:44:58 2018 guy


• Preoperative Diagnosis: LUMBOSACRAL RADICULOPATHY. Procedure ...
+ wav
Thu Feb 15 22:28:46 2018 wav
Preoperative Diagnosis:
LUMBOSACRAL RADICULOPATHY.

Procedure:
L5-S1 INTERLAMINAR EPIDURAL STEROID INJECTION.

After re-discussion of procedure with the patient including risks, benefits, outcome data, possibility of no effect, and increased pain, informed consent was obtained verbally and in writing and decision was made to proceed. The patient denied history of bleeding tendencies or evidence of recent infections. We also repeated a BMP. Her preop potassium is 5.8 _____ safe and appropriate to proceed with the procedure. Attending was present throughout the course of the procedure. The patient was placed on the fluoroscopy table in a prone position with pillow under her abdomen.
** • on repeat is 5.1 so we think it is - poi
Thu Feb 15 22:37:06 2018 poi

**** • Thanks a lot. - guy
Thu Feb 15 23:25:39 2018 guy


• Preoperative Diagnosis: URETHROCUTANEOUS FISTULA. Procedure: ...
+ wav
Thu Feb 15 20:51:10 2018 wav
Preoperative Diagnosis:
URETHROCUTANEOUS FISTULA.

Procedure:
CYSTOSCOPY, SUPRAPUBIC TUBE PLACEMENT.

An incision was then made to allow us to sequentially dilate with a #10 fascial dilator and eventually pass the 20-French introducer sheath into the patients bladder which was confirmed under direct visualization. At this point, the inner sheath was inserted and the patient _____.
** • did buck - poi
Thu Feb 15 21:06:03 2018 poi

**** • Thanks a lot. - guy
Thu Feb 15 21:50:17 2018 guy


• s/l nadson forceps or gnats and forceps
+ no idea
Thu Feb 15 18:04:52 2018 no idea
The patient has an outie belly button and this was opened in the midline using an 11-blade _________ forceps.


This is a pediatric lap appy
** • and Adson forceps - b o l b o m
Thu Feb 15 18:38:55 2018 b o l b o m

**** • thank you - OP
Thu Feb 15 18:50:01 2018 OP


• Orthopedic surgery: "I then placed a pelvic recon plate" SM
+ CO MT
Thu Feb 15 17:16:57 2018 CO MT
There's a Recon Orthopedics company, so I'm not sure if he's referring to them or just abbreviating "reconstruction." Absolutely nothing anywhere in the report gives a clue (like a handy "implants used" section). How would you type this?
** • Thank you, I saw that too when I included "8-hole pelvic recon plate" - CO MT
Thu Feb 15 18:41:44 2018 CO MT

** • it is short-speak for reconstruction (google pelvic recon plate) - b o l b o m
Thu Feb 15 18:39:44 2018 b o l b o m

** • I'm not going to capitalize it, I think - CO MT
Thu Feb 15 17:18:08 2018 CO MT


• Rotator cuff tear: S/L SNIVY or SNIVVY rasp
+ FLCMT
Thu Feb 15 17:00:59 2018 FLCMT
Using a SNIVY rasp, the soft tissues were removed along the area of the tear.
** • I found a "Schneider" rasp in Stedman's ortho? That's the closest to your s/l. - taco
Thu Feb 15 17:03:38 2018 taco

**** • Short "I" sound, like snivvy or snibby. Thanks! ... + l m n o k g
Thu Feb 15 17:05:27 2018 l m n o k g
Short "I" sound, like snivvy or snibby. Thanks!
****** • I kinda like snivvy and snibby, but doubt either are correct. - skivvy
Thu Feb 15 19:54:51 2018 skivvy


• Need help with word please...
+ TAB
Thu Feb 15 16:01:03 2018 TAB
Doctor was talking about patient having a swaying gait and going from side to side and later in referring to her gait again, she says, "She has a *s/l trunk-o-lane* bilaterally, more so to the left than the right."
** • trunk lean - nm
Thu Feb 15 16:07:48 2018 nm

**** • Oh wow, thanks! - n e c d d m
Thu Feb 15 22:45:57 2018 n e c d d m


• Which of these 3 is correct? Thanks.
+ n e c d d m
Thu Feb 15 15:36:35 2018 n e c d d m
There are five...

non rib bearing vertebrae.

non-rib-bearing vertebrae.

non rib-bearing vertebrae.


** • #2 - l m n o k g
Thu Feb 15 17:23:27 2018 l m n o k g

** • I vote for #2 (like non-insulin-dependent diabetes). I could be wrong. - taco
Thu Feb 15 15:48:23 2018 taco

**** • That's what I thought too but was not positive. Thanks for your input! - n e c d d m
Thu Feb 15 15:57:30 2018 n e c d d m


• tender around the gluteal piriformis area. No tenderness __. He was unable to brid
+ WAV
Thu Feb 15 13:58:33 2018 WAV
There was no tenderness to palpation around the greater trochanter or psoas. He was tender around the gluteal piriformis area. No tenderness __. He was unable to bridge due to back pain.
** • through ITB? - b o l b o m
Thu Feb 15 14:11:23 2018 b o l b o m

**** • AHA! Thank you! - :)
Thu Feb 15 14:13:37 2018 :)

** • throughout hip ? (sounds like she says "hip A" ?) - taco
Thu Feb 15 14:04:43 2018 taco

**** • Thank you for trying taco! - .
Thu Feb 15 14:13:48 2018 .

**** • can't be because pt is there due to a sore tender hip - hmmm
Thu Feb 15 14:06:41 2018 hmmm


• progressive aortic s/l redilatation
+ sm
Thu Feb 15 12:12:20 2018 sm
Hypertension related to his aortic valve caused progressive aortic s/l "re"dilatation
** • regurgitation? - b o l b o m
Thu Feb 15 12:41:10 2018 b o l b o m

** • aortic root dilatation? - taco
Thu Feb 15 12:38:35 2018 taco

**** • ^ That's the one. - nm
Thu Feb 15 16:51:04 2018 nm


• Preoperative Diagnosis: POSSIBLE FLAP COMPROMISE. Procedure: ...
+ wav
Thu Feb 15 09:03:35 2018 wav
Preoperative Diagnosis:
POSSIBLE FLAP COMPROMISE.

Procedure:
LEFT NECK EXPLORATION WITH INTERROGATION OF VENOUS AND ARTERIAL ANASTOMOSES.

This is a 60-year-old male with a history of stage 4B oral cavity squamous cell carcinoma. The patient underwent induction chemo with only partial response; however, following induction chemotherapy, he was noted to have resectable disease. The decision was made to take the patient to the operating room for composite resection of his left buccal lesion including left hemimandibulectomy, left neck dissection, tracheostomy, left fibular free flap, left split-thickness skin graft. Following the surgery, the patient was noted to have good Doppler signal and had good response to the pinprick test; however, one to two hours following transfer to the recovery room, the patient was noted to have lost his Doppler signal. At this point, _____ and there was noted to be decreased blood. Given the concern for possible flap compromise, a d
** • well, maybe "his wound" instead of his tongue... - b o l b o m
Thu Feb 15 09:12:52 2018 b o l b o m

** • his tongue was inspected again ... ? - b o l b o m
Thu Feb 15 09:12:18 2018 b o l b o m

**** • Thanks a lot. - guy
Thu Feb 15 09:14:13 2018 guy

****** • Any chance it could be 'pricked' since he had passed pinprick test prior to this? - mn
Thu Feb 15 09:25:13 2018 mn

******** • i wouldn't think so? - b o l b o m
Thu Feb 15 10:15:55 2018 b o l b o m


• What would you classify this comma error as?
+ sm
Thu Feb 15 06:48:54 2018 sm
Patient reports by the end of the day, pain intensity could be 8/10.

If the sentence began with "by the end of the day," comma would be correct but because of "patient reports" it's not. Client wants minimal commas (so I wouldn't set off "by the end of the day").

My MTs do this all the time and it drives me NUTS. I continue to correct them and guide them, but at this point I need a different way of explaining since they're just repeating this over and over. Help!
** • Just wrong : ) + sm
Thu Feb 15 16:05:00 2018 sm
I found this rule at the helpful link:

With few exceptions, a comma should not separate a subject from its verb.




**** • Thank you :) - OP
Thu Feb 15 21:20:30 2018 OP

** • sheesh, it's just a comma. Don't go NUTS over it! I have never had a report + lol-poi
Thu Feb 15 12:12:04 2018 lol-poi
sent back from a physician over a comma.
**** • I should tell that to my client's reviewer. I wonder what he'd say. - OP
Thu Feb 15 15:39:20 2018 OP

****** • does your "client's reviewer" return reports because of a comma? - poi
Thu Feb 15 19:37:55 2018 poi

******** • No but it's mentioned in the rare cases it happens. With error in subj line. Bottom line + OP
Thu Feb 15 21:13:41 2018 OP
is practice's MTs were replaced with my company and they're reviewing so there's tension.
******** • What is the reason for minimal commas? Saving a few pennies? + just curious - poi
Thu Feb 15 19:46:52 2018 just curious - poi
I am not saying that there might not be some rule for or against its usage, I just can't understand why some people go NUTS over stuff that has no effect on patient care.
********** • ...And my purpose for posting was asking for help finding a rule. - OP
Thu Feb 15 21:17:02 2018 OP

************ • I figured that...was just curious. - poi
Thu Feb 15 21:20:59 2018 poi

** • sm + b o l b o m
Thu Feb 15 08:58:52 2018 b o l b o m
I use the comma as an "introductory clause" (see link below)
**** • Helpful link, thanks. Still doesn't explain why a comma is incorrect when these types of + OP
Thu Feb 15 12:06:46 2018 OP
phrases are mid sentence. It's not introductory if it doesn't begin the sentence.

• Preoperative Diagnosis: RIGHT TIBIA MALUNION. Procedure: ...
+ mp3
Thu Feb 15 05:09:20 2018 mp3
Preoperative Diagnosis:
RIGHT TIBIA MALUNION.

Procedure:
RIGHT TIBIA OSTEOTOMY, CIRCULAR FRAME APPLICATION, REMOVAL OF HARDWARE.

Tourniquet was inflated to 250 mm. The prior scar on the lateral tibial plateau was utilized and a 4 cm incision was made along that to expose the proximal plate that was placed at an outside hospital on the lateral tibial plateau. This was a Stryker proximal fibular plate that was appreciated on the tibial plateau surface. The cortical screws and plate was removed. Next, a 1 cm incision was made along the medial aspect of the proximal tibia corresponding to the entry site for the flexible nails and two flexible nails were removed with _____. These wounds were then copiously irrigated and closed in standard fashion.
** • Slap hammer wrenches. - mn
Thu Feb 15 07:46:39 2018 mn

**** • Thanks a lot. - guy
Thu Feb 15 09:03:10 2018 guy


• At the end of the case, all trocar wounds had been closed with the use ...
+ wav
Thu Feb 15 03:50:42 2018 wav
At the end of the case, all trocar wounds had been closed with the use of as previously mentioned interrupted Monocryl covered with Steri-Strips, Telfa, and Tegaderm, and once the ostomy had been matured, this was covered with same appliance which was applied around the ostomy. The patient was _____ at the end of the case by the ICU team in an attempt to extubate the patient and transferred him to the PACU in a stable condition
** • "popular short form of bronchoscopy meaning to perform a bronchoscopy; as, to bronch a pt" - mn - found this
Thu Feb 15 07:51:34 2018 mn - found this

**** • Thanks a lot. - guy
Thu Feb 15 09:04:43 2018 guy


• retinopathy of prematurity with stages 0 bilateral and she discussed sm
+ wav :)
Thu Feb 15 01:38:10 2018 wav :)
her being higher risk for refractive error and _____ strabismus.
** • error, amblyopia... - billybob
Thu Feb 15 02:11:13 2018 billybob

**** • Thanks billybob - :)
Thu Feb 15 02:36:56 2018 :)


• Preoperative Diagnosis: PROSTATE CANCER. Procedure: RADIC ...
+ wav
Thu Feb 15 01:23:45 2018 wav
Preoperative Diagnosis:
PROSTATE CANCER.

Procedure:
RADICAL ROBOTIC-ASSISTED PROSTATECTOMY, PELVIC LYMPH NODE DISSECTION.

The DVC was then closed using a running 2-0 V-Loc suture. Hemostasis was confirmed and the pneumoperitoneum was reduced to 15. The urethra was transected sharply. The prostate was then completely freed and placed into an Endo Catch bag along with our node packets. Hemostasis was again confirmed. The bladder neck was inspected and narrowed slightly using a _____ handle suture of 2-0 V-Loc. The urethrovesical anastomosis was then performed using _____ 3-0 suture double-armed.
** • racket handle suture - :)
Thu Feb 15 01:35:34 2018 :)

**** • Thanks a lot. - guy
Thu Feb 15 01:37:32 2018 guy

** • No wav file there. - :)
Thu Feb 15 01:28:50 2018 :)

**** • wav posted again. Thanks - guy
Thu Feb 15 01:29:18 2018 guy

****** • never mind. Thanks to anyone who tried. - guy
Thu Feb 15 01:34:40 2018 guy


• A Veress needle was passed through this incision into the peritoneal c ...
+ mp3
Thu Feb 15 01:01:37 2018 mp3
A Veress needle was passed through this incision into the peritoneal cavity. The pneumoperitoneum was initiated to 15 mmHg. An 8 mm robotic trocar was then passed through the abdomen without difficulty. Laparoscopy was performed. There were no abnormalities or adhesions noted. An inverted _____ placed into the peritoneum. Approximately 8 cm from the midline on the left side and the right side, 8 mm robotic trocars were inserted to the peritoneum under direct vision.
** • got it. thanks. + guy
Thu Feb 15 01:09:38 2018 guy
An inverted-V pattern trocar arrangement was placed

• She had occasional mild episodes of apnea at rest that required sm
+ wav :)
Thu Feb 15 00:47:36 2018 wav :)
stimulation but with no significant episodes of apnea bradycardia requiring stimulation a few days prior to discharge and she was on caffeine for _____.
** • for less than a month? - guy
Thu Feb 15 01:02:41 2018 guy

**** • Thank you so much. I guess I was trying to make it something harder than it was. - :)
Thu Feb 15 01:03:47 2018 :)


• Procedures: 1. BALLOON ANGIOPLASTY X2 OF RIGHT PERONEAL ARTERY. ...
+ WAV
Wed Feb 14 23:59:42 2018 WAV
Procedures:
1. BALLOON ANGIOPLASTY X2 OF RIGHT PERONEAL ARTERY.
2. BALLOON ANGIOPLASTY WITH DRUG-COATED BALLOON TO RIGHT SUPERFICIAL FEMORAL ARTERY.

We began by using a 5 x 40 mm balloon which demonstrated a nice waist as the pressure was increased. We had improved result after that, but there was still residual stenosis. As such, we treated with a 5 x 100 mm Lutonix balloon _____. We then performed diagnostic arteriography revealing brisk flow through the SFA.
** • before finishing?? hard to tell with a yawn - poi
Thu Feb 15 00:02:42 2018 poi

**** • Thanks a lot. - guy
Thu Feb 15 00:06:20 2018 guy


• Preoperative Diagnosis: SEVERE ATHEROSCLEROTIC CORONARY ARTERY DISE ...
+ wav
Wed Feb 14 20:41:04 2018 wav
Preoperative Diagnosis:
SEVERE ATHEROSCLEROTIC CORONARY ARTERY DISEASE WITH ACUTE CORONARY SYNDROME.

Procedure:
CORONARY ARTERY BYPASS SURGERY X2 (LIMA TO LAD, SVG TO OBTUSE MARGINAL) VIA MEDIAN STERNOTOMY AND UTILIZING CARDIOPULMONARY BYPASS AND ENDOSCOPIC VEIN HARVEST.

The vessel was opened and a saphenous vein graft segment was sewn in an end to side anastomosis with a continued running 7-0 Prolene. The target was of excellent size and quality. The anastomosis _____ graft and a small dose of cardioplegia was then administered down the graft.
** • was saline tested through the - poi
Wed Feb 14 20:53:51 2018 poi

**** • Thanks a lot. - guy
Wed Feb 14 20:58:03 2018 guy


• It was recommended to her that she take aspirin 81 mg p.o. daily, but she
- g j g m d p
Wed Feb 14 17:08:56 2018 g j g m d p

** • Dr. spells this, cannot find + g j g m d p
Wed Feb 14 17:09:41 2018 g j g m d p
states is taking s/l nadykinase and that she is not interested in taking NOAC.
**** • nattokinase (check out www.drugs.com/search-wildcard-phonetic.html) - taco (sm)
Wed Feb 14 17:22:25 2018 taco (sm)

****** • Thank you! - g j g m d p
Wed Feb 14 17:41:43 2018 g j g m d p


• Given that this was still elevated and not within the normal range, a ...
+ mp3
Wed Feb 14 16:33:13 2018 mp3
Given that this was still elevated and not within the normal range, a decision was to send another sample to ensure that the parathyroid hormone was elevated just secondary to manipulation of the gland, whether or not this was in fact an adenoma versus needing to continue to explore for four-gland potential hyperplasia. The next sample came back _____ and the decision was made to continue examining for another adenoma versus hyperplastic parathyroid gland.
** • at 88 - taco
Wed Feb 14 16:54:33 2018 taco

**** • Thanks a lot. - guy
Wed Feb 14 20:41:27 2018 guy

** • never mind. Thanks to anyone who tried. - guy
Wed Feb 14 16:46:49 2018 guy


• Frozen came back with hyperplasia and they were not able to determine ...
+ mp3
Wed Feb 14 16:26:09 2018 mp3
Frozen came back with hyperplasia and they were not able to determine whether it was an adenoma versus a discrete hyperplasia. The intraoperative PTH came down to 122. Given the _____ not within the normal range, a decision was to send another sample to ensure that the parathyroid hormone was elevated just secondary to manipulation of the gland.
** • Given that this was still elevated and... - taco
Wed Feb 14 16:29:20 2018 taco

**** • Thanks a lot. - guy
Wed Feb 14 16:31:52 2018 guy


• Preoperative Diagnosis: HYPERPARATHYROIDISM. Procedure: F ...
+ wav
Wed Feb 14 16:06:11 2018 wav
Preoperative Diagnosis:
HYPERPARATHYROIDISM.

Procedure:
FOUR-GLAND EXPLORATION, EXCISION OF LEFT UPPER AND LOWER PARATHYROIDS, INTRAOPERATIVE PTH.

This is a 65-year-old male who has known hyperparathyroidism. He has been suffering from nephrolithiasis for 40 years, requiring multiple ER visits due to pain, hematuria _____ constipation, also with osteopenia. The patient underwent ultrasound and
** • never mind. Thanks to anyone who tried. - guy-
Wed Feb 14 16:44:54 2018 guy-


• What I hear I cannot confirm with Google, so perhaps I am hearing wrong? Thanks
+ mp3
Wed Feb 14 14:59:08 2018 mp3
A 6-mm __________ incision was created at the 12 o'clock position. This lens was removed and a secondary anterior chamber intraocular lens was placed
** • s/l groove and tunnel to me - b o l b o m
Wed Feb 14 15:39:05 2018 b o l b o m

**** • Yes, I heard groove and tunnel also. Just wasn't sure since I could not confirm. Thank you - mp3
Wed Feb 14 15:41:43 2018 mp3

** • groove in tunnel? groove and tunnel? groove internal? groove external? - something like that
Wed Feb 14 15:15:03 2018 something like that

**** • Thank you. I will stick with groove and tunnel. - mp3
Wed Feb 14 15:42:06 2018 mp3


• s/l corrolic (ESL)
+ g j g m d p
Wed Feb 14 11:49:09 2018 g j g m d p
The patient had confusion as manifestation of her TIA which lasted less than 24 hours. She was seen by Dr.xxx who ordered a CTA of the head and neck to rule out _____ or intracranial stenosis, echocardiogram, telemetry monitoring, hemoglobin A1c, and fasting lipid profile.
** • I think they would want to rule out carotid stenosis. - nm
Wed Feb 14 11:54:26 2018 nm

**** • Ty! That's it! - g j g m d p
Wed Feb 14 12:08:30 2018 g j g m d p


• hepatitis C infection
+ sm
Wed Feb 14 10:50:31 2018 sm
normal histology after 20 years of s/l hff infection.

• ultrasound carotid arteries-what's usually said
+ sm
Wed Feb 14 10:32:36 2018 sm
Right: No morphological significant plaque or stenosis is identified.

Can't tell because of accent whether saying normal morphological or no morphological
** • No morphologically significant... - nm
Wed Feb 14 12:42:26 2018 nm

** • I'd say no (since he says morphological significant, normal just doesn't fit here IMHO - b o l b o m
Wed Feb 14 11:21:43 2018 b o l b o m

**** • thanks - t
Wed Feb 14 11:35:17 2018 t


• Saccade test, gaze test, tracking test, positional test, ultra dynamic ...
+ h o f o a d
Wed Feb 14 09:01:50 2018 h o f o a d
Saccade test, gaze test, tracking test, positional test, ultra dynamic test, Dix-Hallpike test, and bithermal caloric
** • s/l ultra dynamic - see below
Wed Feb 14 09:02:32 2018 see below


• Procedure: RIGHT KNEE DISARTICULATION, LEFT FEMORAL HEMODIALYSIS CA ...
+ wav
Wed Feb 14 05:06:48 2018 wav
Procedure:
RIGHT KNEE DISARTICULATION, LEFT FEMORAL HEMODIALYSIS CATHETER PLACEMENT.

The patient is a 43-year-old female with extensive past medical history including diabetes and end-stage renal disease complicated by _____ secondary to necrotizing fascitis of the right lower extremity for which she initially underwent a right below-knee amputation
** • septic shock? - mn
Wed Feb 14 08:49:15 2018 mn

**** • Thanks a lot. - guy
Wed Feb 14 15:41:02 2018 guy




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