This study aims to systematically compare and
contrast the two most commonly used techniques of
tonsillectomy- Cold tonsillectomy and cobilation tonsillectomy.
Three different age group of patients were examined and
operated. The total number of patients was 104. There were 52
patients each of cobilation and cold tonsillectomy. The
specifications being following: 35 patients of age between 3 to 7
years, 6 patients of age 7-12 years and 11 patients of age greater
than 12 years.
The result of this study showed that there is no significant and
noticeable difference between the two procedures of operating
tonsils. However slight differences in the post operative pain and
primary and secondary bleeding was seen. The operation time
was considerably lower in patients of younger age.
Is there a role for internal iliac artery ligation in post cesarean uterine a...Apollo Hospitals
A pseudoaneurysm is a blood-filled cavity communicating with the arterial lumen owing to deficiency in one or more layers of the arterial wall. Development of pseudoaneurysms is a complication of vascular injury resulting from inflammation, trauma, or iatrogenic causes such as surgical procedures, percutaneous biopsy, or drainage. Pseudoaneurysm of the uterine artery is a rare but serious complication of gynecologic surgery that may be unnoticed in the early post-operative period. Without precise ultrasonographic and radiologic diagnosis before the manifestation of symptoms associated with hemorrhage, these pseudoaneurysms are prone to unpredictable rupture, resulting in exsanguination with high morbidity and mortality rates.
This study aims to systematically compare and
contrast the two most commonly used techniques of
tonsillectomy- Cold tonsillectomy and cobilation tonsillectomy.
Three different age group of patients were examined and
operated. The total number of patients was 104. There were 52
patients each of cobilation and cold tonsillectomy. The
specifications being following: 35 patients of age between 3 to 7
years, 6 patients of age 7-12 years and 11 patients of age greater
than 12 years.
The result of this study showed that there is no significant and
noticeable difference between the two procedures of operating
tonsils. However slight differences in the post operative pain and
primary and secondary bleeding was seen. The operation time
was considerably lower in patients of younger age.
Is there a role for internal iliac artery ligation in post cesarean uterine a...Apollo Hospitals
A pseudoaneurysm is a blood-filled cavity communicating with the arterial lumen owing to deficiency in one or more layers of the arterial wall. Development of pseudoaneurysms is a complication of vascular injury resulting from inflammation, trauma, or iatrogenic causes such as surgical procedures, percutaneous biopsy, or drainage. Pseudoaneurysm of the uterine artery is a rare but serious complication of gynecologic surgery that may be unnoticed in the early post-operative period. Without precise ultrasonographic and radiologic diagnosis before the manifestation of symptoms associated with hemorrhage, these pseudoaneurysms are prone to unpredictable rupture, resulting in exsanguination with high morbidity and mortality rates.
ENDOSCOPIC TREATMENT OF PILONIDAL SINUS IN EGYPTIAN PATIENTSindexPub
Background: Treatment for pilonidal disease using minimally invasive methods is a reliable and successful alternative to conventional surgery, with quicker recovery, better cosmetic outcomes, and better pain management. The primary goals of this study are to assess the early outcomes of endoscopic pilonidal sinus treatment and to demonstrate the surgical approach and its adaptations. Materials and Methods: Our study was conducted on 30 patients with pilonidal sinus disease as a prospective cohort study for endoscopic treatment of the pilonidal sinus, from October 2021 to October 2022, in our surgical department at Theodor Bilharz Research Institute (TBRI). Surgical outcomes of sinus healing, pain, and discharge were reviewed in the outpatient clinic, and patient satisfaction levels were assessed through a standardized phone interview. Results: There were 24 males and 6 females, with a median age of 21.87±1.85 years (ranging from 16 to 57 years). The mean operative time was 44.17 (35-55) ±1.26 min. During the follow-up period of 24 weeks, wound closure was seen after a median of 4 weeks. Wounds were closed in 72% of patients after one month and 93% of patients after two months. 2 patients had to be re-operated due to failure: one had persistence of discharge, and the other had recurrence after 3 months. The satisfaction rate was 93.3%. Conclusions: Endoscopic pilonidal sinus treatment is a minimally invasive and cosmetically favorable procedure. To find out if it reduces recovery time and the long-term recurrence rate, a larger sample size and a longer follow-up are needed.
M132 Module 06 Coding Assignment 1. Case Study #1PREOPERAT.docxinfantsuk
M132 Module 06 Coding Assignment
1. Case Study #1
PREOPERATIVE DIAGNOSIS: Carcinoma of the right breast, status post neoadjuvant chemotherapy.
POSTOPERATIVE DIAGNOSIS: Carcinoma of the right breast, status post neoadjuvant chemotherapy.
PROCEDURE PERFORMED: Right modified radical mastectomy, left prophylactic mastectomy
PREOPERATIVE HISTORY: The patient is an unfortunate 37-year-old woman who had a pregnancy associated breast cancer of the right breast with extensive involvement of the breast, clinically a stage III breast cancer. She underwent neoadjuvant chemotherapy with a complete clinical response to therapy with no residual palpable tumor in the breast and no palpable adenopathy. She has elected to undergo a bilateral mastectomy. She will have reconstructive surgery at a later time.
OPERATIVE NOTE: The patient was taken to the operating room. General anesthesia was induced. A Foley catheter was inserted. Her arms were placed on pads. Her legs were placed on pads. Bear hugger was applied and her entire upper torso was sterilely prepped and draped in usual fashion. Symmetric skin sparing mastectomies were planned incorporating the nipple-areolar complex on both sides. We began on the left side. An elliptical incision was made incorporating the nipple-areolar complex, carried down through the skin into the subcutaneous tissue. Flaps were raised circumferentially from the superior aspect to the clavicle, medially to the midline, inferiorly to the inframammary, fold and laterally out to the latissimus dorsi. The breast was then removed from the pectoralis major muscle incorporating the fascia, reflected laterally and truncated. It was marked for orientation, weighed and sent to pathology. Hemostasis was achieved where necessary using electrocautery. There was no evidence of bleeding at the end of the case. Moist laps were placed under the flaps and we moved to the right breast. Again, an elliptical incision was created incorporating the nipple-areolar complex and a little more skin laterally in that breast because the breast was a larger breast on that side. Flaps again were raised from superior infraclavicular and a portion of the breast circumferentially to the midline and subsequently to the inframammary fold and subsequently out to the latissimus dorsi muscle. The breast was removed from the pectoralis major muscle incorporating the fascia, reflected laterally. The clavipectoral fascia was opened and a level I and level II axillary lymph node dissection was performed on both sides, sparing the long thoracic and the thoracodorsal neurovascular bundle, as well as at least 1 intercostal brachial cutaneous nerves. The axillary lymph nodes will be examined for metastasis. There was no palpable adenopathy in level III. The breast and axilla were marked for orientation, weighed and sent to pathology. Irrigation was performed. Hemostasis was achieved where necessary using some Surgiclips and electrocautery. There was no evidence of blee ...
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ENDOSCOPIC TREATMENT OF PILONIDAL SINUS IN EGYPTIAN PATIENTSindexPub
Background: Treatment for pilonidal disease using minimally invasive methods is a reliable and successful alternative to conventional surgery, with quicker recovery, better cosmetic outcomes, and better pain management. The primary goals of this study are to assess the early outcomes of endoscopic pilonidal sinus treatment and to demonstrate the surgical approach and its adaptations. Materials and Methods: Our study was conducted on 30 patients with pilonidal sinus disease as a prospective cohort study for endoscopic treatment of the pilonidal sinus, from October 2021 to October 2022, in our surgical department at Theodor Bilharz Research Institute (TBRI). Surgical outcomes of sinus healing, pain, and discharge were reviewed in the outpatient clinic, and patient satisfaction levels were assessed through a standardized phone interview. Results: There were 24 males and 6 females, with a median age of 21.87±1.85 years (ranging from 16 to 57 years). The mean operative time was 44.17 (35-55) ±1.26 min. During the follow-up period of 24 weeks, wound closure was seen after a median of 4 weeks. Wounds were closed in 72% of patients after one month and 93% of patients after two months. 2 patients had to be re-operated due to failure: one had persistence of discharge, and the other had recurrence after 3 months. The satisfaction rate was 93.3%. Conclusions: Endoscopic pilonidal sinus treatment is a minimally invasive and cosmetically favorable procedure. To find out if it reduces recovery time and the long-term recurrence rate, a larger sample size and a longer follow-up are needed.
M132 Module 06 Coding Assignment 1. Case Study #1PREOPERAT.docxinfantsuk
M132 Module 06 Coding Assignment
1. Case Study #1
PREOPERATIVE DIAGNOSIS: Carcinoma of the right breast, status post neoadjuvant chemotherapy.
POSTOPERATIVE DIAGNOSIS: Carcinoma of the right breast, status post neoadjuvant chemotherapy.
PROCEDURE PERFORMED: Right modified radical mastectomy, left prophylactic mastectomy
PREOPERATIVE HISTORY: The patient is an unfortunate 37-year-old woman who had a pregnancy associated breast cancer of the right breast with extensive involvement of the breast, clinically a stage III breast cancer. She underwent neoadjuvant chemotherapy with a complete clinical response to therapy with no residual palpable tumor in the breast and no palpable adenopathy. She has elected to undergo a bilateral mastectomy. She will have reconstructive surgery at a later time.
OPERATIVE NOTE: The patient was taken to the operating room. General anesthesia was induced. A Foley catheter was inserted. Her arms were placed on pads. Her legs were placed on pads. Bear hugger was applied and her entire upper torso was sterilely prepped and draped in usual fashion. Symmetric skin sparing mastectomies were planned incorporating the nipple-areolar complex on both sides. We began on the left side. An elliptical incision was made incorporating the nipple-areolar complex, carried down through the skin into the subcutaneous tissue. Flaps were raised circumferentially from the superior aspect to the clavicle, medially to the midline, inferiorly to the inframammary, fold and laterally out to the latissimus dorsi. The breast was then removed from the pectoralis major muscle incorporating the fascia, reflected laterally and truncated. It was marked for orientation, weighed and sent to pathology. Hemostasis was achieved where necessary using electrocautery. There was no evidence of bleeding at the end of the case. Moist laps were placed under the flaps and we moved to the right breast. Again, an elliptical incision was created incorporating the nipple-areolar complex and a little more skin laterally in that breast because the breast was a larger breast on that side. Flaps again were raised from superior infraclavicular and a portion of the breast circumferentially to the midline and subsequently to the inframammary fold and subsequently out to the latissimus dorsi muscle. The breast was removed from the pectoralis major muscle incorporating the fascia, reflected laterally. The clavipectoral fascia was opened and a level I and level II axillary lymph node dissection was performed on both sides, sparing the long thoracic and the thoracodorsal neurovascular bundle, as well as at least 1 intercostal brachial cutaneous nerves. The axillary lymph nodes will be examined for metastasis. There was no palpable adenopathy in level III. The breast and axilla were marked for orientation, weighed and sent to pathology. Irrigation was performed. Hemostasis was achieved where necessary using some Surgiclips and electrocautery. There was no evidence of blee ...
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
1. Consent Procedure
CONSENT:
[_] During the informed consent discussion regarding the procedure, or treatment, I explained the following
to the patient/designee:
a. Nature of the procedure or treatment and who will perform the procedure or treatment.
b. Necessity for procedure and the possible benefits.
c. Risks and complications (most common and serious).
d. Alternative treatments and the risks, benefits and side effects of each (including no treatment).
e. Likelihood of the patient achieving his/her goals without this procedure and surgery treatment.
f. Problems that might occur during the recuperation.
g. Conflicts of interest, if any
[_] The procedure was emergent, the patient was unable to provide consent, and a designee was not
immediately available.
Central Venous Catheter (CVC, Central Line) Placement
Date: <____>
Time: <____>
Indication: Hemodynamic monitoring/Intravenous access
Resident: <____>
Attending: <____>
A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if
applicable. The patient was placed in a dependent position appropriate for central line placement based on
the vein to be cannulated. The patient’s <right/left> < neck/shoulder/groin> was prepped and draped in
sterile fashion. 1% Lidocaine was used to anesthetize the surrounding skin area. A triple lumen <9-
French> Cordis catheter was introduced into the the <subclavian/internal jugular/common femoral vein>
using the Seldinger technique <and under ultrasound guidance>. The catheter was threaded smoothly over
the guide wire and appropriate blood return was obtained. Each lumen of the catheter was evacuated of air
and flushed with sterile saline. The catheter was then sutured in place to the skin and a sterile dressing
applied. Perfusion to the extremity distal to the point of catheter insertion was checked and found to be
adequate. <Attending/Resident> was present for the entire procedure.
Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.
2. Endotracheal Intubation
Date: <____>
Time: <____>
Indication: Respiratory Distress
Resident: <____>
Attending: <____>
A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if
applicable. The patient was placed in a flat position. Sedation was obtained using <Versed 3mg>, and
additionally with <Etomidate 20mg>. The patient was easily ventilated using an ambu bag. The
<GLIDESCOPE TECHNOLOGY/ MAC 3 BLADE> was used and inserted into the oropharynx at which
time there was a Grade 1 view of the vocal cords. A 7.5-french endotracheal tube was inserted and
visualized going through the vocal cords. The stylette was removed. Colorimetric change was visualized on
the CO2 meter. Breath sounds were heard in both lung fields equally. The endotracheal tube was placed at
23 cm, measured at the teeth. <Attending/Resident> was present for the entire procedure.
A chest x-ray was ordered to assess for pneumothorax and verify endotrachealtube placement.
Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.
ARTERIAL LINE (A-Line) PLACEMENT
Date: <____>
Time: <____>
Indication: Hemodynamic monitoring
Resident: <____>
Attending: <____>
A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if
applicable. Allen’s test was performed to ensure adequate perfusion. The patient’s <right/left> wrist was
prepped and draped in sterile fashion. 1% Lidocaine was used to anesthetize the area. A <18G/20G> Arrow
arterial line was introduced into the <radial/femoral> artery. The catheter was threaded over the guide wire
and the needle was removed with appropriate pulsatile blood return. The catheter was then sutured in place
to the skin and a sterile dressing applied. Perfusion to the extremity distal to the point of catheter insertion
was checked and found to be adequate. <Attending/Resident> was present for the entire procedure.
Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.
Lumbar Puncture
Date: <____>
Time: <____>
Indication: Altered Mental Status
Resident: <____>
Attending: <____>
3. A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if
applicable. The patient was placed in the <LEFT/RIGHT> lateral decubitus position in a semi-fetal position
with help from the nursing staff. The area was cleansed and draped in usual sterile fashion. 1% lidocaine
was used anesthetize the surrounding skin area. A <20-gauge 3.5-inch> spinal needle was placed in the
<L3-L4/L4-L5> interspace. Clear cerebral spinal fluid was obtained and the opening pressure was noted to
be <?cm>. Four tubes were filled with 4 mL of CSF. These were sent for the usual tests, including 1 tube to
be held for further analysis if needed. <Attending/Resident> was present for the entire procedure
Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.
Thoracentesis
Date: <____>
Time: <____>
Indication: Large pleural effusion
Resident: <____>
Attending: <____>
A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if
applicable. The patient’s <right/left> side was prepped and draped in a sterile manner after the appropriate
infiltration level was confirmed by ultrasound. 1% lidocaine was used anesthetize the surrounding skin. A
finder needle was then used to locate fluid and clear yellow fluid was obtained. A 10-blade scalpel used to
make the incision. The thoracentesis catheter was then threaded without difficulty. The patient had <?mL>
of clear yellow fluid removed. <Attending/Resident> was present for the entire procedure. A post-
procedure chest x-ray was ordered and the fluid will be sent for several studies.
Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.
THORACOSTOMY (CHEST TUBE) PLACEMENT
Date: <____>
Time: <____>
Indication: Pneumothorax/Hemothorax
Resident: <____>
Attending: <____>
A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if
applicable. The patient was positioned appropriately for chest tube placement. The patient’s <right/left>
chest was prepped and draped in sterile fashion. 1% Lidocaine was used to anesthetize the surrounding skin
area. A <2 cm> skin incision was made in the mid-axillary line at the inframammarycrease. Utilizing blunt
dissection a subcutaneous tunnel was created cephalad just adjacent to the superior rib. The pleural space
was entered bluntly and gush of <air/blood> was observed. A finger was inserted into the pleural space to
check for anatomy and guide tube insertion. A <36F/40F> thoracostomy tube was inserted using a Kelly
clamp and positioned appropriately. The chest tube was sutured securely to the skin and a sterile dressing
applied. A pleurevac was attached to the chest tube and a chest x-ray obtained. <Attending/Resident> was
present for the entire procedure.
Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.
4. Swan-Ganz Catheter Placement
Date: <____>
Time: <____>
Indication: Hemodynamic monitoring/Intravenous access
Resident: <____>
Attending: <____>
A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if
applicable. The patient was placed in a dependent position appropriate for central line placement based on
the vein already cannulated with a 9F Cordis catheter. The patient’s <right/left> <shoulder/neck/groin>
was prepped and draped in sterile fashion. A triple lumen continuous cardiac output Swan-Ganz catheter
was brought onto the field and each line flushed with sterile saline and the SVO2 sensor calibrated. The
catheter was introduced into the Cordis catheter to a distance of 15-17 cm. The balloon was then inflated
and the catheter was advanced through the right ventricle and into the pulmonary artery until a wedge
position pressure tracing was obtained. The balloon was then deflated and verification of return of a
pulmonary artery pressure tracing made. During the floating procedure to position the catheter the position
of the catheter tip was determined by continuous pressure monitoring via the distal port. The catheter was
locked to the Cordis with the tip inserted to a distance of <?cm> and a sterile dressing applied.
<Attending/Resident> was present for the entire procedure.
Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.
ROS
Subjective
Patient ID: Manique Huston is a 47 y.o. female.
HPI
Review of Systems
Constitutional: Negative for activity change, appetite change, chills, diaphoresis, fatigue,
fever and unexpected weight change.
HENT: Negative for congestion, dental problem, drooling, ear discharge, ear pain, facial
swelling, hearing loss, mouth sores, nosebleeds, postnasal drip, rhinorrhea, sinus
pressure, sinus pain, sneezing, sore throat, tinnitus, trouble swallowing and voice
change.
Eyes: Negative for photophobia, pain, discharge, redness, itching and visual
disturbance.
Respiratory: Negative for apnea, cough, choking, chest tightness, shortness of breath,
wheezing and stridor.
Cardiovascular: Negative for chest pain, palpitations and leg swelling.
Gastrointestinal: Negative for abdominal distention, abdominal pain, anal bleeding,
blood in stool, constipation, diarrhea, nausea, rectal pain and vomiting.
5. Endocrine: Negative for cold intolerance, heat intolerance, polydipsia, polyphagia and
polyuria.
Genitourinary: Negative for decreased urine volume, difficulty urinating, dyspareunia,
dysuria, enuresis, flank pain, frequency, genital sores, hematuria, menstrual problem,
pelvic pain, urgency, vaginal bleeding, vaginal discharge and vaginal pain.
Musculoskeletal: Negative for arthralgias, back pain, gait problem, joint swelling,
myalgias, neck pain and neck stiffness.
Skin: Negative for color change, pallor, rash and wound.
Allergic/Immunologic: Negative for environmental allergies, food allergies and
immunocompromised state.
Neurological: Negative for dizziness, tremors, seizures, syncope, facial asymmetry,
speech difficulty, weakness, light-headedness, numbness and headaches.
Hematological: Negative for adenopathy. Does not bruise/bleed easily.
Psychiatric/Behavioral: Negative for agitation, behavioral problems, confusion,
decreased concentration, dysphoric mood, hallucinations, self-injury, sleep disturbance
and suicidal ideas. The patient is not nervous/anxious and is not hyperactive.
Objective
Physical Exam
Objective
Physical Exam
Vitals reviewed. Exam conducted with a chaperone present.
Constitutional:
General: She is not in acute distress.
Appearance: Normal appearance. She is obese. She is not ill-appearing, toxic-
appearing or diaphoretic.
HENT:
Head: Normocephalic and atraumatic.
Right Ear: Tympanic membrane, ear canal and external ear normal. There is no
impacted cerumen.
Left Ear: Tympanic membrane, ear canal and external ear normal. There is no
impacted cerumen.
Nose: Nose normal. No congestion or rhinorrhea.
Mouth/Throat:
Mouth: Mucous membranes are moist.
Pharynx: Oropharynx is clear. No oropharyngeal exudate or posterior oropharyngeal
erythema.
6. Eyes:
General: No scleral icterus.
Right eye: No discharge.
Left eye: No discharge.
Extraocular Movements: Extraocular movements intact.
Conjunctiva/sclera: Conjunctivae normal.
Pupils: Pupils are equal, round, and reactive to light.
Neck:
Vascular: No carotid bruit.
Cardiovascular:
Rate and Rhythm: Normal rate and regular rhythm.
Pulses: Normal pulses.
Heart sounds: Normal heart sounds. No murmur heard.
No friction rub. No gallop.
Pulmonary:
Effort: Pulmonary effort is normal. No respiratory distress.
Breath sounds: Normal breath sounds. No stridor. No wheezing, rhonchi or rales.
Chest:
Chest wall: No tenderness.
Abdominal:
General: Abdomen is flat. Bowel sounds are normal. There is no distension.
Palpations: Abdomen is soft. There is no mass.
Tenderness: There is no abdominal tenderness. There is no right CVA tenderness, left
CVA tenderness, guarding or rebound.
Hernia: No hernia is present.
Genitourinary:
General: Normal vulva.
Vagina: No vaginal discharge.
Rectum: Normal. Guaiac result negative.
Musculoskeletal:
General: No swelling, tenderness, deformity or signs of injury. Normal range of motion.
Cervical back: Normal range of motion and neck supple. No rigidity or tenderness.
Right lower leg: No edema.
Left lower leg: No edema.
Lymphadenopathy:
Cervical: No cervical adenopathy.
Skin:
General: Skin is warm and dry.
Capillary Refill: Capillary refill takes less than 2 seconds.
Coloration: Skin is not jaundiced or pale.
Findings: No bruising, erythema, lesion or rash.
7. Neurological:
General: No focal deficit present.
Mental Status: She is alert and oriented to person, place, and time. Mental status is at
baseline.
Cranial Nerves: No cranial nerve deficit.
Sensory: No sensory deficit.
Motor: No weakness.
Coordination: Coordination normal.
Psychiatric:
Mood and Affect: Mood normal.
Behavior: Behavior norm
Assessment/Plan: