trans 1 and 2 final
docx
keyboard_arrow_up
School
St. Clair College *
*We aren’t endorsed by this school
Course
A1
Subject
Medicine
Date
Jan 9, 2024
Type
docx
Pages
5
Uploaded by SargentAardvarkMaster940
Name Gautam Sudhir Audio no:1
___________________
OPERATIVE REPORT
Patient Name: Mary Ann Compton
Patient ID: 16-87330
Date of Procedure: 8/20/2021
Page 2
INDICATIONS: This 55-year-old white diabetic female with a history of below knee amputation
has persistent pain. She has failed to respond to prosthetics management after reviewing the risk,
benefits, and alternatives. Patient has agreed to proceed with surgical treatment. The risks of
delayed healing, non-healing infection nerval vessel and tendon injury, ongoing pain discomfort,
deformity failure and need for revision were all ordered.
DESCRIPTION OF PROCEDURE: Patient was taken to the OR where general anesthesia was.
induced. Time out was taken indicating appropriate site, procedure, and patient. Initialed
operative limb. 1g of Ancef was given IV. A well-padded proximal tourniquet was placed. The
extremity was prepped and draped in the usual sterile fashion. The extremity was exsanguinated.
and tourniquet inflated. Long ellipse was made over the pray incision. Skin and subcutaneous
tissue were excised down to the fascia. The subcutaneous tumor at the anterior aspect of the
distal tibia was excised. Consistent with the bursa. Next a linear incision was made in fascia over.
the tibia. The tibia was exposed distally and subperiosteally including the very irregular and
distal remnant. The distal tibia was excised, removing the distal 3mm to 4mm including the
irregular remnant with a small oscillating saw. The wound was irrigated copiously with normal.
saline. The fascia was advanced and repaired with inverted Vicryl sutures in a figure of 8.
configuration. Subcutaneous tissue was closed with 3-o Vicarly. Skin was closed 4-o nylon and
skin clips. Sterile dressing was applied. Telfa dressing, sponge row, cotton row, and plaster
splints applied. Tracheal tube was removed. No complications. Patient was taken to PAR in
stable condition. She will be transferred to the floor after appropriate care and observation. The
case was discussed with the patient’s family and with Dr. Davida, who was kind enough to help.
this admission. Dr. Shuff will consult from nephrology to assist with the patient’s peritoneal
Dialysais.
Bobbie J. Palmer, PA-C
BP :ke
D : 8/20/2021
T : 8/20/2021
C: Phyllis Shuff, MD, Nephrology
Lyudmila Davida, MD, Internal Medicine
Audio 2
PLASTIC SURGERY CONSULTATION Patient Name: Roy Mitchell Patient ID: M-14 Date of Consultation: 05/11/---- Age / Sex: 9/M PCP: Antonia Connerly, MD, Pediatrics Consultant: Mark Swafford, MD, Plastics & Reconstructive Surgery REASON FOR CONSULT:
Patient presents at 1400 hours today for the evaluation of dog bites to bilateral upper extremities. He is accompanied by his mother. HISTORY OF PRESENT ILLNESS: Roy is a 9-year-old white male, bitten by a bullmastiff on the left hand and right forearm and hand on 5/10. Initially seen in Hillcrest Emergency Department, evaluated by emergency medicine physicians and an orthopedic surgeon. Patient found to have significant bites, one on the volar ulnar aspect of his mid-
forearm of the right upper extremity, and another puncture type wound with some erythema, induration, and edema on the Thenar eminence volar of his left hand. The patient received one dose of intravenous Zosyn while in the ED and was discharged at 5 o'clock on 5/10. The patient followed up with orthopedics at 1000 hours on 5/11 and was found to be not significantly improved. He was subsequently referred for hospital admission if deemed necessary by our service P&RC. The patient has had no fevers and has been doing reasonably well at home with no significant change with his over pain status. The background on the dog was that it was a stray male dog that had been taken from an animal shelter as the patient's mother is doing rescue work with these types of animals. The child had been playing in the backyard with the animal unsupervised, apparently in somewhat of a playful not exactly provoked manner. The dog bit the child on the right wrist, forearm, and left hand as previously described. The dog has since been euthanized and decapitated for cranial analysis for rabies. All appropriate forms have been filled out by the shelter for once the dog came and also from the hospital ED. MEDICATIONS: None. Previous antibiotics received include Zosyn IV in the ED. PAST MEDICAL / SURGICAL HISTORY: - Pressure equalization tubes x2 - AVM in the antecubital fossa in the right upper arm, corrected surgically. - Left Tympanoplasty. - Right neck biopsy of benign tissue SOCIAL HISTORY: Patient lives at home with his mother who is a widow. No siblings PHYSICAL EXAMINATION:
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
- Weight: 30.5 kg - VITAL SIGNS: Stable. No fever noted. - Exam of the patient’s upper extremities reveals full strength with strength 5 out of 5 in bilateral deltoids, biceps, triceps, Brachioradialis, wrist flexors, wrist extensors, finger flexors, finger extensors, and interossei. Overall, light touch sensation is intact in BUE along the median ulnar and radial dermal distribution. - Distal neurologic status shows a 5 out of 5 strengths in and along the anterior interosseous and posterior interosseous as well as ulnar nerve distribution. Capillary refill is less than two seconds in all fingers, radial pulses easily palpated and is 2+ in nature bilaterally. Specific attention to the skin findings shows multiple very small and shallow puncture/abrasions on the volar and dorsal aspects of the forearm of the RUE and on the palm and dorsum of the left hand. None of these are deep, and each has a very scant coagulated scab present. No fluid inexpressible from the sites. The only ones that have mild erythema associated with them include one on the volar ulnar aspect of the mid forearm in the RUE, and
the Hypothenar eminence of the left hand, which has a fair amount of erythema. No induration and no Fluctuance are noted. The Thenar eminence is soft, and the patient tolerates palpation of the area without difficulty. Passive finger extension and flexion are unimpeded and pain-free. No fluid or pus is expressed from any of these lesions. LAB & X-RAY DATA: Patients WBC count is 8.3, ESR is 14, CRP is 0.8. X-rays done on 11th of May, of the right forearm and hand. The left hand shows no interval changes, still with some subcutaneous air in the Volaris, back to the distal radius on the right. ASSESSMENT: This is a 9-year-old white male with bilateral hand and forearm dog bites, with cellulitis over the left Thenar eminence, and over the volar ulnar mid-forearm of the right hand without evidence of abscess at
this time. PLAN: I planned to have the patient admitted overnight to the Hillcrest Medical Center pediatric service, for IV antibiotics for the next 12 to 24 hours. I plan to have the patient start Zosyn 2.4 g, IV, q.8.h., which is 80 mg per kg per 8 hours. The patient will take Tylenol for pain control, will follow closely in the morning with laboratory evaluation as well as repeat examination of his wounds. The patient will be NPO past midnight tonight, however, he can eat dinner this evening. I plan to place the patient in a small pancake volar splint for the left hand, for soft tissue rest, and re-evaluate in the morning as previously described.
Mark Swafford, MD, Plastic & Reconstructive Surgery FB: ad D: 05/11/---- T: 05/11/---- C: Antonia Connerly, MD, Pediatrics David Lanewala, MD, Orthopedic Surgery