audio_file,speaker,text,specialty,specialty_id,generated_tokens,section_number,total_sections
tara_Cardiovascular _ Pulmonary_0000_chunk8of26.wav,tara,She is a mother of two. There is no family history of congenital heart disease.,Cardiovascular / Pulmonary,33,435,8,26
tara_Cardiovascular _ Pulmonary_0000_chunk11of26.wav,tara,"Remote history is significant for an ACL repair, complicated by contact urticaria from a neoprene cast. No regular medications prior to admission.",Cardiovascular / Pulmonary,33,890,11,26
tara_Cardiovascular _ Pulmonary_0000_chunk16of26.wav,tara,"Cardiac exam is regular without murmurs, gallops, or rubs. Abdomen is soft without guarding, rebound masses, or bruits.",Cardiovascular / Pulmonary,33,722,16,26
tara_Cardiovascular _ Pulmonary_0000_chunk17of26.wav,tara,Extremities well perfused. No edema.,Cardiovascular / Pulmonary,33,351,17,26
tara_Cardiovascular _ Pulmonary_0000_chunk20of26.wav,tara,"Thyroid function is pending. Two-dimensional echocardiogram shows no evidence of clinically significant structural or functional heart disease.IMPRESSION/ , Episodic palpitations over a nine-year period.",Cardiovascular / Pulmonary,33,1058,20,26
tara_SOAP _ Chart _ Progress Notes_0001_chunk17of20.wav,tara,2. Push fluids.,SOAP / Chart / Progress Notes,34,253,17,20
tara_Radiology_0002_chunk4of17.wav,tara,The spleen is normal in size and attenuation.A 2. 2 x 1.,Radiology,15,1051,4,17
tara_Cardiovascular _ Pulmonary_0003_chunk6of30.wav,tara,Chronic obstructive pulmonary disease. 3.,Cardiovascular / Pulmonary,33,330,6,30
tara_Cardiovascular _ Pulmonary_0003_chunk28of30.wav,tara,"b.i.d. He was also to use a Ventolin inhaler every four hours as needed, and Azmacort four puffs twice per day.",Cardiovascular / Pulmonary,33,848,28,30
tara_Cardiovascular _ Pulmonary_0003_chunk30of30.wav,tara,"Arrangements have been made for the patient to have an echocardiogram for further evaluation of his congestive heart failure later on the day of discharge.cardiovascular / pulmonary, discharge summary, ada diet, congestive heart failure, coronary artery disease, respiratory arrest, chest pain, chronic obstructive pulmonary disease, emergency room, hypertension, sputum, wheezing, respiratory distress, myocardial infarctions, respiratory failure, pulmonary disease, basilar rales, heart failure, infarctions, heart, wheezes, coronary, pulmonary, discharge, respiratory,",Cardiovascular / Pulmonary,33,4894,30,30
tara_Gastroenterology_0004_chunk13of32.wav,tara,"Laboratories drawn at 1449 today, WBC 10, hemoglobin and hematocrit 11. 5 and 33.",Gastroenterology,23,939,13,32
tara_Gastroenterology_0004_chunk22of32.wav,tara,"We will continue to monitor the patient overnight to ensure there is no further bleeding. If there are no further episodes of melena and hemoglobin is stable or unchanged in the morning, the patient will be transferred back to medical floor for continuing treatment of his chronic obstructive pulmonary disease exacerbation.",Gastroenterology,23,1443,22,32
tara_Cardiovascular _ Pulmonary_0006_chunk10of27.wav,tara,"The wire was secured in place with the hemostat. Using a 10 and 15 scalpel blade, a 5 cm horizontal incision was made in the left pectoral deltoid region where the skin was dissected and blunted down into the pectoris major muscle fascia.",Cardiovascular / Pulmonary,33,1205,10,27
tara_Cardiovascular _ Pulmonary_0007_chunk2of8.wav,tara,"The patient is a 28-year-old male, status post abdominal trauma, splenic laceration, and splenectomy performed at the outside hospital, who was admitted to the Trauma Intensive Care Unit on the evening of August 4, 2008. Greater than 24 hours postoperative, the patient began to run a fever in excess of 102.",Cardiovascular / Pulmonary,33,1681,2,8
tara_Cardiovascular _ Pulmonary_0007_chunk6of8.wav,tara,"The patient tolerated the procedure well and had no episodes of desaturation, apnea, or cardiac arrhythmia. A postoperative chest x-ray was obtained.cardiovascular / pulmonary, abdominal trauma, bal lavage, lukens trap suction, splenectomy, splenic laceration, bronchoalveolar lavage, fever, catheter, bronchoalveolar, lavage, airwayNOTE,: Thesetranscribed medical transcription sample reports and examples are provided by various users andare for reference purpose only.",Cardiovascular / Pulmonary,33,3060,6,8
tara_Cardiovascular _ Pulmonary_0009_chunk17of26.wav,tara,",He had a resting electrocardiogram on December 20, 2002, which was also normal. He had a treadmill Cardiolite, which was performed only to stage 2 and was terminated by the supervising physician when the patient achieved 90% of the predicted maximum heart rate.",Cardiovascular / Pulmonary,33,1660,17,26
tara_Cardiovascular _ Pulmonary_0009_chunk25of26.wav,tara,"If indeed, he is considered to be a diabetic, a much more aggressive program should be entertained for reducing the risks of atherosclerosis in general, and coronary artery disease in particular.I do not find an indication at this point in time to proceed with any further testing, such as coronary angiography, in the absence of symptoms. If you have any further questions, please do not hesitate to let me know.",Cardiovascular / Pulmonary,33,2143,25,26
tara_SOAP _ Chart _ Progress Notes_0010_chunk6of24.wav,tara,"No more than 1 to 2 of 10 in intensity. , Karnofsky score 100.",SOAP / Chart / Progress Notes,34,659,6,24
tara_Gastroenterology_0011_chunk2of22.wav,tara,"2. Intractable nausea, vomiting, and dysphagia.1.",Gastroenterology,23,449,2,22
tara_Gastroenterology_0011_chunk4of22.wav,tara,"Intractable nausea, vomiting, and dysphagia. 3.",Gastroenterology,23,589,4,22
tara_Gastroenterology_0011_chunk8of22.wav,tara,She has been hospitalized multiple times for intractable nausea and vomiting and dehydration. She states that her decreased p.o.,Gastroenterology,23,624,8,22
tara_Gastroenterology_0011_chunk10of22.wav,tara,Lang and was evaluated by Dr. Wickless as well all of whom agreed that the best option for supplemental nutrition for this patient was placement of a PEG tube.,Gastroenterology,23,904,10,22
tara_Gastroenterology_0011_chunk11of22.wav,tara,", After risks, complications, and benefits were explained to the patient and informed consent was obtained, the patient was taken to the operating room. She was placed in the supine position.",Gastroenterology,23,1030,11,22
tara_Gastroenterology_0013_chunk26of32.wav,tara,"Normal male. Deferred, but there was no perianal lesion.",Gastroenterology,23,631,26,32
tara_Gastroenterology_0013_chunk28of32.wav,tara,"No cyanosis. Alert, active and playful.",Gastroenterology,23,456,28,32
tara_Gastroenterology_0013_chunk32of32.wav,tara,"diff toxin, culture, blood for RAST test for cow milk, soy, wheat and egg. Monitor hemoglobin.nan",Gastroenterology,23,904,32,32
tara_Radiology_0014_chunk8of9.wav,tara,Arterial waveform is triphasic throughout except in posterior tibial artery where it is biphasic. 4.,Radiology,15,729,8,9
tara_Cardiovascular _ Pulmonary_0020_chunk5of34.wav,tara,", Selective coronary angiography, coronary angioplasty. After informed consent was obtained, the patient was taken to the cath lab, placed on the table in the supine position.",Cardiovascular / Pulmonary,33,1128,5,34
tara_Cardiovascular _ Pulmonary_0020_chunk10of34.wav,tara,"The patient was given a bolus of heparin and an ACT of approximately 50 seconds was obtained, we rebolused and the ACT was slightly lower. We repeated the level and it was slightly higher.",Cardiovascular / Pulmonary,33,1086,10,34
tara_Cardiovascular _ Pulmonary_0020_chunk22of34.wav,tara,", Isovue-370, 120 mL. , 9.",Cardiovascular / Pulmonary,33,456,22,34
tara_Cardiovascular _ Pulmonary_0020_chunk23of34.wav,tara,"4 minutes. , 30 mL.",Cardiovascular / Pulmonary,33,295,23,34
tara_Cardiovascular _ Pulmonary_0021_chunk3of21.wav,tara,", The patient was admitted for an acute onset of congestion. She was checked for RSV, which was positive and admitted to the hospital for acute bronchiolitis.",Cardiovascular / Pulmonary,33,764,3,21
tara_Cardiovascular _ Pulmonary_0021_chunk17of21.wav,tara,"346 kg, which is up 6 grams from admission. , No one should smoke near The patient.",Cardiovascular / Pulmonary,33,736,17,21
tara_Gastroenterology_0022_chunk3of13.wav,tara,"Distal esophageal reflux-induced stricture, dilated to 18 mm. 3.",Gastroenterology,23,561,3,13
tara_Cardiovascular _ Pulmonary_0023_chunk6of41.wav,tara,"However, she states that for the last several years may be up to 7 years that she can recollect that she has been fatigued, and over the past couple of years, her symptoms have become more severe. She said she can walk no more than 25 feet without becoming tired.",Cardiovascular / Pulmonary,33,1275,6,41
tara_Cardiovascular _ Pulmonary_0023_chunk8of41.wav,tara,"She actually today has no complaints, and states that she has been compliant with her medications and has started taking her Coumadin as directed.1. Hypertension.",Cardiovascular / Pulmonary,33,10000,8,41
tara_Cardiovascular _ Pulmonary_0023_chunk13of41.wav,tara,6. CVA in 2002 and in 2003 with right eye blindness.1.,Cardiovascular / Pulmonary,33,568,13,41
tara_Cardiovascular _ Pulmonary_0023_chunk21of41.wav,tara,4. Hydrochlorothiazide 25 mg a day.,Cardiovascular / Pulmonary,33,421,21,41
tara_Cardiovascular _ Pulmonary_0023_chunk26of41.wav,tara,No JVD. No carotid bruits.,Cardiovascular / Pulmonary,33,316,26,41
tara_Cardiovascular _ Pulmonary_0023_chunk28of41.wav,tara,"No murmurs, gallops or rubs. Clear to auscultation bilaterally.",Cardiovascular / Pulmonary,33,477,28,41
tara_Cardiovascular _ Pulmonary_0023_chunk36of41.wav,tara,"5. Given the patient's history of a stroke in her age and recurrent atrial fibrillation, the patient should be continued on Coumadin indefinitely.",Cardiovascular / Pulmonary,33,799,36,41
tara_Cardiovascular _ Pulmonary_0023_chunk37of41.wav,tara,"6. Depending upon the results of her transthoracic echocardiogram, the patient may benefit from repeat heart catheterization.",Cardiovascular / Pulmonary,33,673,37,41
tara_Radiology_0024_chunk1of7.wav,tara,", Nuclear medicine tumor localization, whole body. , Status post subtotal thyroidectomy for thyroid carcinoma, histology not provided.",Radiology,15,967,1,7
tara_Gastroenterology_0025_chunk2of14.wav,tara,She has been sedated with Ativan and came into the emergency room obtunded and unable to give any history. On a chest x-ray for what appeared to be shortness of breath she was found to have what was thought to be free air under the right diaphragm.,Gastroenterology,23,1191,2,14
tara_Gastroenterology_0025_chunk11of14.wav,tara,"Alkaline phosphatase of 96, bilirubin 0. 8.",Gastroenterology,23,540,11,14
tara_SOAP _ Chart _ Progress Notes_0026_chunk4of26.wav,tara,She has lost over 30 pounds after exercising doing water aerobics at Genesis in Wichita. She has noticed her fasting blood sugars have been ranging from 100 to 120.,SOAP / Chart / Progress Notes,34,848,4,26
tara_SOAP _ Chart _ Progress Notes_0026_chunk21of26.wav,tara,Did discuss with her that we need to stick to the diet especially after going off of Lipitor. We will see how she does with her bone pain/leg pain off of Lipitor.,SOAP / Chart / Progress Notes,34,883,21,26
tara_SOAP _ Chart _ Progress Notes_0026_chunk22of26.wav,tara,If she has improvement may consider Crestor in one month. I am going to check her lipid panel and a CMP.,SOAP / Chart / Progress Notes,34,659,22,26
tara_Cardiovascular _ Pulmonary_0027_chunk11of24.wav,tara,11. Hyperlipidemia.,Cardiovascular / Pulmonary,33,351,11,24
tara_Cardiovascular _ Pulmonary_0027_chunk21of24.wav,tara,Pantoprazole - 40 mg once daily. 6.,Cardiovascular / Pulmonary,33,456,21,24
tara_Radiology_0028_chunk11of36.wav,tara,"Mother died of MI, age73. Brother died of Brain tumor, age 9.",Radiology,15,687,11,36
tara_Radiology_0028_chunk12of36.wav,tara,",Retired employee of Champion Automotive Co. Denies use of TOB/ETOH/Illicit drugs.",Radiology,15,764,12,36
tara_Gastroenterology_0029_chunk11of13.wav,tara,Abdomen is otherwise soft. Positive bowel sounds.,Gastroenterology,23,414,11,13
tara_SOAP _ Chart _ Progress Notes_0031_chunk20of26.wav,tara,"After she left, I got to thinking about it and looked into her record. She has been in here multiple times for pain medicine.",SOAP / Chart / Progress Notes,34,806,20,26
tara_Gastroenterology_0032_chunk7of17.wav,tara,"Bilateral groin incisions were made, and the common femoral arteries were dissected out bilaterally. The patient was then heparinized.",Gastroenterology,23,806,7,17
tara_Gastroenterology_0032_chunk15of17.wav,tara,Both surgical sites were then irrigated thoroughly. Meticulous hemostasis was achieved.,Gastroenterology,23,568,15,17
tara_Gastroenterology_0032_chunk16of17.wav,tara,Both wounds were then closed in a routine layered fashion. Sterile antibiotic dressings were applied.,Gastroenterology,23,645,16,17
tara_Cardiovascular _ Pulmonary_0033_chunk6of14.wav,tara,A small left pleural effusion is noted. Right lower lobe atelectasis is present.,Cardiovascular / Pulmonary,33,512,6,14
tara_Cardiovascular _ Pulmonary_0034_chunk5of12.wav,tara,",Sodium 139, potassium 4. 5, BUN 42, and creatinine 1.",Cardiovascular / Pulmonary,33,743,5,12
tara_Cardiovascular _ Pulmonary_0034_chunk7of12.wav,tara,7 and hematocrit 31. 7.,Cardiovascular / Pulmonary,33,428,7,12
tara_Cardiovascular _ Pulmonary_0037_chunk1of12.wav,tara,", Smoking history zero. , Dyspnea with walking less than 100 yards.",Cardiovascular / Pulmonary,33,428,1,12
tara_Cardiovascular _ Pulmonary_0037_chunk9of12.wav,tara,Moderate restrictive lung disease. 2.,Cardiovascular / Pulmonary,33,295,9,12
tara_SOAP _ Chart _ Progress Notes_0039_chunk15of15.wav,tara,"basis and send Dr. XYZ a letter on this office visit.soap / chart / progress notes, cetaphil cleansing lotion, hand dermatitis, aristocort, wash, ointment, hand, lotion, dermatitis",SOAP / Chart / Progress Notes,34,1975,15,15
tara_Gastroenterology_0040_chunk19of24.wav,tara,"There was no evidence of bleeding from any of the suture sites. Next, a side-by-side anastomosis was performed between the transverse colon and the terminal ileum.",Gastroenterology,23,932,19,24
tara_Gastroenterology_0040_chunk21of24.wav,tara,"The anastomosis was then protected with a 2-0 Vicryl 0-muscular suture. Next, the mesenteric root was closed with a running 0-Vicryl suture to prevent any chance of internal hernia.",Gastroenterology,23,1100,21,24
tara_Cardiovascular _ Pulmonary_0042_chunk1of12.wav,tara,", Metastatic glossal carcinoma, needing chemotherapy and a port. , Metastatic glossal carcinoma, needing chemotherapy and a port.PROCEDURES,1.",Cardiovascular / Pulmonary,33,1121,1,12
tara_Cardiovascular _ Pulmonary_0042_chunk2of12.wav,tara,Open exploration of the left subclavian/axillary vein. 2.,Cardiovascular / Pulmonary,33,519,2,12
tara_Cardiovascular _ Pulmonary_0042_chunk3of12.wav,tara,"Insertion of a double lumen port through the left femoral vein, radiological guidance. , After obtaining the informed consent, the patient was electively taken to the operating room, where he underwent a general anesthetic through his tracheostomy.",Cardiovascular / Pulmonary,33,1261,3,12
tara_Cardiovascular _ Pulmonary_0042_chunk4of12.wav,tara,The left deltopectoral and cervical areas were prepped and draped in the usual fashion. Local anesthetic was infiltrated in the area.,Cardiovascular / Pulmonary,33,764,4,12
tara_Cardiovascular _ Pulmonary_0042_chunk6of12.wav,tara,"I tried to cannulate it, but I could not advance the wire. At that moment, I decided that there was no way we are going to put a port though that area.",Cardiovascular / Pulmonary,33,904,6,12
tara_Cardiovascular _ Pulmonary_0042_chunk7of12.wav,tara,I packed the incision and we prepped and redraped the patient including both groins. Local anesthetic was infiltrated and then the left femoral vein was percutaneously cannulated without any difficulty.,Cardiovascular / Pulmonary,33,1107,7,12
tara_Cardiovascular _ Pulmonary_0042_chunk9of12.wav,tara,"Again, I was able to position the catheter in the junction of inferior vena cava and right atrium. The catheter was looked upwards and the double lumen port was inserted subcutaneously towards the iliac area.",Cardiovascular / Pulmonary,33,1135,9,12
tara_Cardiovascular _ Pulmonary_0042_chunk10of12.wav,tara,The port had been aspirated satisfactorily and irrigated with heparin solution. The drain incision was closed in layers including subcuticular suture with Monocryl.,Cardiovascular / Pulmonary,33,918,10,12
tara_Cardiovascular _ Pulmonary_0042_chunk12of12.wav,tara,"The patient tolerated the procedure well and was sent back to recovery room in satisfactory condition.cardiovascular / pulmonary, axillary, vein, subclavian, double lumen port, femoral vein, radiological guidance, glossal carcinoma, port, inserstion, femoral, radiological, metastatic, carcinoma, chemotherapy, anesthetic, catheter,",Cardiovascular / Pulmonary,33,3123,12,12
tara_Gastroenterology_0044_chunk3of15.wav,tara,"However, there is very mild left renal pelvis and proximal ureteral dilatation with a small amount of left perinephric stranding asymmetric to the right. The right renal pelvis is not dilated.",Gastroenterology,23,1128,3,15
tara_Gastroenterology_0044_chunk10of15.wav,tara,There is no abdominal free fluid or pathologic adenopathy. There are degenerative changes of the lumbar spine.1.,Gastroenterology,23,778,10,15
tara_Gastroenterology_0044_chunk13of15.wav,tara,Diverticulosis. 3.,Gastroenterology,23,288,13,15
tara_Gastroenterology_0044_chunk14of15.wav,tara,Moderate amount of stool throughout the colon. 4.,Gastroenterology,23,337,14,15
tara_Cardiovascular _ Pulmonary_0046_chunk1of42.wav,tara,"OPERATION,1. Ivor-Lewis esophagogastrectomy.",Cardiovascular / Pulmonary,33,568,1,42
tara_Cardiovascular _ Pulmonary_0046_chunk5of42.wav,tara,",General endotracheal anesthesia with a dual-lumen tube. , After obtaining informed consent from the patient, including a thorough explanation of the risks and benefits of the aforementioned procedure, the patient was taken to the operating room and general endotracheal anesthesia was administered.",Cardiovascular / Pulmonary,33,1541,5,42
tara_Cardiovascular _ Pulmonary_0046_chunk28of42.wav,tara,"We dissected the esophagus to just above the azygos vein. The azygos vein, in fact, was taken with 0 silk ligatures and reinforced with 2-0 stick ties.",Cardiovascular / Pulmonary,33,1072,28,42
tara_Cardiovascular _ Pulmonary_0048_chunk16of60.wav,tara,The balloon catheter was then removed in its entirety. Echocardiogram again demonstrated no change in the appearance of the tricuspid valve.,Cardiovascular / Pulmonary,33,757,16,60
tara_Cardiovascular _ Pulmonary_0048_chunk24of60.wav,tara,"Angiograms with injection in the right coronary artery, left coronary artery, superior vena cava, inferior vena cava, and right ventricle. After angiography, two normal-appearing renal collecting systems were visualized.",Cardiovascular / Pulmonary,33,1450,24,60
tara_Cardiovascular _ Pulmonary_0048_chunk43of60.wav,tara,",1. Pulmonary atresia.",Cardiovascular / Pulmonary,33,295,43,60
tara_Cardiovascular _ Pulmonary_0048_chunk56of60.wav,tara,4. Patent Fontan fenestration.,Cardiovascular / Pulmonary,33,379,56,60
tara_Cardiovascular _ Pulmonary_0049_chunk3of10.wav,tara,3. Severe heterogeneous plaque seen in external carotid artery with degree of stenosis around 70%.,Cardiovascular / Pulmonary,33,680,3,10
tara_Cardiovascular _ Pulmonary_0049_chunk7of10.wav,tara,2. Moderate heterogeneous plaque seen in the bulb and internal carotid artery with degree of stenosis less than 50%.,Cardiovascular / Pulmonary,33,806,7,10
tara_SOAP _ Chart _ Progress Notes_0051_chunk1of13.wav,tara,", Postoperative visit for craniopharyngioma. Briefly, a 16-year-old right-handed boy who is in eleventh grade, who presents with some blurred vision and visual acuity difficulties, was found to have a suprasellar tumor.",SOAP / Chart / Progress Notes,34,1198,1,13
tara_SOAP _ Chart _ Progress Notes_0051_chunk9of13.wav,tara,There is no evidence of erythema or collection. The lumbar drain was also well healed.,SOAP / Chart / Progress Notes,34,603,9,13
tara_SOAP _ Chart _ Progress Notes_0051_chunk12of13.wav,tara,"I discussed the options with our radiation oncologist, Dr. X.",SOAP / Chart / Progress Notes,34,400,12,13
tara_Gastroenterology_0052_chunk2of14.wav,tara,The patient had a history of hypertension and TIA/stroke. The patient denied history of heartburn and/or gastroesophageal reflux disorder.,Gastroenterology,23,995,2,14
tara_Gastroenterology_0052_chunk12of14.wav,tara,The patient to take small bite and small sips to help decrease the risk of aspiration and penetration. 2.,Gastroenterology,23,652,12,14
tara_Cardiovascular _ Pulmonary_0053_chunk3of10.wav,tara,"Through this, a moveable guidewire was then advance to the level of the diaphragm, and through it, a 6 French pigtail catheter was advanced under hemodynamic monitoring to the ascending aorta and inserted into the left ventricle. Pressure measurements were obtained and cineangiograms in the RAO and LAO positions were then obtained.",Cardiovascular / Pulmonary,33,1709,3,10
tara_Cardiovascular _ Pulmonary_0053_chunk9of10.wav,tara,", Reglan 10 mg p.o. 5 mg p.o.",Cardiovascular / Pulmonary,33,512,9,10
tara_Gastroenterology_0054_chunk10of18.wav,tara,The clips were carefully placed to avoid occluding the juncture with the common bile duct. The cystic artery was found medially and slightly posterior to the cystic duct.,Gastroenterology,23,869,10,18
tara_Gastroenterology_0054_chunk17of18.wav,tara,Dressings were applied. All surgical counts were reported as correct.,Gastroenterology,23,456,17,18
tara_Cardiovascular _ Pulmonary_0055_chunk2of37.wav,tara,2. Hypotension resolved.,Cardiovascular / Pulmonary,33,274,2,37
tara_Cardiovascular _ Pulmonary_0055_chunk4of37.wav,tara,4. Anasarca improving.,Cardiovascular / Pulmonary,33,351,4,37
tara_Cardiovascular _ Pulmonary_0055_chunk14of37.wav,tara,"The patient has been diuresed aggressively over the last 4 to 5 days, and this seems to have made some improvement in his swelling. This morning, the patient denies any acute distress.",Cardiovascular / Pulmonary,33,981,14,37
tara_Cardiovascular _ Pulmonary_0055_chunk15of37.wav,tara,"He states he is feeling good and understands that he is being discharged to another facility for continued care and rehabilitation. He will be discharged to Garden Court skilled nursing facility.DISCHARGE MEDICATIONS/, He is going to be going with Protonix 40 mg daily, metoclopramide 10 mg every 6 hours, Zyvox 600 mg daily for 5 days, Diflucan 150 mg p.o.",Cardiovascular / Pulmonary,33,2157,15,37
tara_Cardiovascular _ Pulmonary_0055_chunk17of37.wav,tara,b.i.d. Ensure 1 can t.i.d.,Cardiovascular / Pulmonary,33,631,17,37
tara_Cardiovascular _ Pulmonary_0055_chunk26of37.wav,tara,The swelling in this area also appears improved. Show no clubbing or cyanosis.,Cardiovascular / Pulmonary,33,596,26,37
tara_Cardiovascular _ Pulmonary_0055_chunk34of37.wav,tara,"8, phosphorus is a little high at 5. 5, magnesium 2.",Cardiovascular / Pulmonary,33,673,34,37
tara_Gastroenterology_0056_chunk6of26.wav,tara,"Bowel sounds are positive, soft, and nontender. No edema.",Gastroenterology,23,561,6,26
tara_Gastroenterology_0056_chunk12of26.wav,tara,8 from 1. 89 from 2.,Gastroenterology,23,344,12,26
tara_Gastroenterology_0058_chunk7of10.wav,tara,"Five-mm ports placed in left lower and hypogastric areas. On visualization of the right lower quadrant, appendix was visualized stuck against the right anterior abdominal wall, there is obvious site of perforation and leakage of content and pus.",Gastroenterology,23,1275,7,10
tara_Cardiovascular _ Pulmonary_0060_chunk1of12.wav,tara,",Resting Myoview and adenosine Myoview SPECT. Chest pain.",Cardiovascular / Pulmonary,33,463,1,12
tara_Cardiovascular _ Pulmonary_0060_chunk2of12.wav,tara,13. 3 mCi of Tc-99m tetrofosmin was injected and resting Myoview SPECT was obtained.,Cardiovascular / Pulmonary,33,729,2,12
tara_Gastroenterology_0061_chunk1of6.wav,tara,", Following premedication with Vistaril 50 mg and Atropine 0. 4 mg IM, the patient received Versed 5.",Gastroenterology,23,813,1,6
tara_Cardiovascular _ Pulmonary_0063_chunk2of19.wav,tara,"She is now being seen for her first post-CyberKnife treatment visit. Since undergoing CyberKnife treatment, she has had low-level nausea without vomiting.",Cardiovascular / Pulmonary,33,771,2,19
tara_Cardiovascular _ Pulmonary_0063_chunk16of19.wav,tara,Normocephalic. Pupils are equal and reactive to light and accommodation.,Cardiovascular / Pulmonary,33,484,16,19
tara_Cardiovascular _ Pulmonary_0064_chunk5of7.wav,tara,"From then on, I proceeded manually to withdraw 2000 mL of a light milky fluid. The patient tolerated the procedure fairly well, but almost at the end of it she said that she was feeling like fainting and therefore we carefully withdrew the needle.",Cardiovascular / Pulmonary,33,1394,5,7
tara_Cardiovascular _ Pulmonary_0065_chunk1of30.wav,tara,"DIAGNOSES ON ADMISSION,1. Cerebrovascular accident (CVA) with right arm weakness.",Cardiovascular / Pulmonary,33,708,1,30
tara_Cardiovascular _ Pulmonary_0065_chunk5of30.wav,tara,"5. Thrombocytopenia.DIAGNOSES ON DISCHARGE,1.",Cardiovascular / Pulmonary,33,568,5,30
tara_Cardiovascular _ Pulmonary_0065_chunk17of30.wav,tara,He had no further progressions. His cough improved with oral Zithromax and nebulizer treatments.,Cardiovascular / Pulmonary,33,519,17,30
tara_Cardiovascular _ Pulmonary_0065_chunk18of30.wav,tara,"His platelets also improved as well. By discharge, his platelets was up to 107,000.",Cardiovascular / Pulmonary,33,603,18,30
tara_Cardiovascular _ Pulmonary_0065_chunk24of30.wav,tara,"7. At the time of discharge, the patient's cough was much improved.",Cardiovascular / Pulmonary,33,498,24,30
tara_Cardiovascular _ Pulmonary_0066_chunk1of5.wav,tara,", Endotracheal intubation. ,The patient was intubated secondary to respiratory distress and increased work of breathing and falling saturation on 15 liters nonrebreather.",Cardiovascular / Pulmonary,33,960,1,5
tara_Cardiovascular _ Pulmonary_0066_chunk4of5.wav,tara,"Fiberoptically, a bronchoscope was passed for lavage and the tube was found to be in good position 3 cm above the main carina where it was kept there and the right lower lobe was lavaged with trap A lavage with 100 mL of normal sterile saline for cytology, AFB, and fungal smear and culture. A separate trap B was then lavaged for bacterial C&S and Gram stain and was sent for those purposes.",Cardiovascular / Pulmonary,33,2255,4,5
tara_SOAP _ Chart _ Progress Notes_0067_chunk2of14.wav,tara,Physical therapy is helping. The subjective pain is on the bilateral knees right worse than left.,SOAP / Chart / Progress Notes,34,659,2,14
tara_SOAP _ Chart _ Progress Notes_0067_chunk7of14.wav,tara,",Back pain: None. ,Radicular type pain: None.",SOAP / Chart / Progress Notes,34,512,7,14
tara_SOAP _ Chart _ Progress Notes_0067_chunk10of14.wav,tara,", 10 bilaterally. , 8,A-1 , 0,See the enclosed WOMAC osteoarthritis index, which accompanies the patient's chart, for complete details of the patient's limitations to activities of daily living.",SOAP / Chart / Progress Notes,34,1268,10,14
tara_SOAP _ Chart _ Progress Notes_0067_chunk14of14.wav,tara,No chest pain on exertion.GI:nan,SOAP / Chart / Progress Notes,34,442,14,14
tara_Gastroenterology_0068_chunk11of18.wav,tara,"The gallbladder was punctured with the aspirating needle, and under C-arm fluoroscopy was filled with contrast, filling the intra- and extrahepatic biliary trees, which appeared normal. Extra contrast was aspirated and the aspirating needle was removed.",Gastroenterology,23,1723,11,18
tara_Cardiovascular _ Pulmonary_0069_chunk4of11.wav,tara,", Same day rest/stress protocol was utilized with 12 mCi for the rest dose and 33 mCi for the stress test. 53 mg of Persantine were used, reversed with 125 mg of aminophylline.1.",Cardiovascular / Pulmonary,33,1198,4,11
tara_Cardiovascular _ Pulmonary_0070_chunk12of19.wav,tara,The ramus intermedius is a small vessel with minor irregularities. 6.,Cardiovascular / Pulmonary,33,533,12,19
tara_SOAP _ Chart _ Progress Notes_0071_chunk2of23.wav,tara,She has had no headache. She is breastfeeding and feels like her milk is adequate.,SOAP / Chart / Progress Notes,34,414,2,23
tara_SOAP _ Chart _ Progress Notes_0071_chunk6of23.wav,tara,Prenatal vitamins. She thinks to Benadryl.,SOAP / Chart / Progress Notes,34,323,6,23
tara_SOAP _ Chart _ Progress Notes_0071_chunk7of23.wav,tara,", Mother is 50 and healthy. Dad is 40 and healthy.",SOAP / Chart / Progress Notes,34,617,7,23
tara_SOAP _ Chart _ Progress Notes_0071_chunk9of23.wav,tara,Weight: 124 pounds. Blood pressure 96/54.,SOAP / Chart / Progress Notes,34,582,9,23
tara_SOAP _ Chart _ Progress Notes_0071_chunk15of23.wav,tara,Ears: TMs intact. Mouth: No lesion.,SOAP / Chart / Progress Notes,34,414,15,23
tara_SOAP _ Chart _ Progress Notes_0071_chunk18of23.wav,tara,Pelvic: Uterus is involuting. Rectal: She has one external hemorrhoid which has inflamed.,SOAP / Chart / Progress Notes,34,694,18,23
tara_SOAP _ Chart _ Progress Notes_0071_chunk20of23.wav,tara,She was cautioned about the possibility that this may alter her milk supply. She is to drink extra fluids and call if she has problems with that.,SOAP / Chart / Progress Notes,34,666,20,23
tara_SOAP _ Chart _ Progress Notes_0071_chunk21of23.wav,tara,"We will try ProctoFoam HC. For the hemorrhoids, also increase the fiber in her diet.",SOAP / Chart / Progress Notes,34,617,21,23
tara_SOAP _ Chart _ Progress Notes_0072_chunk1of15.wav,tara,", The patient is a 67-year-old white female with a history of uterine papillary serous carcinoma who is status post 6 cycles of carboplatin and Taxol, is here today for followup. Her last cycle of chemotherapy was finished on 01/18/08, and she complains about some numbness in her right upper extremity.",SOAP / Chart / Progress Notes,34,1541,1,15
tara_SOAP _ Chart _ Progress Notes_0072_chunk12of15.wav,tara,She is doing well with no evidence of disease clinically or radiologically.1. Plan to follow her every 3 months and CT scans every 6 months for the first 2 years.,SOAP / Chart / Progress Notes,34,827,12,15
tara_Cardiovascular _ Pulmonary_0073_chunk3of21.wav,tara,A thoracoabdominal incision was made. The 8th interspace was entered.,Cardiovascular / Pulmonary,33,589,3,21
tara_Cardiovascular _ Pulmonary_0073_chunk7of21.wav,tara,"The patient was heparinized. Through a stab wound in the center of this, a right-angle venous cannula was then placed at the left atrium and secured to a Rumel tourniquet.",Cardiovascular / Pulmonary,33,855,7,21
tara_Cardiovascular _ Pulmonary_0073_chunk12of21.wav,tara,"The aorta was opened longitudinally, going posterior between the left and right renal arteries, and it was completely transected at its bifurcation. The SMA, celiac and right renal artery were then dissected free as a complete island, and the left renal was dissected free as a complete Carrell patch.",Cardiovascular / Pulmonary,33,1513,12,21
tara_Cardiovascular _ Pulmonary_0074_chunk6of14.wav,tara,"Right brachiocephalic angiography, right subclavian angiography, selective catheterization of the right subclavian, selective aortic arch angiogram, right iliofemoral angiogram, 6 French Angio-Seal placement. The patient was brought to the cardiac catheterization lab in the usual fasting state.",Cardiovascular / Pulmonary,33,1639,6,14
tara_Cardiovascular _ Pulmonary_0074_chunk9of14.wav,tara,"Aortic arch angiogram was then performed with injection of 45 ml of contrast, rate of 20 ml per second, maximum pressure 750 PSI in the 4 degree LAO view. Next, the right subclavian was selectively cannulated.",Cardiovascular / Pulmonary,33,1387,9,14
tara_Gastroenterology_0075_chunk1of11.wav,tara,", History of polyps.1. Normal colonoscopy, left colonic diverticular disease.",Gastroenterology,23,673,1,11
tara_Gastroenterology_0075_chunk2of11.wav,tara,2. 3+ benign prostatic hypertrophy.,Gastroenterology,23,407,2,11
tara_SOAP _ Chart _ Progress Notes_0076_chunk12of28.wav,tara,Lungs: Clear. Abdomen: Mildly tender throughout the epigastrium.,SOAP / Chart / Progress Notes,34,596,12,28
tara_SOAP _ Chart _ Progress Notes_0076_chunk27of28.wav,tara,4. Refer over to Scotland Orthopedics.,SOAP / Chart / Progress Notes,34,309,27,28
tara_Gastroenterology_0077_chunk2of6.wav,tara,Ultrasound demonstrates free fluid in the abdomen. The area of interest was localized with ultrasonography.,Gastroenterology,23,638,2,6
tara_Gastroenterology_0078_chunk15of34.wav,tara,"Clear to auscultation, with no retractions. Regular rhythm without murmur.",Gastroenterology,23,540,15,34
tara_Gastroenterology_0078_chunk26of34.wav,tara,Dental cavities. 4.,Gastroenterology,23,274,26,34
tara_Gastroenterology_0078_chunk28of34.wav,tara,"History of urinary tract infections. , Our plan would be to continue with the medications as follows:,1.",Gastroenterology,23,764,28,34
tara_Gastroenterology_0078_chunk29of34.wav,tara,Prograf 0. 5 mg p.o.,Gastroenterology,23,400,29,34
tara_Gastroenterology_0078_chunk32of34.wav,tara,3. Labs every 2 to 3 months.,Gastroenterology,23,337,32,34
tara_Gastroenterology_0078_chunk34of34.wav,tara,5. To refer this patient to a pediatric dentist for assessment of the dental cavities.nan,Gastroenterology,23,610,34,34
tara_Radiology_0079_chunk3of30.wav,tara,"He was given some NSAID and drove home. By the time he got home he had great difficulty walking due to LBP and weakness in BLE, but managed to feed his pets and himself.",Radiology,15,1023,3,30
tara_Radiology_0079_chunk15of30.wav,tara,No rigidity and essential normal muscle tone on passive motion. Decreased vibratory sense in stocking distribution from toes to knees in BLE (worse on right).,Radiology,15,995,15,30
tara_Radiology_0081_chunk1of5.wav,tara,", MRI of lumbar spine without contrast. A 24-year-old female with chronic back pain.",Radiology,15,638,1,5
tara_Radiology_0082_chunk18of25.wav,tara,"During the exam the patient experienced a spell during which his head turned and eyes deviated to the leftward, and his right hand twitched. The entire spell lasted one minute.",Radiology,15,1051,18,25
tara_Cardiovascular _ Pulmonary_0083_chunk4of28.wav,tara,4. History of hypertension.,Cardiovascular / Pulmonary,33,260,4,28
tara_Cardiovascular _ Pulmonary_0083_chunk11of28.wav,tara,"Lower extremity Duplex ultrasound. , Please refer to my H&P for full details.",Cardiovascular / Pulmonary,33,554,11,28
tara_Cardiovascular _ Pulmonary_0083_chunk18of28.wav,tara,"I was going to call Neurology at XYZ for evaluation. However, secondary to his indication for transfer, this could be followed up at ABCD with Dr.",Cardiovascular / Pulmonary,33,960,18,28
tara_Cardiovascular _ Pulmonary_0083_chunk21of28.wav,tara,Aspirin 325 mg p.o. daily.,Cardiovascular / Pulmonary,33,393,21,28
tara_Radiology_0084_chunk3of14.wav,tara,There is an infiltrative mass like lesion extending into the pre-epiglottic space. There is no demonstrated effacement of the piriform sinuses.,Radiology,15,862,3,14
tara_Radiology_0084_chunk4of14.wav,tara,The mass obliterates the right vallecula. The paraglottic spaces are normal.,Radiology,15,449,4,14
tara_Radiology_0084_chunk9of14.wav,tara,"There is an enlarged second right high deep cervical node measuring 12 x 10 x 10 mm but no demonstrated central necrosis. There is an enlarged left mid level deep cervical node measuring 9 x 16 x 6 mm, located inferior to the hyoid bone but cephalad to the cricoid consistent with a Level III node.",Radiology,15,1786,9,14
tara_Cardiovascular _ Pulmonary_0085_chunk1of17.wav,tara,", Respiratory failure. ,Respiratory failure.",Cardiovascular / Pulmonary,33,323,1,17
tara_Cardiovascular _ Pulmonary_0085_chunk9of17.wav,tara,Blunt dissection was used to expose adequate cartilaginous rings. A 4.,Cardiovascular / Pulmonary,33,561,9,17
tara_Radiology_0087_chunk7of11.wav,tara,", Resting and stress images were obtained with 10. 8, 30.",Radiology,15,414,7,11
tara_Radiology_0087_chunk9of11.wav,tara,Gated and SPECT revealed normal wall motion and ejection fraction of 75%. End-diastolic volume was 57 and end-systolic volume of 12.1.,Radiology,15,981,9,11
tara_Radiology_0088_chunk3of35.wav,tara,"MRI scan of the brain (done locally) on 6/23/95 revealed increased periventricular white matter signal on T2 images, particularly in the left temporo-occipital and right parietal lobes. There was ring enhancement of a lesion in the left occipital lobe on T1 gadolinium contrast enhanced images.",Radiology,15,1933,3,35
tara_Radiology_0088_chunk21of35.wav,tara,Lower extremities: 4/4 proximally and 5/5 @ and below knees. unremarkable.,Radiology,15,10000,21,35
tara_Radiology_0088_chunk33of35.wav,tara,She was tapered off all immunosuppressive medications and her polymyositis remained clinically stable. She had a seizure in 12/95 and was placed on Dilantin.,Radiology,15,813,33,35
tara_Gastroenterology_0089_chunk19of27.wav,tara,Regular rate and rhythm. Clear to auscultation bilaterally.,Gastroenterology,23,505,19,27
tara_Gastroenterology_0089_chunk25of27.wav,tara,I have also set him up for a barium enema to study the rectal stump. He will return to us in two weeks at which time we will review his radiological studies and his medical records from the outside hospital and determine the best course of action from that point.,Gastroenterology,23,1107,25,27
tara_SOAP _ Chart _ Progress Notes_0090_chunk8of17.wav,tara,Oropharynx is pink and moist. No erythema or exudates.,SOAP / Chart / Progress Notes,34,498,8,17
tara_Gastroenterology_0093_chunk3of13.wav,tara,", The patient is a 17-month-old baby girl with biliary atresia, who had a delayed diagnosis and a late attempted Kasai portoenterostomy, which failed. The patient has progressive cholestatic jaundice and is on the liver transplant list at ABCD.",Gastroenterology,23,1219,3,13
tara_Gastroenterology_0093_chunk10of13.wav,tara,"After her endotracheal tube was placed and securely taped to the left side of her mouth, I positioned the patient with a prominent shoulder roll and neck hyperextension and then used the laryngoscope to elevate the tiny glottic mechanism. A rigid esophagoscope was then inserted into the proximal esophagus, and the scope was gradually advanced with the lumen directly in frontal view.",Gastroenterology,23,1814,10,13
tara_Gastroenterology_0093_chunk13of13.wav,tara,"There were no intraoperative complications. There was only one single coin noted, and she was awakened and taken to the recovery room in good condition.gastroenterology, portoenterostomy, foreign body removal, proximal esophagus, coin, esophagoscopy, esophageal, esophagus,",Gastroenterology,23,1947,13,13
tara_Cardiovascular _ Pulmonary_0094_chunk13of19.wav,tara,X was able to _____ the inferior portions of the mass. This left the external surface of the mass much more malleable and easier to retract.,Cardiovascular / Pulmonary,33,10000,13,19
tara_Cardiovascular _ Pulmonary_0094_chunk19of19.wav,tara,"The patient was then rolled in the supine position where she was awakened from general endotracheal anesthesia and taken to the recovery room in stable condition.cardiovascular / pulmonary, posterior mediastinal mass, neural foraminal, nerve sheath tumor, frozen section, thoracotomy, mediastinal mass, foraminal, neural, sheath, mediastinal,",Cardiovascular / Pulmonary,33,1947,19,19
tara_Radiology_0095_chunk9of15.wav,tara,"05) 1. 00, 37weeks 4days.",Radiology,15,547,9,15
tara_Radiology_0095_chunk15of15.wav,tara,"Placental grade is II. No evidence of gross anatomical abnormality, with a biophysical profile total equal to 8 out of 8.nan",Radiology,15,750,15,15
tara_Cardiovascular _ Pulmonary_0096_chunk5of11.wav,tara,Aortic valve seen with good motion. 5.,Cardiovascular / Pulmonary,33,365,5,11
tara_Cardiovascular _ Pulmonary_0096_chunk8of11.wav,tara,No pericardial effusion or intracardiac masses.1. Trace mitral regurgitation.,Cardiovascular / Pulmonary,33,526,8,11
tara_Gastroenterology_0097_chunk3of17.wav,tara,"A modified barium swallow study was ordered to objectively evaluate the patient's swallowing function and safety and to rule out aspiration. , Modified barium swallow study was performed in the radiology suite in cooperation with Dr.",Gastroenterology,23,1296,3,17
tara_Gastroenterology_0097_chunk14of17.wav,tara,The patient should have unthickened water in between meals to help decrease his risk of dehydration. 3.,Gastroenterology,23,603,14,17
tara_Cardiovascular _ Pulmonary_0098_chunk3of28.wav,tara,", The patient has a complex history, which goes back about four months ago when she started having respiratory symptoms and one week ago she was admitted to another hospital with hemoptysis and on her evaluation there which included two CAT scans of chest she was found to have marked consolidation of the left lung with a questionable lung abscess or cavity with hydropneumothorax. There was also noted to be some mild infiltrates of the right lung.",Cardiovascular / Pulmonary,33,2164,3,28
tara_Cardiovascular _ Pulmonary_0098_chunk6of28.wav,tara,"The patient had a flexible fiberoptic bronchoscopy that showed no endobronchial lesions, but there was bloody mucous in the left main stem bronchus and this was suctioned out. This was suctioned out with the addition of the use of saline ***** in the bronchus.",Cardiovascular / Pulmonary,33,1247,6,28
tara_Cardiovascular _ Pulmonary_0098_chunk8of28.wav,tara,"Today, the double lumen tube was placed and there was some erythema of the mucosa noted in the airways in the bronchi and also remarkably bloody secretions were also noted. These were suctioned, but it was enough to produce a temporary obstruction of the left mainstem bronchus.",Cardiovascular / Pulmonary,33,1359,8,28
tara_Cardiovascular _ Pulmonary_0098_chunk12of28.wav,tara,There was quite a bit of whitish fibrotic fibrinous deposit on the parietal pleura of the lung especially the upper lobe. The adhesions were taken down and they were quite bloody in some areas indicating that the process had been present for some time.,Cardiovascular / Pulmonary,33,1338,12,28
tara_Cardiovascular _ Pulmonary_0098_chunk16of28.wav,tara,"Therefore, the next incision for Thoracoport and thoracoscopy insertion through the port was over the sixth intercostal space and a little bit better visualization was achieved, but it was clear that we would be unable to complete the procedure by thoracoscopy. Therefore posterolateral thoracotomy incision was made, entering the pleural space and what is probably the sixth intercostal space.",Cardiovascular / Pulmonary,33,2094,16,28
tara_Cardiovascular _ Pulmonary_0098_chunk18of28.wav,tara,"Suture ligatures of Prolene were required. When the cavity was encountered it was due to some compression and dissection of some of the fibrinous deposit in the upper lobe laterally and anterior and this became identified as a very thin layer in one area over this abscess and when it was opened it was quite large and we unroofed it completely and there was bleeding down in the depths of the cavity, which appeared to be from pulmonary veins and these were sutured with a ""tissue pledget"" of what was probably intercostal nozzle and endothoracic fascia with Prolene sutures.",Cardiovascular / Pulmonary,33,2640,18,28
tara_Cardiovascular _ Pulmonary_0098_chunk19of28.wav,tara,"Also as the upper lobe was retracted in caudal direction the tissue was quite dense and the superior branch of the pulmonary artery on the left side was torn and for hemostasis a 14-French Foley catheter was passed into the area of the tear and the balloon was inflated, which helped establish hemostasis and suturing was carried out again with utilizing a small pledget what was probably intercostal muscle and endothoracic fascia and this was sutured in place and the Foley catheter was removed. The patch was sutured onto the pulmonary artery tear.",Cardiovascular / Pulmonary,33,2892,19,28
tara_Cardiovascular _ Pulmonary_0098_chunk20of28.wav,tara,"A similar maneuver was utilized on the pulmonary vein bleeding site down deep in the cavity. Also on the pulmonary artery repair some ***** material was used and also thrombin, Gelfoam and Surgicel.",Cardiovascular / Pulmonary,33,1233,20,28
tara_Cardiovascular _ Pulmonary_0098_chunk26of28.wav,tara,The chest wall was closed with running 1 Vicryl and then 2-0 Vicryl subcutaneous and staples on the skin. The chest tubes were connected to water-seal drainage with 40 cm of water negative pressure.,Cardiovascular / Pulmonary,33,1142,26,28
tara_Cardiovascular _ Pulmonary_0098_chunk27of28.wav,tara,Sterile dressings were applied. The patient tolerated the procedure well and was turned in the supine position where the double lumen endotracheal tube was switched out with single lumen.,Cardiovascular / Pulmonary,33,820,27,28
tara_Cardiovascular _ Pulmonary_0100_chunk4of6.wav,tara,"The patient was in the SDI unit, attached to noninvasive monitoring devices. After Brevital was brought by the anesthesia service a single 150 joule synchronized biphasic shock using AP paddles did restore him to sinus rhythm in the 80s.",Cardiovascular / Pulmonary,33,1387,4,6
tara_Cardiovascular _ Pulmonary_0100_chunk5of6.wav,tara,He tolerated it well. He will be observed for couple hours and discharged home later today.,Cardiovascular / Pulmonary,33,10000,5,6
tara_Gastroenterology_0102_chunk2of20.wav,tara,2. Family history of colon polyps.1.,Gastroenterology,23,358,2,20
leah_Gastroenterology_0103_chunk3of42.wav,leah,3. Placement of two right-sided 28-French chest tubes.,Gastroenterology,23,414,3,42
leah_Gastroenterology_0103_chunk15of42.wav,leah,The esophagus and the esophageal hiatus were identified in the abdomen. We next turned our attention to the left gastric artery.,Gastroenterology,23,638,15,42
leah_Gastroenterology_0103_chunk20of42.wav,leah,We tied down in place. We then used 3-0 silk sutures to perform a Witzel.,Gastroenterology,23,477,20,42
leah_Gastroenterology_0103_chunk27of42.wav,leah,"We placed standard chest retractors. Next, we incised the peritoneum over the esophagus.",Gastroenterology,23,526,27,42
leah_Gastroenterology_0103_chunk32of42.wav,leah,"Next, we tabularized our stomach using a 80 GIA stapler. After doing so, we chose a portion of the stomach more distally and opened it using Bovie electrocautery.",Gastroenterology,23,995,32,42
leah_Gastroenterology_0103_chunk33of42.wav,leah,We placed our EEA stapler through it and then punched out through the gastric wall. We connected our anvil to the EEA stapler.,Gastroenterology,23,652,33,42
leah_Cardiovascular _ Pulmonary_0104_chunk2of8.wav,leah,",After obtaining informed consent from the patient's family, including a thorough explanation of the risks and benefits of the aforementioned procedure, patient was taken to the operating room and general endotracheal anesthesia was administered. Next, the neck and chest were prepped and draped in the standard surgical fashion.",Cardiovascular / Pulmonary,33,1618,2,8
leah_Cardiovascular _ Pulmonary_0104_chunk3of8.wav,leah,A 10-blade scalpel was used to make an incision in the area of the xiphoid process. Dissection was carried down to the level of the fascia using Bovie electrocautery.,Cardiovascular / Pulmonary,33,904,3,8
leah_Cardiovascular _ Pulmonary_0105_chunk8of8.wav,leah,"4. Normal global and regional wall motion.cardiovascular / pulmonary, dobutamine stress test, atrial fibrillation, lv myocardial perfusion, lv systolic ejection fraction, coronary disease, dobutamine, ejection fraction, gated tomographic spect system, thallous chloride, wall motion, stress, fibrillation, atrial",Cardiovascular / Pulmonary,33,2220,8,8
leah_Cardiovascular _ Pulmonary_0106_chunk11of29.wav,leah,"The four pulmonary veins are identified. The left atrial appendage is interrogated, including with Doppler and color flow, and while there is good to-and-fro motion seen, echo smoke is seen, and in fact, an intracardiac thrombus is identified and circumscribed at 1.",Cardiovascular / Pulmonary,33,1506,11,29
leah_Cardiovascular _ Pulmonary_0106_chunk16of29.wav,leah,There is trace aortic insufficiency. There is trace pulmonic insufficiency.,Cardiovascular / Pulmonary,33,470,16,29
leah_Cardiovascular _ Pulmonary_0106_chunk21of29.wav,leah,"61 cm. The intra-atrial septum is identified as are the SVC and IVC, and these are within normal limits.",Cardiovascular / Pulmonary,33,722,21,29
leah_Cardiovascular _ Pulmonary_0106_chunk22of29.wav,leah,"The intra-atrial septum is interrogated with color flow as well as agitated D5W and there is no evidence of intracardiac shunting, including no atrial septal defect nor patent foramen ovale. No pericardial effusion.",Cardiovascular / Pulmonary,33,1219,22,29
leah_Gastroenterology_0107_chunk7of12.wav,leah,Her parents have not noted any significant problems with the gastrostomy site. The patient's exam today is excellent.,Gastroenterology,23,652,7,12
leah_Gastroenterology_0107_chunk11of12.wav,leah,"Hopefully, the exquisite control of acid reflux by fundoplication will help her airway heal, and if she does well, allow decannulation in the future. If she does require laryngotracheoplasty, the protection from acid reflux will be important to healing of that procedure as well.",Gastroenterology,23,1569,11,12
leah_SOAP _ Chart _ Progress Notes_0108_chunk7of25.wav,leah,Brother died from lymphoma. She has one brother living who has had angioplasties x 2.,SOAP / Chart / Progress Notes,34,519,7,25
leah_SOAP _ Chart _ Progress Notes_0108_chunk17of25.wav,leah,General Appearance: She is an elderly female patient who is not in acute distress. Mouth: Posterior pharynx is clear.,SOAP / Chart / Progress Notes,34,729,17,25
leah_SOAP _ Chart _ Progress Notes_0108_chunk19of25.wav,leah,Auscultation reveals normal breath sounds. Heart: Normal S1 and S2 without gallops or rubs.,SOAP / Chart / Progress Notes,34,652,19,25
leah_Cardiovascular _ Pulmonary_0109_chunk5of9.wav,leah,"Peak stress echo imaging shows EF of 75%, no regional wall motion abnormalities. There was resting hypertension noted, systolic of approximately 152 mmHg with appropriate response of blood pressure to exercise.",Cardiovascular / Pulmonary,33,1492,5,9
leah_Cardiovascular _ Pulmonary_0109_chunk7of9.wav,leah,2. Resting hypertension with appropriate response of blood pressure to exercise.,Cardiovascular / Pulmonary,33,484,7,9
leah_Gastroenterology_0111_chunk3of13.wav,leah,", After informed consent was obtained, the patient was brought to the operative suite and placed supine on the operating table. General endotracheal anesthesia was induced without incident.",Gastroenterology,23,988,3,13
leah_Gastroenterology_0111_chunk9of13.wav,leah,The stump of the appendix was cauterized and the cecum was returned to the abdomen. The peritoneum was irrigated with warm sterile saline.,Gastroenterology,23,785,9,13
leah_Cardiovascular _ Pulmonary_0112_chunk2of20.wav,leah,", Syncope with severe aortic stenosis. None.",Cardiovascular / Pulmonary,33,309,2,20
leah_Cardiovascular _ Pulmonary_0112_chunk14of20.wav,leah,The remainder of the vessel has moderate diffuse luminal irregularities with no critical lesions. The left ventricle appears to be normal sized.,Cardiovascular / Pulmonary,33,729,14,20
leah_SOAP _ Chart _ Progress Notes_0114_chunk10of11.wav,leah,The procedure is being scheduled. The patient's medications are refilled.,SOAP / Chart / Progress Notes,34,414,10,11
leah_Cardiovascular _ Pulmonary_0115_chunk1of30.wav,leah,", This 66-year-old white male was seen in my office on Month DD, YYYY. Patient was recently discharged from Doctors Hospital at Parkway after he was treated for pneumonia.",Cardiovascular / Pulmonary,33,988,1,30
leah_Cardiovascular _ Pulmonary_0115_chunk7of30.wav,leah,"Head normocephalic. Eyes, no evidence of anemia or jaundice.",Cardiovascular / Pulmonary,33,470,7,30
leah_Cardiovascular _ Pulmonary_0115_chunk8of30.wav,leah,"Oral hygiene is good. , Supple.",Cardiovascular / Pulmonary,33,253,8,30
leah_Cardiovascular _ Pulmonary_0115_chunk21of30.wav,leah,7. Toprol XL 100 mg daily.,Cardiovascular / Pulmonary,33,330,21,30
leah_Cardiovascular _ Pulmonary_0115_chunk22of30.wav,leah,8. Flovent 100 mcg twice a day.1.,Cardiovascular / Pulmonary,33,442,22,30
leah_Cardiovascular _ Pulmonary_0115_chunk30of30.wav,leah,2. Patient will be seen again in my office in four weeks.nan,Cardiovascular / Pulmonary,33,442,30,30
leah_Cardiovascular _ Pulmonary_0117_chunk10of38.wav,leah,6. Status post thyroidectomy for thyroid carcinoma.General: Unremarkable.,Cardiovascular / Pulmonary,33,561,10,38
leah_Cardiovascular _ Pulmonary_0117_chunk14of38.wav,leah,"His mother has congestive heart failure. ,The patient is married.",Cardiovascular / Pulmonary,33,386,14,38
leah_Cardiovascular _ Pulmonary_0117_chunk32of38.wav,leah,"Folic acid 1 mg daily. , None.General: A well-appearing, obese black male.",Cardiovascular / Pulmonary,33,582,32,38
leah_Cardiovascular _ Pulmonary_0118_chunk7of26.wav,leah,"Therefore the patient was seen in our thoracic tumor board where it was recommended to have resection performed with chest wall reconstruction. In the outpatient setting, the patient was willing to proceed.",Cardiovascular / Pulmonary,33,960,7,26
leah_Cardiovascular _ Pulmonary_0118_chunk8of26.wav,leah,", After informed consent was obtained, the patient identified correctly. She was taken to the operating room where an epidural catheter was placed by Anesthesia without difficulty.",Cardiovascular / Pulmonary,33,890,8,26
leah_Cardiovascular _ Pulmonary_0118_chunk14of26.wav,leah,"There were thin adhesions to the pleura, but no invasion of the chest wall that could be identified. The tumor was very mobile and was on a pedunculated stalk, approximately 1.",Cardiovascular / Pulmonary,33,960,14,26
leah_Cardiovascular _ Pulmonary_0118_chunk17of26.wav,leah,"Laparoscopic scissors were placed through the posterior port, but it was necessary to have another instrument to provide more tension than just gravity. Therefore because of the need to bring the specimen through the chest wall, a small 3-cm thoracotomy was made, which incorporated the posterior port site.",Cardiovascular / Pulmonary,33,1716,17,26
leah_Cardiovascular _ Pulmonary_0118_chunk22of26.wav,leah,Specimen came off the chest wall very easily. There was good hemostasis.,Cardiovascular / Pulmonary,33,449,22,26
leah_Cardiovascular _ Pulmonary_0118_chunk24of26.wav,leah,There was good hemostasis. Camera was removed.,Cardiovascular / Pulmonary,33,330,24,26
leah_Cardiovascular _ Pulmonary_0119_chunk1of27.wav,leah,", Critical left carotid stenosis. , Critical left carotid stenosis.",Cardiovascular / Pulmonary,33,435,1,27
leah_Cardiovascular _ Pulmonary_0119_chunk4of27.wav,leah,"She wishes to undergo bilateral carotid endarterectomy, however, it was felt necessary by Dr. X to perform cardiac catheterization.",Cardiovascular / Pulmonary,33,785,4,27
leah_Cardiovascular _ Pulmonary_0119_chunk13of27.wav,leah,The internal carotid artery is controlled with Heifitz clip followed by the external carotid artery and the superior thyroid artery being controlled with Heifitz clips. The common carotid artery was controlled with profunda clamp.,Cardiovascular / Pulmonary,33,1184,13,27
leah_Cardiovascular _ Pulmonary_0119_chunk19of27.wav,leah,The suture line began at both sites. The suture was tied in the center along the anterior and posterior walls.,Cardiovascular / Pulmonary,33,659,19,27
leah_Cardiovascular _ Pulmonary_0121_chunk12of12.wav,leah,"Sponge, instrument and needle counts were reported as correct.cardiovascular / pulmonary, angioplasty, venous, anastomosis, patch angioplasty, av shunt, venous anastomosis, av, thrombectomy, thrombosed, arteriovenous, vein, forearm, shunt,",Cardiovascular / Pulmonary,33,1919,12,12
leah_Radiology_0122_chunk11of12.wav,leah,She recovered with residual left hemisensory loss. In 12/92 she presented with an interventricular hemorrhage and was managed conservatively and refused any future neuroradiologic intervention.,Radiology,15,1100,11,12
leah_Cardiovascular _ Pulmonary_0123_chunk11of13.wav,leah,The LP contact tip laser was utilized to vaporize the scar tissue and release the scar banding following which the scope was passed and further dilation carried out. Mid and distal trachea were widely patent.,Cardiovascular / Pulmonary,33,1156,11,13
leah_Cardiovascular _ Pulmonary_0123_chunk13of13.wav,leah,"This was further dilated and following which was removed and a new 5 metal tracheostomy tube inserted. The patient tolerated the procedure well without complications and was taken to recovery room in satisfactory condition.cardiovascular / pulmonary, airway obstruction, oral cavity, bronchoscopy, buccal cavity, hypopharynx, laryngeal, larynx, microlaryngoscopy, nasal cavity, polychondritis, subglottic, tracheal stenosis, tracheostomy tube, scar tissue, subglottic stenosis, tracheal, airway, cavity, tube, scarring, stenosis,",Cardiovascular / Pulmonary,33,2577,13,13
leah_Gastroenterology_0124_chunk2of10.wav,leah,Exam under anesthesia with control of bleeding via cautery. General endotracheal.,Gastroenterology,23,484,2,10
leah_Gastroenterology_0125_chunk3of7.wav,leah,",This healthy 28-year-old woman has had biliary colic-type symptoms for the past 3-1/2 weeks, characterized by severe pain, and brought on by eating greasy foods. She has had similar episodes couple of years ago and was told, at one point, that she had gallstones, but after her pregnancy, a repeat ultrasound was done, and apparently was normal, and nothing was done at that time.",Gastroenterology,23,2157,3,7
leah_Cardiovascular _ Pulmonary_0126_chunk10of30.wav,leah,"There was possibility of subchondral fracture and some swelling of her suprapatellar bursa on the right side. This morning, she denied any headache, back pain or neck pain.",Cardiovascular / Pulmonary,33,904,10,30
leah_Cardiovascular _ Pulmonary_0126_chunk26of30.wav,leah,"However, she may need home O2 for a short period of time. 3.",Cardiovascular / Pulmonary,33,484,26,30
leah_Cardiovascular _ Pulmonary_0128_chunk12of17.wav,leah,"Oxygen saturation was checked today on room air, at rest it was 90%.1. Chronic obstructive pulmonary disease/emphysema, severe but stable.",Cardiovascular / Pulmonary,33,1016,12,17
leah_Cardiovascular _ Pulmonary_0129_chunk6of10.wav,leah,"Doppler analysis outflow velocity through the aortic valve normal, inflow velocities through the mitral valve are normal. There is mild tricuspid regurgitation.",Cardiovascular / Pulmonary,33,862,6,10
leah_Radiology_0131_chunk5of10.wav,leah,0. The spiculated density seen in the right upper lobe on the CT scan does not demonstrate FDG activity on this PET scan.,Radiology,15,771,5,10
leah_Cardiovascular _ Pulmonary_0132_chunk4of10.wav,leah,"053, 82% predicted, postbronchodilator improves by 35%. DLCO is 35, 121% predicted.",Cardiovascular / Pulmonary,33,1072,4,10
leah_Cardiovascular _ Pulmonary_0132_chunk5of10.wav,leah,"Residual volume is 3. 04, 139% predicted.",Cardiovascular / Pulmonary,33,526,5,10
leah_Cardiovascular _ Pulmonary_0133_chunk3of28.wav,leah,3. LV gram with power injection.,Cardiovascular / Pulmonary,33,288,3,28
leah_Cardiovascular _ Pulmonary_0133_chunk6of28.wav,leah,"Procedure explained to the patient, with risks and benefits. The patient agreed and signed the consent form.",Cardiovascular / Pulmonary,33,596,6,28
leah_Cardiovascular _ Pulmonary_0133_chunk10of28.wav,leah,The wire was removed. Catheter was engaged into the left main.,Cardiovascular / Pulmonary,33,393,10,28
leah_Cardiovascular _ Pulmonary_0133_chunk23of28.wav,leah,The RCA was a small nondominant system with no focal stenosis and supplying the RV marginal.LV gram showed that the LV EF is preserved with EF of 60%. No mitral regurgitation identified.1.,Cardiovascular / Pulmonary,33,1289,23,28
leah_Cardiovascular _ Pulmonary_0134_chunk2of8.wav,leah,The patient ruled out for myocardial infarction on serial troponins. Result of nuclear stress test is pending.,Cardiovascular / Pulmonary,33,631,2,8
leah_Cardiovascular _ Pulmonary_0134_chunk3of8.wav,leah,"2. Elevated liver enzymes, etiology uncertain for an outpatient followup.",Cardiovascular / Pulmonary,33,477,3,8
leah_Cardiovascular _ Pulmonary_0134_chunk7of8.wav,leah,"The patient is stable to be discharged pending the results of nuclear stress test and cardiologist's recommendations. He will follow up with cardiologist, Dr.",Cardiovascular / Pulmonary,33,897,7,8
leah_Cardiovascular _ Pulmonary_0134_chunk8of8.wav,leah,"X, in two weeks and with his primary physician in two to four weeks. Discharge medications will depend on results of nuclear stress test.cardiovascular / pulmonary, chest pain, serial troponins, premature coronary artery disease, coronary artery disease, nuclear stress test, stress test",Cardiovascular / Pulmonary,33,1765,8,8
leah_Radiology_0135_chunk1of8.wav,leah,", Chest pain. Graded exercise treadmill stress test.",Radiology,15,337,1,8
leah_SOAP _ Chart _ Progress Notes_0136_chunk2of14.wav,leah,"On this dose, he is having firm erection, able to penetrate, lasting for about 10 or so minutes. No chest pain, no nitroglycerin usage, no fever, no chills.",SOAP / Chart / Progress Notes,34,1065,2,14
leah_SOAP _ Chart _ Progress Notes_0136_chunk4of14.wav,leah,"He does have a history of elevated PSA and biopsy June of this year was noted for high grade PIN, mid left biopsy, with two specimens being too small to evaluate. PSA 11.",SOAP / Chart / Progress Notes,34,1037,4,14
leah_SOAP _ Chart _ Progress Notes_0136_chunk6of14.wav,leah,"X's notes are reviewed. ,1.",SOAP / Chart / Progress Notes,34,260,6,14
leah_SOAP _ Chart _ Progress Notes_0136_chunk9of14.wav,leah,"Elevated PSA in a patient with a recent biopsy showing high-grade PIN, as well as two specimens not being large enough to evaluate. The patient tells me he has met with his primary care physician and after discussion, he is in consideration of repeating a prostate ultrasound and biopsy.",SOAP / Chart / Progress Notes,34,1520,9,14
leah_Gastroenterology_0137_chunk1of16.wav,leah,", Leaking anastomosis from esophagogastrectomy. , Leaking anastomosis from esophagogastrectomy.",Gastroenterology,23,351,1,16
leah_Gastroenterology_0137_chunk2of16.wav,leah,", Exploratory laparotomy and drainage of intra-abdominal abscesses with control of leakage. , None.",Gastroenterology,23,561,2,16
leah_Gastroenterology_0137_chunk7of16.wav,leah,These were carefully dissected to expose initially the closure over the gastrotomy site. Initially this looked like this was leaking but it was actually found to be intact.,Gastroenterology,23,967,7,16
leah_Gastroenterology_0137_chunk10of16.wav,leah,"Stomach itself appeared viable, there was no necrotic sections. Upper apex of the stomach was felt to be viable also.",Gastroenterology,23,680,10,16
leah_Cardiovascular _ Pulmonary_0139_chunk7of25.wav,leah,Vicodin p.r.n. and Nexium 40 mg-given samples of this today.,Cardiovascular / Pulmonary,33,547,7,25
leah_Cardiovascular _ Pulmonary_0139_chunk10of25.wav,leah,PR: 70. WT: 223 pounds (up three pounds).,Cardiovascular / Pulmonary,33,463,10,25
leah_Cardiovascular _ Pulmonary_0139_chunk17of25.wav,leah,"2. Mild pedal edema-Has to cut down on fluid intake, weight loss will help as well, continue with the chlorthalidone.",Cardiovascular / Pulmonary,33,736,17,25
leah_Gastroenterology_0140_chunk5of27.wav,leah,",The patient was taken to the operating room and placed supine on the operating room table. All pressure points were carefully padded.",Gastroenterology,23,659,5,27
leah_Gastroenterology_0140_chunk8of27.wav,leah,Marcaine was then injected through umbilicus. A small incision was made.,Gastroenterology,23,428,8,27
leah_Gastroenterology_0140_chunk10of27.wav,leah,A 12-mm VersaStep port was placed through the umbilicus. I then placed a 5-mm port just anterior to the midaxillary line and just subcostal on the right side.,Gastroenterology,23,932,10,27
leah_Gastroenterology_0140_chunk14of27.wav,leah,"I then ran the distal bowel down, approximately 100 cm, and at 100 cm, I made a hole at the antimesenteric portion of the Roux limb and a hole in the antimesenteric portion of the duodenogastric limb, and I passed a 45 white load stapler and fired a stapler creating a side-to-side anastomosis. I reapproximated the edges of the defect.",Gastroenterology,23,2164,14,27
leah_Gastroenterology_0140_chunk21of27.wav,leah,"I joined the spike with the anvil and fired a stapler creating an end-to-side anastomosis, then divided across the redundant portion of my Roux limb with a white load GI stapler, and removed it with an Endocatch bag. I put some additional 2-0 Vicryl sutures in the anastomosis for further security.",Gastroenterology,23,1555,21,27
leah_Cardiovascular _ Pulmonary_0141_chunk8of25.wav,leah,", Local, 1% lidocaine. Less than 5 cc.",Cardiovascular / Pulmonary,33,400,8,25
leah_Cardiovascular _ Pulmonary_0141_chunk19of25.wav,leah,"1% Xylocaine was used to anesthetize an area just inferior and lateral to the angle of the clavicle. Using the anesthetic needle, we checked down to the soft tissues anesthetizing, as we proceeded to the angle of the clavicle, this was also anesthetized.",Cardiovascular / Pulmonary,33,1408,19,25
leah_Cardiovascular _ Pulmonary_0141_chunk21of25.wav,leah,There was good venous return noted immediately. The syringe was removed and a Seldinger guidewire was inserted through the needle to cannulate the vein.,Cardiovascular / Pulmonary,33,792,21,25
leah_Cardiovascular _ Pulmonary_0141_chunk22of25.wav,leah,"The needle was then removed. A small skin nick was made with a 11 blade scalpel and the provided dilator was used to dilate the skin, soft tissue and vein.",Cardiovascular / Pulmonary,33,876,22,25
leah_Cardiovascular _ Pulmonary_0142_chunk5of7.wav,leah,"With synchronized biphasic waveform at 150 J, one shock was successful in restoring sinus rhythm. The patient had some occasional PACs noticed with occasional sinus tachycardia.",Cardiovascular / Pulmonary,33,1023,5,7
leah_Cardiovascular _ Pulmonary_0143_chunk1of26.wav,leah,",1. Left superficial femoral artery subtotal stenosis.",Cardiovascular / Pulmonary,33,533,1,26
leah_Cardiovascular _ Pulmonary_0143_chunk18of26.wav,leah,", With the patient in the supine position under general anesthesia, the abdomen and lower extremities were prepped and draped in the sterile fashion. The right common femoral artery was punctured percutaneously, and a 5-French sheath was initially placed.",Cardiovascular / Pulmonary,33,1296,18,26
leah_Cardiovascular _ Pulmonary_0143_chunk21of26.wav,leah,"5-mm laser probe to laser the proximal superficial femoral artery. Because of the findings as noted above, this became more involved than initially hoped for.",Cardiovascular / Pulmonary,33,911,21,26
leah_Gastroenterology_0144_chunk9of9.wav,leah,"The patient will remain on antiemetics and be started on a clear liquid diet.gastroenterology, mallory-weiss tear, submucosal hemorrhage, esophagitis, vomiting, bicap cautery, mallory weiss, diabetes, esophagus, submucosal, hemorrhage, trauma, hematemesis,",Gastroenterology,23,1744,9,9
leah_SOAP _ Chart _ Progress Notes_0145_chunk2of17.wav,leah,"The patient has chronic atrial fibrillation, on anticoagulation. The patient is doing fairly well.",SOAP / Chart / Progress Notes,34,575,2,17
leah_SOAP _ Chart _ Progress Notes_0145_chunk7of17.wav,leah,25 mg daily. 3.,SOAP / Chart / Progress Notes,34,253,7,17
leah_Radiology_0146_chunk3of20.wav,leah,"There is good demonstration of the coronary arteries and there is good bolus timing.,The left main coronary artery is a moderate-sized vessel with a normal ostium. There is no calcific or non-calcific plaque.",Radiology,15,1114,3,20
leah_Radiology_0146_chunk8of20.wav,leah,There is only minimal contrast that is identified in the distal vessel.The left circumflex artery is a moderate-sized vessel with a patent ostium. There is calcific plaque within the proximal vessel.,Radiology,15,1065,8,20
leah_Radiology_0146_chunk18of20.wav,leah,"There is marked tapering of the D1 branch distal to the calcific plaque and occlusion cannot be excluded. There is dense calcific plaque within the left circumflex artery, and although a flow-limiting lesion cannot be excluded here, there is no evidence of an occlusion or high-grade stenosis.",Radiology,15,1499,18,20
leah_Cardiovascular _ Pulmonary_0147_chunk6of28.wav,leah,Lipitor 40 mg q.d. metoprolol 25 mg b.i.d.,Cardiovascular / Pulmonary,33,540,6,28
leah_Cardiovascular _ Pulmonary_0147_chunk15of28.wav,leah,Possible gallstones seen.1. CAD-Status post anterior wall MI 07/07 and was found to a have multivessel CAD.,Cardiovascular / Pulmonary,33,862,15,28
leah_SOAP _ Chart _ Progress Notes_0148_chunk2of15.wav,leah,"She indicates that her blood sugar on Friday night was 187 at bedtime and that when she woke up in the morning her blood sugar was 477. She gave herself, in smaller increments, a total of 70 extra units of her Humalog.",SOAP / Chart / Progress Notes,34,1331,2,15
leah_Cardiovascular _ Pulmonary_0150_chunk5of30.wav,leah,", Positive for coronary artery disease. , The patient denies any major surgeries.",Cardiovascular / Pulmonary,33,491,5,30
leah_Cardiovascular _ Pulmonary_0150_chunk11of30.wav,leah,"Shortness of breath, congestive heart failure, and arrhythmia. Prior history of chest pain.",Cardiovascular / Pulmonary,33,547,11,30
leah_Cardiovascular _ Pulmonary_0150_chunk18of30.wav,leah,"Pulse of 60, blood pressure of 129/73, afebrile, and respiratory rate 16 per minute. Atraumatic and normocephalic.",Cardiovascular / Pulmonary,33,911,18,30
leah_Cardiovascular _ Pulmonary_0150_chunk29of30.wav,leah,"Cardiac enzyme profile first set 0. 04, BNP of 10,000.",Cardiovascular / Pulmonary,33,512,29,30
leah_Cardiovascular _ Pulmonary_0150_chunk30of30.wav,leah,"Nuclear myocardial perfusion scan with adenosine in the office done about a couple of weeks ago shows ejection fraction of 39% with inferior reversible defect. , The patient is a 75-year-old gentleman admitted for:nan",Cardiovascular / Pulmonary,33,1366,30,30
leah_Cardiovascular _ Pulmonary_0154_chunk4of40.wav,leah,"He was found to have 2. 5L of bloody pleural effusions, some loculated pleural effusion, adhesions, and carcinomatosis in the parenchyma.",Cardiovascular / Pulmonary,33,988,4,40
leah_Cardiovascular _ Pulmonary_0154_chunk10of40.wav,leah,"No neurological or musculoskeletal signs or symptoms. He reports that he is able to ambulate to the bathroom, but gets short of breath on exertion.",Cardiovascular / Pulmonary,33,904,10,40
leah_Cardiovascular _ Pulmonary_0154_chunk34of40.wav,leah,Y in Pathology here at Methodist XYZ Hospital. I will try to obtain the slides for comparison from XYZ Hospital for comparison and immunohistochemical staining.,Cardiovascular / Pulmonary,33,1128,34,40
leah_Cardiovascular _ Pulmonary_0155_chunk24of65.wav,leah,", Her father died at age of 65 of massive heart attack and mother died at age of 62 of cancer. She had a one brother who died of massive heart attack in his 50s, a brother died at the age of 47 of cancer, and another brother died in his 60s of possible rupture of appendix.",Cardiovascular / Pulmonary,33,1548,24,65
leah_Cardiovascular _ Pulmonary_0155_chunk29of65.wav,leah,Appetite is good. She sleeps good at night.,Cardiovascular / Pulmonary,33,281,29,65
leah_Cardiovascular _ Pulmonary_0155_chunk30of65.wav,leah,"She has no headaches and she has mild joint pains from arthritis. Pulse 90 per minute and regular, blood pressure 140/90 mmHg, respirations 18, and temperature of 98.",Cardiovascular / Pulmonary,33,1212,30,65
leah_Cardiovascular _ Pulmonary_0155_chunk38of65.wav,leah,The extremities are heavy. There is no pitting at this stage.,Cardiovascular / Pulmonary,33,400,38,65
leah_Cardiovascular _ Pulmonary_0157_chunk5of33.wav,leah,The patient was placed under general endotracheal anesthesia breathing on 30% oxygen throughout the case. Cardiac catheterization was performed as outlined in the attached continuation sheets.,Cardiovascular / Pulmonary,33,981,5,33
leah_Cardiovascular _ Pulmonary_0157_chunk16of33.wav,leah,Right-to-left pulmonary artery capillary wedge pressures were normal with an A-wave similar to the normal left ventricular end-diastolic pressure of 12 mmHg. Left ventricular systolic pressure was systemic with no outflow obstruction to the ascending aorta.,Cardiovascular / Pulmonary,33,1471,16,33
leah_Cardiovascular _ Pulmonary_0157_chunk21of33.wav,leah,Angiogram with contrast injection in the right coronary artery showed a non-dominant coronary with a small fistula arising from the proximal right coronary artery coursing over the infundibulum and entering the left facing sinus of the main pulmonary artery.1. Membranous pulmonary atresia.,Cardiovascular / Pulmonary,33,1569,21,33
leah_Cardiovascular _ Pulmonary_0158_chunk2of22.wav,leah,He is currently stabilized and improving in strength. He is living in Nantucket with his daughter Debra Anderson while he recuperates and completes the cardiac rehabilitation program.,Cardiovascular / Pulmonary,33,918,2,22
leah_Cardiovascular _ Pulmonary_0158_chunk10of22.wav,leah,His resting heart rate is 80. His resting blood pressure is 112/70.,Cardiovascular / Pulmonary,33,477,10,22
leah_Gastroenterology_0159_chunk4of23.wav,leah,"Cholelithiasis. , Laparoscopic cholecystectomy with cholangiogram.",Gastroenterology,23,477,4,23
leah_Gastroenterology_0159_chunk11of23.wav,leah,Peritoneal cavity was carefully entered. Hasson cannula was inserted and peritoneal cavity was insufflated with CO2.,Gastroenterology,23,743,11,23
leah_Gastroenterology_0159_chunk12of23.wav,leah,"Laparoscopic camera was inserted, and the patient was placed in reverse Trendelenburg, rotated to the left. A 11-mm trocar was placed in the subxiphoid space and two 5-mm in the right subcostal region.",Gastroenterology,23,1275,12,23
leah_Gastroenterology_0159_chunk15of23.wav,leah,"The fundus of the gallbladder was retracted superiorly, and dissection was carried at the neck of the gallbladder where a cystic duct was identified and isolated. It was clipped distally and using C-arm fluoroscopy, intraoperative cystic duct cholangiogram was done, which was interpreted as normal.",Gastroenterology,23,1660,15,23
leah_Cardiovascular _ Pulmonary_0160_chunk3of16.wav,leah,"1 x 10. 6 x,4.",Cardiovascular / Pulmonary,33,337,3,16
leah_Cardiovascular _ Pulmonary_0160_chunk7of16.wav,leah,7 cm and is located 3. 7 cm from the closest surgical margin and 3.,Cardiovascular / Pulmonary,33,589,7,16
leah_Cardiovascular _ Pulmonary_0160_chunk15of16.wav,leah,In situ carcinoma: Absent. Non-neoplastic lung: Emphysema.,Cardiovascular / Pulmonary,33,519,15,16
leah_SOAP _ Chart _ Progress Notes_0161_chunk20of44.wav,leah,No hepatitis panels. No alpha-fetoprotein level.,SOAP / Chart / Progress Notes,34,386,20,44
leah_SOAP _ Chart _ Progress Notes_0162_chunk5of32.wav,leah,They were prescribing methadone for some time. He says that did help.,SOAP / Chart / Progress Notes,34,512,5,32
leah_SOAP _ Chart _ Progress Notes_0162_chunk15of32.wav,leah,"His allergies are no known drug allergies. Medications, he takes no medications regularly.",SOAP / Chart / Progress Notes,34,645,15,32
leah_SOAP _ Chart _ Progress Notes_0162_chunk18of32.wav,leah,"He showed me his injection sites. I can see marks, but they seem to be healing up nicely.",SOAP / Chart / Progress Notes,34,498,18,32
leah_SOAP _ Chart _ Progress Notes_0162_chunk29of32.wav,leah,He has to call on his own. He has no insurance.,SOAP / Chart / Progress Notes,34,330,29,32
leah_SOAP _ Chart _ Progress Notes_0163_chunk6of56.wav,leah,"At that time, although she had complained of foot discomfort, she was not treated for it. This was in 1993 after which she and her new husband moved to the Boston area, where she lived from 1995-1996.",SOAP / Chart / Progress Notes,34,1296,6,56
leah_SOAP _ Chart _ Progress Notes_0163_chunk7of56.wav,leah,She was seen at the Pain Center by Dr. R with similar complaints of hip and knee pain.,SOAP / Chart / Progress Notes,34,463,7,56
leah_SOAP _ Chart _ Progress Notes_0163_chunk10of56.wav,leah,"She was referred to a podiatrist by her local doctor who found several fractured sesamoid bones in her both feet, but this was later found not to be the case. Subsequently, nuclear bone scans revealed osteoarthritis.",SOAP / Chart / Progress Notes,34,1247,10,56
leah_SOAP _ Chart _ Progress Notes_0163_chunk43of56.wav,leah,"Clear to auscultation without wheeze or rhonchi. Regular rate and rhythm without murmur, gallop, or rub.",SOAP / Chart / Progress Notes,34,631,43,56
leah_Cardiovascular _ Pulmonary_0165_chunk5of10.wav,leah,"There was no overt bleeding.PROCEDURE 2: , Attempted and unsuccessful insertion of arterial venous lines.DESCRIPTION OF PROCEDURE 2:, Both groins were prepped and draped. The patient was placed at 10 degrees head-up position.",Cardiovascular / Pulmonary,33,1226,5,10
leah_Cardiovascular _ Pulmonary_0166_chunk8of43.wav,leah,"Unable to obtain the place, location, anatomy, and the year it was performed. 2.",Cardiovascular / Pulmonary,33,582,8,43
leah_Cardiovascular _ Pulmonary_0166_chunk19of43.wav,leah,Left facial droop. Left side hemiplegia.,Cardiovascular / Pulmonary,33,344,19,43
leah_Cardiovascular _ Pulmonary_0166_chunk29of43.wav,leah,"Lipid profile: Triglycerides 64, total cholesterol 106, HDL 26, LDL 17. Liver function tests are within normal limits.",Cardiovascular / Pulmonary,33,1065,29,43
leah_Cardiovascular _ Pulmonary_0166_chunk38of43.wav,leah,"Currently, the patient's heart rate is well controlled, antiarrhythmic agent is not recommended at this point. 2.",Cardiovascular / Pulmonary,33,652,38,43
leah_Cardiovascular _ Pulmonary_0166_chunk41of43.wav,leah,"However, given the patient's current acute stroke, revascularization is not indicated at this time. 3.",Cardiovascular / Pulmonary,33,715,41,43
leah_Cardiovascular _ Pulmonary_0167_chunk13of34.wav,leah,"The patient was full term and mom was noted to have gestational diabetes controlled with diet during her pregnancy. , Brother, mother, and father all have asthma.",Cardiovascular / Pulmonary,33,918,13,34
leah_Cardiovascular _ Pulmonary_0167_chunk19of34.wav,leah,No respiratory distress. Head is normocephalic and atraumatic.,Cardiovascular / Pulmonary,33,400,19,34
leah_Cardiovascular _ Pulmonary_0168_chunk9of9.wav,leah,", I recommend followup in the office in one week and she will need Toprol-XL 12. 5 mg every day if symptoms persist.cardiovascular / pulmonary, vasovagal syncope, tilt table test, blood pressure, heart rate, dizziness,",Cardiovascular / Pulmonary,33,1457,9,9
leah_Cardiovascular _ Pulmonary_0169_chunk24of38.wav,leah,"Closing pressure was 97/68 with a mean of 82. Right heart catheterization with right atrial pressure at 13, right ventricle 31/9, pulmonary artery 33/19 with a mean of 25, and capillary wedge pressure of 19.",Cardiovascular / Pulmonary,33,1639,24,38
leah_Gastroenterology_0171_chunk1of20.wav,leah,"PREOPERATIVE DIAGNOSIS (ES):,1. Cholelithiasis.",Gastroenterology,23,526,1,20
leah_Gastroenterology_0171_chunk2of20.wav,leah,"2. Cholecystitis.POSTOPERATIVE DIAGNOSIS (ES):,1.",Gastroenterology,23,554,2,20
leah_Gastroenterology_0171_chunk6of20.wav,leah,General endotracheal anesthesia. Correct.,Gastroenterology,23,302,6,20
leah_Gastroenterology_0171_chunk12of20.wav,leah,A camera was placed into the abdomen and there was noted to be omentum overlying the subhepatic space. A second trocar was placed in the standard fashion in the subxiphoid area this was a 10/12 mm non-bladed trocar.,Gastroenterology,23,1268,12,20
leah_SOAP _ Chart _ Progress Notes_0172_chunk8of25.wav,leah,"Negative for fevers, chills, chest pain, and shortness of breath. ,On examination, Ms.",SOAP / Chart / Progress Notes,34,603,8,25
leah_SOAP _ Chart _ Progress Notes_0172_chunk12of25.wav,leah,Light touch sensation decreased in the right greater than left C6 distribution. Biceps and brachioradialis reflexes are 3 plus.,SOAP / Chart / Progress Notes,34,820,12,25
leah_SOAP _ Chart _ Progress Notes_0172_chunk17of25.wav,leah,"It demonstrates evidence of moderate stenosis at C4-5, C5-6. These stenosis is in the bilateral neural foramina and there is also significant disk herniation noted at the C6-7 level.",SOAP / Chart / Progress Notes,34,1184,17,25
leah_SOAP _ Chart _ Progress Notes_0172_chunk18of25.wav,leah,Minimal degenerative disk disease is seen at the C6-7. This stenosis is greater than C5-6 and the next level is more significantly involved at C4-5.,SOAP / Chart / Progress Notes,34,988,18,25
leah_Radiology_0173_chunk1of14.wav,leah,",MRI LEFT FOOT, A 49-year-old female with ankle pain times one month, without a specific injury. Patient complains of moderate to severe pain, worse with standing or walking on hard surfaces, with tenderness to palpation at the plantar aspect of the foot and midfoot region and tenderness over the course of the posterior tibialis tendon.Received for second opinion interpretations is an MRI examination performed on 05/27/2005.",Radiology,15,2577,1,14
leah_Radiology_0173_chunk12of14.wav,leah,"The metatarsophalangeal joint of the hallux was partially excluded from the field-of-view of this examination.Tendinosis of the posterior tibialis tendon with tendon thickening and possible surface fraying / tearing of the tendon immediately distal to the tip of the medial malleolus, however, confirmation of this finding would require additional imaging. Minimal synovitis of the flexor digitorum longus and flexor hallucis longus tendon sheaths, consistent with flexor splinting.",Radiology,15,2451,12,14
leah_Radiology_0173_chunk13of14.wav,leah,Edema of the subcutis adipose space along the medial and lateral aspects of the ankle suggesting altered biomechanics and crural fascial strain. Mild tendinosis of the tibialis anterior tendon with mild tendon thickening.,Radiology,15,1338,13,14
leah_Gastroenterology_0175_chunk10of19.wav,leah,"An 11 mm trocar was placed in the midline, superior to the GelPort and a 5 mm trocar placed in the midaxillary line below the costal margin. A liver retractor was placed to this.",Gastroenterology,23,1128,10,19
leah_Gastroenterology_0175_chunk18of19.wav,leah,He tolerated the procedure well. All sponge and instrument counts were correct.,Gastroenterology,23,435,18,19
leah_Gastroenterology_0176_chunk10of19.wav,leah,", After informed written consent, the risks and benefits of the procedure were explained to the patient and the patient's family. First, the EGD was to be performed.",Gastroenterology,23,876,10,19
leah_Cardiovascular _ Pulmonary_0177_chunk4of29.wav,leah,"His history from cardiac standpoint as mentioned below. , History of hypertension, history of diabetes mellitus, nonsmoker.",Cardiovascular / Pulmonary,33,715,4,29
leah_Cardiovascular _ Pulmonary_0177_chunk20of29.wav,leah,None significant. No TIA or CVA.,Cardiovascular / Pulmonary,33,372,20,29
leah_Cardiovascular _ Pulmonary_0177_chunk23of29.wav,leah,"Pulse of 75, blood pressure 130/68, afebrile, and respiratory rate 16 per minute. Atraumatic, normocephalic.",Cardiovascular / Pulmonary,33,904,23,29
leah_Cardiovascular _ Pulmonary_0178_chunk8of16.wav,leah,Mild stenosis mid LAD with mixed plaque. No stenosis.,Cardiovascular / Pulmonary,33,435,8,16
leah_Cardiovascular _ Pulmonary_0179_chunk9of14.wav,leah,No obvious intracardiac mass or thrombi noted. Doppler study reveals mild-to-moderate mitral regurgitation.,Cardiovascular / Pulmonary,33,757,9,14
leah_Cardiovascular _ Pulmonary_0179_chunk12of14.wav,leah,2. Moderate mitral regurgitation.,Cardiovascular / Pulmonary,33,295,12,14
leah_Cardiovascular _ Pulmonary_0180_chunk8of60.wav,leah,", Cosmetic surgery of the nose and forehead. NO KNOWN DRUG ALLERGIES.CURRENT MEDICATIONS,1.",Cardiovascular / Pulmonary,33,631,8,60
leah_Cardiovascular _ Pulmonary_0180_chunk9of60.wav,leah,Acyclovir 400 mg p.o. b.i.d.,Cardiovascular / Pulmonary,33,428,9,60
leah_Cardiovascular _ Pulmonary_0180_chunk42of60.wav,leah,"8, hematocrit of 30 and platelets 395. INR is 0.",Cardiovascular / Pulmonary,33,575,42,60
leah_Cardiovascular _ Pulmonary_0180_chunk48of60.wav,leah,", A middle-aged white female undergoing autologous stem cell transplant for multiple myeloma, now with paroxysmal atrial fibrillation. Currently enrolled in a blinded study, where she may receive a drug for prophylaxis against mucositis, which has at least one reported incident of acceleration of preexisting tachycardia.RECOMMENDATIONS,1.",Cardiovascular / Pulmonary,33,3634,48,60
leah_Cardiovascular _ Pulmonary_0180_chunk50of60.wav,leah,"However, given the risk of thromboembolic complications, would like to convert to normal sinus rhythm if possible. Given that she was in normal sinus rhythm approximately 24 hours ago, this is relatively acute onset within the last 24 hours.",Cardiovascular / Pulmonary,33,1401,50,60
leah_Cardiovascular _ Pulmonary_0180_chunk51of60.wav,leah,"We will initiate therapy with amiodarone 150 mg intravenous (IV) bolus followed by mg/minute at this juncture. If she does not have spontaneous cardioversion, we will consider either electrical cardioversion or anticoagulation with heparin within 24 hours from initiation of amiodarone.",Cardiovascular / Pulmonary,33,1828,51,60
leah_Radiology_0181_chunk1of8.wav,leah,",Left arm and hand numbness. , Noncontrast axial CT images of the head were obtained with 5 mm slice thickness.",Radiology,15,687,1,8
leah_Cardiovascular _ Pulmonary_0183_chunk4of12.wav,leah,"Chest catheter had been placed previously, and she had been draining up to 1. 5 liters of serous fluid a day.",Cardiovascular / Pulmonary,33,610,4,12
leah_SOAP _ Chart _ Progress Notes_0184_chunk2of27.wav,leah,He denies any more diarrhea or abdominal pain. Bowels are working okay.,SOAP / Chart / Progress Notes,34,456,2,27
leah_Gastroenterology_0185_chunk9of29.wav,leah,Thirty ml. Gastrostomy tube was placed to Foley.,Gastroenterology,23,337,9,29
leah_Gastroenterology_0185_chunk27of29.wav,leah,The catheter was then secured to the skin with two 2-0 silk sutures. Hemostasis was checked and the peritoneal cavity was washed out and brought to the surgical field.,Gastroenterology,23,939,27,29
leah_Cardiovascular _ Pulmonary_0187_chunk5of20.wav,leah,"Family history is remarkable for an older sibling found to have a small ventricular septal defect that is spontaneously closed. , A complete review of systems including neurologic, respiratory, gastrointestinal, genitourinary are otherwise negative.",Cardiovascular / Pulmonary,33,1422,5,20
leah_Cardiovascular _ Pulmonary_0187_chunk8of20.wav,leah,She had symmetric shallow breath sounds clear to auscultation. She had full symmetrical pulses.,Cardiovascular / Pulmonary,33,568,8,20
leah_Cardiovascular _ Pulmonary_0187_chunk13of20.wav,leah,The aorta was malopposed arising from the right ventricle in the anterior position with the left aortic arch. There was a small vertical ductus as a sole source of pulmonary artery blood flow.,Cardiovascular / Pulmonary,33,1037,13,20
leah_Cardiovascular _ Pulmonary_0188_chunk9of10.wav,leah,The right coronary artery was free of disease. There was no gradient across the aortic valve.,Cardiovascular / Pulmonary,33,540,9,10
leah_Cardiovascular _ Pulmonary_0189_chunk2of7.wav,leah,", Bronchoscopy with bronchoalveolar lavage. , 5 mg of Versed.",Cardiovascular / Pulmonary,33,435,2,7
leah_Cardiovascular _ Pulmonary_0189_chunk4of7.wav,leah,"Bronchoscope was advanced. Both right and left mainstem bronchioles and secondary and tertiary bronchioles were cannulated sequentially, lavaged out.",Cardiovascular / Pulmonary,33,771,4,7
leah_Cardiovascular _ Pulmonary_0189_chunk6of7.wav,leah,Specimen collected for culture. No obvious other abnormalities were noted.,Cardiovascular / Pulmonary,33,435,6,7
leah_Cardiovascular _ Pulmonary_0190_chunk5of24.wav,leah,"He denies any shortness of breath or dizziness, and states that the pain feels unlike the pain of his myocardial infarction. The patient has no other complaints at this time.",Cardiovascular / Pulmonary,33,946,5,24
leah_Cardiovascular _ Pulmonary_0190_chunk19of24.wav,leah,"O2 saturation, as interpreted by me, is 99%. ,The patient had a stable, uncomplicated emergency department course.",Cardiovascular / Pulmonary,33,869,19,24
leah_Cardiovascular _ Pulmonary_0192_chunk9of47.wav,leah,", The patient resides full time at ABC supervised living facility. He is nonsmoker, nondrinker.",Cardiovascular / Pulmonary,33,659,9,47
leah_Cardiovascular _ Pulmonary_0192_chunk18of47.wav,leah,"Ears, nose, mouth, and throat. Supple.",Cardiovascular / Pulmonary,33,414,18,47
leah_Cardiovascular _ Pulmonary_0192_chunk21of47.wav,leah,S1 and S2 are normal. No S3 or S4.,Cardiovascular / Pulmonary,33,449,21,47
leah_Cardiovascular _ Pulmonary_0192_chunk38of47.wav,leah,"No Q waves at the baseline of atrial fibrillation. Last measured ejection fraction 40% 12/08 with no significant decompensation.IMPRESSION/,1.",Cardiovascular / Pulmonary,33,981,38,47
leah_Cardiovascular _ Pulmonary_0193_chunk8of22.wav,leah,", The patient was admitted from the office by Dr. X.",Cardiovascular / Pulmonary,33,295,8,22
leah_Cardiovascular _ Pulmonary_0193_chunk16of22.wav,leah,"3. White blood cell count was 6100 with a normal differential, H&H 37.",Cardiovascular / Pulmonary,33,673,16,22
leah_Cardiovascular _ Pulmonary_0193_chunk17of22.wav,leah,"4/12. 1, platelets 335,000.",Cardiovascular / Pulmonary,33,414,17,22
leah_Cardiovascular _ Pulmonary_0193_chunk22of22.wav,leah,"Her daughter has been spoken to by phone and she will notify me if she worsens or has problems. ,Guarded.cardiovascular / pulmonary, chronic obstructive pulmonary disease exacerbation, chronic obstructive pulmonary disease, pulmonary, copd, discharge, bronchitis,",Cardiovascular / Pulmonary,33,1681,22,22
leah_Cardiovascular _ Pulmonary_0194_chunk3of17.wav,leah,XYZ Estep. He had concurred with Dr.,Cardiovascular / Pulmonary,33,421,3,17
leah_Cardiovascular _ Pulmonary_0194_chunk4of17.wav,leah,XYZ that an open lung biopsy was appropriate and she was actually scheduled for this but both Dr. XYZ and I were unavailable before the procedure was originally scheduled so he had it delayed so that she could talk with us prior to having the biopsy.,Cardiovascular / Pulmonary,33,1373,4,17
leah_Cardiovascular _ Pulmonary_0194_chunk12of17.wav,leah,"I also told her we could continue to monitor her breathing problems and continue to monitor her CAT scan, x-ray, and pulmonary function tests. And if there was some sign that this was a progressive problem, she could still go ahead with the lung biopsy.",Cardiovascular / Pulmonary,33,1247,12,17
leah_Cardiovascular _ Pulmonary_0194_chunk13of17.wav,leah,But she needed to understand that the treatment and likely diagnosis found from an open lung biopsy were not highly likely to be of any great help to her. She understands that the diagnoses made from open lung biopsy are not all that specific and that the treatment for the few specific things that can be detected are not often well tolerated or extremely helpful.,Cardiovascular / Pulmonary,33,1807,13,17
leah_Cardiovascular _ Pulmonary_0194_chunk16of17.wav,leah,These transcribed medical transcription sample reports may include some uncommon or unusual formatsthis would be due to the preference of the dictating physician. All names and dates have beenchanged (or removed) to keep confidentiality.,Cardiovascular / Pulmonary,33,1303,16,17
leah_Cardiovascular _ Pulmonary_0195_chunk2of5.wav,leah,", Insertion of a 12-French pigtail catheter in the left pleural space. ,After obtaining informed consent, the patient was taken to the minor OR in the Same Day Surgery where his posterior left chest was prepped and draped in a usual fashion.",Cardiovascular / Pulmonary,33,1261,2,5
leah_Cardiovascular _ Pulmonary_0196_chunk12of13.wav,leah,"He should be n.p.o. x4 hours, then liquid, then increase as tolerated.",Cardiovascular / Pulmonary,33,533,12,13
leah_Cardiovascular _ Pulmonary_0196_chunk13of13.wav,leah,"Once his infection is cleared, he should follow up with us with regard to followup of patent foramen ovale.cardiovascular / pulmonary, ventricle, atrium, mitral valve, aortic valve, tricuspid valve, pulmonic valve, regurgitation, transesophageal probe, transesophageal echocardiogram, posterior pharynx, transesophageal, valve",Cardiovascular / Pulmonary,33,2052,13,13
leah_Cardiovascular _ Pulmonary_0197_chunk6of6.wav,leah,", Several discrete patchy air-space opacities in the right upper lobe, compatible with pneumonia.cardiovascular / pulmonary, ct chest, air-space, axillary, chest x-ray, consolidation, contrast, contrast-enhanced, effusion, hilar, infiltrates, lung, lymphadenopathy, mass, mediastinal, parenchyma, patchy air-space, pneumonia, pneumothorax, right upper lobe, spiral images, with contrast, air space opacities, upper lobe, opacities, ct, lobe, chest",Cardiovascular / Pulmonary,33,3543,6,6
leah_Gastroenterology_0198_chunk5of47.wav,leah,The patient's normal bowel pattern is loose stools and this is unchanged recently. He has not had any rectal bleeding.,Gastroenterology,23,617,5,47
leah_Gastroenterology_0198_chunk40of47.wav,leah,S's instructions. 3.,Gastroenterology,23,316,40,47
leah_Gastroenterology_0198_chunk45of47.wav,leah,Reviewed the importance of prophylactic treatment of reflux-type symptoms. Encouraged the patient to take over-the-counter H2 blockers on a daily basis to prevent symptoms from occurring.,Gastroenterology,23,946,45,47
leah_Cardiovascular _ Pulmonary_0199_chunk8of42.wav,leah,A 3DRC catheter was intubated into the right coronary artery. Several projections were obtained and the catheter was removed.,Cardiovascular / Pulmonary,33,680,8,42
leah_Cardiovascular _ Pulmonary_0199_chunk34of42.wav,leah,"Then, after stent placement there was 0% residual stenosis however, there was partial occlusion of the third posterolateral branch. Then, a wire was advanced through this and there was improvement of flow.",Cardiovascular / Pulmonary,33,1100,34,42
leah_Cardiovascular _ Pulmonary_0200_chunk1of16.wav,leah,"PREOPERATIVE DIAGNOSES,1. Bilateral bronchopneumonia.",Cardiovascular / Pulmonary,33,477,1,16
leah_Cardiovascular _ Pulmonary_0200_chunk5of16.wav,leah,2. Limited left thoracotomy with partial pulmonary decortication and insertion of chest tubes x2.,Cardiovascular / Pulmonary,33,610,5,16
leah_Cardiovascular _ Pulmonary_0200_chunk10of16.wav,leah,"I had recently re-inspected the CT of the chest and decided to make a limited thoracotomy of about 6 cm or so in the midaxillary line about the sixth intercostal space. Immediately, it was evident that there was a large amount of pus in the left chest.",Cardiovascular / Pulmonary,33,1296,10,16
leah_Cardiovascular _ Pulmonary_0200_chunk15of16.wav,leah,"Then, the patient was transported. Estimated blood loss was minimal and the patient tolerated the procedure well.",Cardiovascular / Pulmonary,33,645,15,16
leah_Cardiovascular _ Pulmonary_0201_chunk2of18.wav,leah,2. Coronary angiography.,Cardiovascular / Pulmonary,33,232,2,18
leah_Cardiovascular _ Pulmonary_0201_chunk4of18.wav,leah,"After informed consent was obtained, the patient was taken to the cardiac catheterization laboratory. Patient was prepped and draped in sterile fashion.",Cardiovascular / Pulmonary,33,876,4,18
leah_Cardiovascular _ Pulmonary_0201_chunk18of18.wav,leah,"3. No significant coronary artery disease identified in the left main coronary artery, left anterior descending coronary artery, circumflex coronary artery or the right coronary artery.cardiovascular / pulmonary, ventriculography, catheterization, seldinger, hypokinesis, estimated ejection fraction, severe mitral regurgitation, descending coronary artery, coronary artery, aortic pressure, heart catheterization, stenotic lesions, coronary, artery, heart, angiography, anterior, ventricular, ventriculogram, lesions",Cardiovascular / Pulmonary,33,3410,18,18
leah_Gastroenterology_0202_chunk6of13.wav,leah,It was carried down to the fascia. An open pneumoperitoneum was created with Hasson technique.,Gastroenterology,23,533,6,13
leah_Gastroenterology_0202_chunk8of13.wav,leah,"It was carefully retracted from the isthmus, and the cystic structure was then carefully identified, dissected, and divided between double clips. The gallbladder was then taken down from the gallbladder fossa with electrocautery.",Gastroenterology,23,1184,8,13
leah_Cardiovascular _ Pulmonary_0203_chunk2of26.wav,leah,"After informed consent, he was medicated with Versed and fentanyl. The right groin was prepped and draped, and infiltrated with 2% Xylocaine.",Cardiovascular / Pulmonary,33,848,2,26
leah_Cardiovascular _ Pulmonary_0203_chunk16of26.wav,leah,"Circumflex artery was nondominant vessel, consisting of an obtuse marginal vessel. The first obtuse marginal had a long 50% narrowing and then the AV groove branch was free of any disease.",Cardiovascular / Pulmonary,33,1107,16,26
leah_Gastroenterology_0204_chunk15of17.wav,leah,2. The patient should be referred to an otolaryngologist for further evaluation of her oral cavity particularly the area between her faucial pillars.,Gastroenterology,23,813,15,17
leah_Gastroenterology_0204_chunk16of17.wav,leah,The above recommendations and results of the evaluation were discussed with the patient as well as her daughter and both responded appropriately. Thank you for the opportunity to be required the patient's medical care.,Gastroenterology,23,974,16,17
leah_Cardiovascular _ Pulmonary_0205_chunk4of30.wav,leah,Additional heparin was given. A 6-French pigtail catheter was passed.,Cardiovascular / Pulmonary,33,400,4,30
leah_Cardiovascular _ Pulmonary_0205_chunk6of30.wav,leah,Nitroglycerin was given in the left main. Left coronary angiography was performed.,Cardiovascular / Pulmonary,33,582,6,30
leah_Cardiovascular _ Pulmonary_0205_chunk11of30.wav,leah,The lesion was measured. A 4.,Cardiovascular / Pulmonary,33,239,11,30
leah_Cardiovascular _ Pulmonary_0205_chunk19of30.wav,leah,There is mild MR noted. 3.,Cardiovascular / Pulmonary,33,267,19,30
leah_Cardiovascular _ Pulmonary_0205_chunk22of30.wav,leah,There is a 1st diagonal which has a branch that is 1. 5 mm with a proximal 50% narrowing.c.,Cardiovascular / Pulmonary,33,680,22,30
leah_Cardiovascular _ Pulmonary_0205_chunk28of30.wav,leah,"Triple-vessel coronary artery disease with a borderline lesion in a very small branch of the 1st diagonal and significant lesions in the mid dominant right coronary artery and the distal circumflex, which is basically old. 4.",Cardiovascular / Pulmonary,33,1317,28,30
jess_Gastroenterology_0206_chunk4of19.wav,jess,Supplemental O2 given. Specifics of the procedure discussed.,Gastroenterology,23,421,4,19
jess_Gastroenterology_0206_chunk14of19.wav,jess,"Extremity exam showed large hands. He was a Mallampati score A, ASA classification type 2.",Gastroenterology,23,603,14,19
jess_Gastroenterology_0209_chunk21of25.wav,jess,"There were also several small sessile polyps, which were removed with biopsy forceps. Biopsy was also taken for CLO.",Gastroenterology,23,659,21,25
jess_Gastroenterology_0209_chunk22of25.wav,jess,A hiatal hernia was present as well. Air was aspirated.,Gastroenterology,23,386,22,25
jess_Cardiovascular _ Pulmonary_0210_chunk1of9.wav,jess,", Chest PA & Lateral. , Shortness of breath, evaluate for pneumothorax versus left-sided effusion.",Cardiovascular / Pulmonary,33,596,1,9
jess_Gastroenterology_0212_chunk4of20.wav,jess,"She then underwent an MRI MRCP, which was notable for stricture of the distal common bile duct. She was then referred to gastroenterology and underwent an ERCP.",Gastroenterology,23,904,4,20
jess_Gastroenterology_0214_chunk5of15.wav,jess,"A curvilinear incision was made below the umbilicus. Through this incision, the camera port was able to be placed into the peritoneal cavity under direct visualization.",Gastroenterology,23,897,5,15
jess_Gastroenterology_0214_chunk7of15.wav,jess,"Once all four ports were placed, the right upper quadrant was then explored. The patient had significant adhesions of omentum and colon to the liver, the gallbladder constituting definitely an acute cholecystitis.",Gastroenterology,23,1086,7,15
jess_Gastroenterology_0214_chunk10of15.wav,jess,"At this point, due to the patient's gallbladder being very necrotic, it was deemed that the patient should have a drain placed. The cystic duct and cystic artery were serially clipped and transected.",Gastroenterology,23,988,10,15
jess_Gastroenterology_0214_chunk15of15.wav,jess,"The skin was reapproximated further using 4-0 Monocryl sutures in a subcuticular technique. The patient tolerated the procedure well and was able to be transferred to the recovery room in stable condition.gastroenterology, acute cholecystitis, cholangiogram, cholelithiasis, cholecystitis, gallbladder, gangrenous cholecystitis, bovie cautery, cystic duct, laparoscopic cholecystectomy, laparoscopic, cholecystectomy, cystic, duct,",Gastroenterology,23,2444,15,15
jess_SOAP _ Chart _ Progress Notes_0216_chunk9of10.wav,jess,Continue present therapy. 3.,SOAP / Chart / Progress Notes,34,232,9,10
jess_Cardiovascular _ Pulmonary_0217_chunk17of22.wav,jess,I carefully questioned mother about compliance and concomitant use of dairy products while taking these medications. She assures me that he is compliant with his medications.,Cardiovascular / Pulmonary,33,876,17,22
jess_Cardiovascular _ Pulmonary_0217_chunk18of22.wav,jess,We will however repeat his hydroxychloroquine and doxycycline levels. 2.,Cardiovascular / Pulmonary,33,456,18,22
jess_Cardiovascular _ Pulmonary_0217_chunk19of22.wav,jess,Repeat Q-fever serology. 3.,Cardiovascular / Pulmonary,33,260,19,22
jess_Radiology_0218_chunk5of10.wav,jess,5. Peak systolic velocity is 280 cm/sec in external carotid artery with moderate spectral broadening.,Radiology,15,659,5,10
jess_SOAP _ Chart _ Progress Notes_0219_chunk4of32.wav,jess,"Also, since she is on Mavik plus verapamil, she could switch over to the combined drug Tarka. However, when we gave her samples of that she thought they were too big for her to swallow.",SOAP / Chart / Progress Notes,34,911,4,32
jess_SOAP _ Chart _ Progress Notes_0219_chunk7of32.wav,jess,"We did do a C-spine and right shoulder x-ray and those just mainly showed some degenerative changes and possibly some rotator cuff injury with the humeral head quite high up in the glenoid in the right shoulder, but this does not seem to cause her any problems. She has some vague “stomach problems”, although apparently it is improved when she stopped Aleve and she does not have any more aches or pains off Aleve.",SOAP / Chart / Progress Notes,34,1989,7,32
jess_SOAP _ Chart _ Progress Notes_0219_chunk10of32.wav,jess,"and also Mylanta at night. She has had dentures for many, many years and just recently I guess in the last few months, although she was somewhat vague on this, she has had some sores in her mouth.",SOAP / Chart / Progress Notes,34,1002,10,32
jess_SOAP _ Chart _ Progress Notes_0219_chunk28of32.wav,jess,5. Osteoporosis.,SOAP / Chart / Progress Notes,34,190,28,32
jess_SOAP _ Chart _ Progress Notes_0219_chunk29of32.wav,jess,6. Osteoarthritis.,SOAP / Chart / Progress Notes,34,225,29,32
jess_SOAP _ Chart _ Progress Notes_0219_chunk30of32.wav,jess,"I think I will just watch everything for now. I would continue the Lexapro, we gave her more samples plus a prescription for the 20 mg that she can cut in half.",SOAP / Chart / Progress Notes,34,764,30,32
jess_Cardiovascular _ Pulmonary_0221_chunk4of61.wav,jess,4. Right heart catheterization.,Cardiovascular / Pulmonary,33,239,4,61
jess_Cardiovascular _ Pulmonary_0221_chunk6of61.wav,jess,The patient was taken to cardiac catheterization suite where the right femoral region was prepped and draped in the usual sterile fashion. 1% lidocaine solution was used to infiltrate the skin overlying the right femoral artery and vein.,Cardiovascular / Pulmonary,33,1240,6,61
jess_Cardiovascular _ Pulmonary_0221_chunk37of61.wav,jess,There is a mid 60% to 70% stenotic lesion followed by a second mid 90% stenotic lesion. The first obtuse marginal branch is small and the second obtuse marginal branch is large without any evidence of critical disease.,Cardiovascular / Pulmonary,33,1352,37,61
jess_Cardiovascular _ Pulmonary_0221_chunk52of61.wav,jess,Two-vessel coronary artery disease with a complex left anterior descending arterial lesion as well as circumflex disease. 2.,Cardiovascular / Pulmonary,33,736,52,61
jess_Cardiovascular _ Pulmonary_0222_chunk12of17.wav,jess,There was no gradient across the aortic valve. The central aortic pressure was 160 mmHg.,Cardiovascular / Pulmonary,33,547,12,17
jess_Lab Medicine - Pathology_0223_chunk4of6.wav,jess,"A frozen section is submitted. , Benign cystic ovary.lab medicine - pathology, right ovarian cyst, specimen, ovarian cyst, frozen section, ovarian, frozen, sectionNOTE,: Thesetranscribed medical transcription sample reports and examples are provided by various users andare for reference purpose only.",Lab Medicine - Pathology,31,1716,4,6
jess_Gastroenterology_0227_chunk6of16.wav,jess,"ABC's sister, after the risks and benefits of the procedure were carefully explained, which included but were not limited to bleeding, infection, perforation, and allergic reaction to the medications. Consent was not obtained from Mrs.",Gastroenterology,23,1163,6,16
jess_Gastroenterology_0227_chunk16of16.wav,jess,", Followup results of the biopsies and will have radiology replace her gastrojejunal feeding tube.gastroenterology, recurrent nausea and vomiting, egd with biopsy, nausea and vomiting, gastrojejunal feeding tube, feeding tube remnant, recurrent nausea, gej feeding, gastrojejunal feeding, proximal esophagus, hiatal hernia, feeding tube, egd, biopsy, nausea, vomiting, gej, gastrojejunal, duodenum, esophagitis, multiple, distal, biopsies, hiatal, hernia, antrum, esophagus, feeding, tube, stomach,",Gastroenterology,23,2850,16,16
jess_Gastroenterology_0230_chunk9of12.wav,jess,"The sigmoid showed diverticula throughout, mild to moderate in nature. The scope was then passed through the descending and transverse colon over to the hepatic flexure area and then the anastomosis site was visualized.",Gastroenterology,23,1065,9,12
jess_Cardiovascular _ Pulmonary_0231_chunk15of19.wav,jess,"After this, the patient's anterior trachea was then identified and cleaned with pusher. After this, the cricoid cartilage along the first and second tracheal rings was identified.",Cardiovascular / Pulmonary,33,890,15,19
jess_Cardiovascular _ Pulmonary_0231_chunk16of19.wav,jess,"The cricoid hook was placed and the trachea was brought more anteriorly and superiorly. After this, the patient's head incision was placed below the second tracheal ring with a 15 Bard-Parker.",Cardiovascular / Pulmonary,33,1128,16,19
jess_Cardiovascular _ Pulmonary_0231_chunk18of19.wav,jess,"After this, the cricoid hook was removed and the patient then had FiO2 on the monitor noted with pulse oximetry of 100%. The patient was then turned back to the anesthesia and transferred to the recovery room in stable condition.",Cardiovascular / Pulmonary,33,1205,18,19
jess_Radiology_0235_chunk2of10.wav,jess,",Duplex and color flow imaging as well as real time gray-scale imaging of the scrotum and testicles was performed. The left testicle measures 5.",Radiology,15,834,2,10
jess_Radiology_0235_chunk6of10.wav,jess,There is a trace hydrocele. The right testicle measures 5.,Radiology,15,344,6,10
jess_Radiology_0236_chunk3of11.wav,jess,", Multiple transaxial images utilized in 10 mm sections were obtained through the chest. Intravenous contrast was administered.",Radiology,15,701,3,11
jess_Gastroenterology_0237_chunk5of13.wav,jess,"Below this, there was a small hiatal hernia with the hiatus noted at 42 cm from the incisors. The mucosa within the hernia was normal.",Gastroenterology,23,764,5,13
jess_Gastroenterology_0237_chunk10of13.wav,jess,Esophagitis. 2.,Gastroenterology,23,183,10,13
jess_Gastroenterology_0237_chunk12of13.wav,jess,Hiatal hernia. 4.,Gastroenterology,23,204,12,13
jess_Gastroenterology_0238_chunk8of12.wav,jess,"At this time, the patient as well complained of epigastric discomfort and nausea. This pain was similar to her previous pain.",Gastroenterology,23,631,8,12
jess_Gastroenterology_0238_chunk12of12.wav,jess,"The patient tolerated the procedure well. We will await evaluation of bile aspirate.gastroenterology, bile aspirate, esophageal, gastroduodenoscopy, kinevac, oropharynx, esophagogastroduodenoscopy, gastroscope",Gastroenterology,23,1219,12,12
jess_Gastroenterology_0239_chunk9of16.wav,jess,There was enough however in the wall to identify the location of the polyp. The lesion was grasped with a Babcock clamp and an Endo GIA stapler used to fire across this transversely.,Gastroenterology,23,967,9,16
jess_Gastroenterology_0239_chunk10of16.wav,jess,The specimen was then removed through the 12-mm port and examined on the back table. The lateral margin was found to be closely involved with the specimen so I did not feel that it was clear.,Gastroenterology,23,904,10,16
jess_Gastroenterology_0240_chunk2of14.wav,jess,", Versed 5 mg IV. The Olympus gastroscope was used.",Gastroenterology,23,463,2,14
jess_Gastroenterology_0240_chunk6of14.wav,jess,There was no blood present within the stomach. The scope was then brought back into the stomach and retroflexed in order to inspect the upper portion of the body of the stomach.,Gastroenterology,23,820,6,14
jess_Gastroenterology_0242_chunk3of8.wav,jess,", After informed consent was obtained, the patient was placed in the left lateral decubitus position and sedated with the above medications. The Olympus video colonoscope was inserted through the anus and was advanced in retrograde fashion through the sigmoid colon, descending colon, around the splenic flexure, into the transverse colon, around the hepatic flexure, down the ascending colon, into the cecum.",Gastroenterology,23,1989,3,8
jess_Radiology_0245_chunk5of7.wav,jess,"No obvious clot identified on the color flow or Doppler images. The left leg is better visualized than the right, but again is limited.",Radiology,15,764,5,7
jess_Radiology_0245_chunk6of7.wav,jess,"No definite clot is seen. , Limited study secondary to body habitus and edema.",Radiology,15,456,6,7
jess_Radiology_0246_chunk9of9.wav,jess,"Small postvoid residual.radiology, bilateral renal ultrasound, postvoid residual, renal ultrasound, residual, kidneys, renal, ultrasound,",Radiology,15,869,9,9
jess_Cardiovascular _ Pulmonary_0247_chunk2of12.wav,jess,"After general endotracheal anesthesia was induced, the appropriate monitoring devices were placed. The patient was placed in the right lateral decubitus position.",Cardiovascular / Pulmonary,33,883,2,12
jess_Cardiovascular _ Pulmonary_0247_chunk7of12.wav,jess,The artery was dissected free and it was divided with an Endo GIA stapler. The vein was then dissected free and divided with an Endo GIA stapler.,Cardiovascular / Pulmonary,33,792,7,12
jess_Cardiovascular _ Pulmonary_0247_chunk8of12.wav,jess,"The bronchus was then cleaned of all nodal tissue. A TA-30 green loaded stapler was then placed across this, fired, and main bronchus divided distal to the stapler.",Cardiovascular / Pulmonary,33,855,8,12
jess_Cardiovascular _ Pulmonary_0249_chunk1of32.wav,jess,",Metastatic renal cell carcinoma. Metastatic renal cell carcinoma.",Cardiovascular / Pulmonary,33,407,1,32
jess_Cardiovascular _ Pulmonary_0249_chunk15of32.wav,jess,", Stable. , The patient was given preoperative informed consent for the procedure as well as for the clinical trial he was enrolled into.",Cardiovascular / Pulmonary,33,673,15,32
jess_Cardiovascular _ Pulmonary_0249_chunk16of32.wav,jess,"The patient agreed based on the risks and the benefits of the procedure, which were presented to him and was taken to the operating room. A correct time out procedure was performed.",Cardiovascular / Pulmonary,33,806,16,32
jess_Cardiovascular _ Pulmonary_0249_chunk18of32.wav,jess,"Fiberoptic bronchoscopy was used to perform confirmation of adequate placement of the double-lumen tube. Following this, the decision was made to proceed with the surgery.",Cardiovascular / Pulmonary,33,904,18,32
jess_Cardiovascular _ Pulmonary_0249_chunk20of32.wav,jess,The patient had a sterile DuraPrep preparation to the left chest. A sterile drape around that was applied.,Cardiovascular / Pulmonary,33,533,20,32
jess_Cardiovascular _ Pulmonary_0249_chunk27of32.wav,jess,"The patient tolerated the procedure well without any complications. The largest lesion was the left upper lobe apex lesion, which was possibly multiple lesions, which was taken in one large wedge segment, and this was also adjacent to another area of the wedges.",Cardiovascular / Pulmonary,33,1422,27,32
jess_Gastroenterology_0251_chunk11of15.wav,jess,Mesoappendix was then taken with 2 fires of the vascular load on the GIA stapler. Appendix was placed in an Endobag and removed from the patient.,Gastroenterology,23,848,11,15
jess_Gastroenterology_0251_chunk12of15.wav,jess,Right lower quadrant was copiously irrigated. All irrigation fluids were removed.,Gastroenterology,23,519,12,15
jess_SOAP _ Chart _ Progress Notes_0252_chunk10of38.wav,jess,4. NPH insulin - 65 units in the morning and 25 units in the evening.,SOAP / Chart / Progress Notes,34,498,10,38
jess_SOAP _ Chart _ Progress Notes_0252_chunk20of38.wav,jess,Able to get up out of a chair with normal get up and go. Bilateral OA changes of the knee.,SOAP / Chart / Progress Notes,34,484,20,38
jess_SOAP _ Chart _ Progress Notes_0252_chunk21of38.wav,jess,"Creatinine 1. 7, which was down from 2.",SOAP / Chart / Progress Notes,34,323,21,38
jess_Cardiovascular _ Pulmonary_0255_chunk8of20.wav,jess,"Beneath the strap muscles, there was dense inflammation scarring obscuring palpable landmarks. There appeared to be significant scarring fusion of soft tissue at the perichondrium and cartilage of the cricoid making the cricoid easily definable.",Cardiovascular / Pulmonary,33,1205,8,20
jess_Cardiovascular _ Pulmonary_0255_chunk11of20.wav,jess,"The tracheal cartilage externally had marked thickening and significant stiffness calcification, and the tracheal wall from the outside of the trachea to the mucosa measured 3 to 4 mm in thickness. The trachea was entered and visualized with thickening of the mucosa and submucosa was noted.",Cardiovascular / Pulmonary,33,1562,11,20
jess_Cardiovascular _ Pulmonary_0256_chunk8of30.wav,jess,"The patient was appropriately prepped and prepared on the table, after which his right groin was locally anesthetized with 1% lidocaine. Then, a 6-French sheath was inserted into the right femoral artery.",Cardiovascular / Pulmonary,33,1107,8,30
jess_Cardiovascular _ Pulmonary_0256_chunk17of30.wav,jess,The PLV branch was 100% occluded at its ostium at the crux. The PDA at the ostium had an 80% stenosis.,Cardiovascular / Pulmonary,33,785,17,30
jess_Cardiovascular _ Pulmonary_0256_chunk29of30.wav,jess,Ancef 1 g IV was given for closure device prophylaxis. 200 mL.,Cardiovascular / Pulmonary,33,484,29,30
jess_Cardiovascular _ Pulmonary_0256_chunk30of30.wav,jess,"12. 4 minutes.cardiovascular / pulmonary, coronary angiography, ventricular pressure, coronary angioplasty, french, pda, drug-eluting stent, coronary artery disease, cardiac catheterization lab, plv branch, cardiac catheterization, femoral artery, coronary artery, artery, coronary, angioplasty, angiogram, angiographically, arteriotomy, angiography, cardiac, circumflex, ostium, ventricular, femoral, percutaneous, catheterization,",Cardiovascular / Pulmonary,33,2808,30,30
jess_Cardiovascular _ Pulmonary_0257_chunk3of26.wav,jess,Esophageal exploration and repair of esophageal perforation. 3.,Cardiovascular / Pulmonary,33,379,3,26
jess_Cardiovascular _ Pulmonary_0257_chunk19of26.wav,jess,"A Veress needle was carefully inserted into the abdomen, pneumoperitoneum was established in the usual fashion, a bladeless 5-mm separator trocar was introduced. The laparoscope was introduced.",Cardiovascular / Pulmonary,33,1135,19,26
jess_Cardiovascular _ Pulmonary_0257_chunk25of26.wav,jess,"Aspiration demonstrated gastric content. Gastrostomy tube study, with interpretation.",Cardiovascular / Pulmonary,33,288,25,26
jess_Cardiovascular _ Pulmonary_0258_chunk2of36.wav,jess,"Using the percutaneous Seldinger technique via the right femoral artery, a left heart catheterization was performed. Coronary arteriography was performed with 6-French performed coronary catheters.",Cardiovascular / Pulmonary,33,1093,2,36
jess_Cardiovascular _ Pulmonary_0258_chunk8of36.wav,jess,The left ventricular cavity is normal in size with excellent contractility. Aneurysmal dilatation and/or dyskinesia absent.,Cardiovascular / Pulmonary,33,792,8,36
jess_Cardiovascular _ Pulmonary_0258_chunk9of36.wav,jess,The aortic valve is tricuspid and normal mobility. The ascending aorta appeared normal.,Cardiovascular / Pulmonary,33,505,9,36
jess_Cardiovascular _ Pulmonary_0258_chunk12of36.wav,jess,"The abdominal aortogram reveals wide patency of that area with mild intimal irregularity. There is a normal left renal artery, normal right renal artery.",Cardiovascular / Pulmonary,33,890,12,36
jess_Cardiovascular _ Pulmonary_0258_chunk15of36.wav,jess,Prior to the introduction of the 5-French JR4 nitroglycerin was administered sublingually. The 6-French JR4 catheters appeared to a show an ostial lesion of over 50%.,Cardiovascular / Pulmonary,33,953,15,36
jess_Cardiovascular _ Pulmonary_0258_chunk16of36.wav,jess,"There was backwash of dye into the aorta, although there is a fine funneling of the ostium towards the proximal right coronary artery. In the proximal portion of the right coronary artery just into the Shepherd turn, there is a 50% smooth tapering of the right coronary artery in the proximal third.",Cardiovascular / Pulmonary,33,1583,16,36
jess_Cardiovascular _ Pulmonary_0258_chunk20of36.wav,jess,"The left coronary artery is normal, although there is a rim of ostial calcification, but there is no tapering or stenosis. It forms the left anterior descending artery, the ramus branch, and the circumflex artery.",Cardiovascular / Pulmonary,33,1212,20,36
jess_Cardiovascular _ Pulmonary_0258_chunk32of36.wav,jess,Ostial stenosis of the right coronary artery that appears to be about 50% or greater. The proximal right coronary artery has 50% stenosis as well.,Cardiovascular / Pulmonary,33,890,32,36
jess_Cardiovascular _ Pulmonary_0258_chunk35of36.wav,jess,"It is at least 50%, but it could be worse. Therefore, she will be evaluated for the possibility of an IVUS and/or _______ analysis of the proximal right coronary artery.",Cardiovascular / Pulmonary,33,1079,35,36
jess_Cardiovascular _ Pulmonary_0259_chunk9of17.wav,jess,Dissection was carried down through the fascia and the xiphoid was resected. The sternum was retracted superiorly the pericardium was identified and pericardial fat was cleared off the pericardium.,Cardiovascular / Pulmonary,33,988,9,17
jess_Cardiovascular _ Pulmonary_0259_chunk16of17.wav,jess,The patient tolerated the procedure well. Chest tubes were placed on 20 cm of water suction.,Cardiovascular / Pulmonary,33,547,16,17
jess_Cardiovascular _ Pulmonary_0262_chunk2of34.wav,jess,VATS right middle lobectomy. 2.,Cardiovascular / Pulmonary,33,281,2,34
jess_Cardiovascular _ Pulmonary_0262_chunk4of34.wav,jess,Mediastinal lymph node sampling including levels 4R and 7. 4.,Cardiovascular / Pulmonary,33,477,4,34
jess_Cardiovascular _ Pulmonary_0262_chunk10of34.wav,jess,All of the biopsy sites were additionally marked with Hemoclips. The right middle lobe lesion was accompanied with distal pneumonitis and otherwise no direct involvement of the right upper lobe or right lower lobe.,Cardiovascular / Pulmonary,33,1086,10,34
jess_Cardiovascular _ Pulmonary_0262_chunk13of34.wav,jess,"The patient was subsequently taken to the operating room on April 4, 2007, was given general anesthesia and was endotracheally intubated without incident. Although, he had markedly difficult airway, the patient had fiberoptic bronchoscopy performed all the way down to the level of the subsegmental bronchi.",Cardiovascular / Pulmonary,33,1555,13,34
jess_Cardiovascular _ Pulmonary_0262_chunk26of34.wav,jess,"Initially, this was thought to be the main right middle lobe bronchus, but in fact it was the medial branch of the right middle lobe bronchus. This was encircled and divided with a blue load stapler with a 45-mm EndoGIA.",Cardiovascular / Pulmonary,33,1163,26,34
jess_Cardiovascular _ Pulmonary_0262_chunk31of34.wav,jess,"Following removal of the right middle lobe, a meticulous lymph node dissection sampling was performed excising the lymph node package in the 4R area as well as the 7 lymph node package. Node station 8 or 9 nodes were easily identified, therefore none were taken.",Cardiovascular / Pulmonary,33,1422,31,34
jess_Cardiovascular _ Pulmonary_0262_chunk32of34.wav,jess,The patient was allowed to ventilate under water on the right lung with no obvious air leaking noted. A 19-French Blake was placed into the posterior apical position and a 32-French chest tube was placed in the anteroapical position.,Cardiovascular / Pulmonary,33,1233,32,34
jess_SOAP _ Chart _ Progress Notes_0263_chunk7of17.wav,jess,"However, I told her that two years ago Dr. XYZ did pulmonary function studies which showed the same change in function.",SOAP / Chart / Progress Notes,34,694,7,17
jess_SOAP _ Chart _ Progress Notes_0263_chunk12of17.wav,jess,"I also told her we could continue to monitor her breathing problems and continue to monitor her CAT scan, x-ray, and pulmonary function tests. And if there was some sign that this was a progressive problem, she could still go ahead with the lung biopsy.",SOAP / Chart / Progress Notes,34,1177,12,17
jess_Radiology_0264_chunk10of28.wav,jess,HR83. RR 20.,Radiology,15,232,10,28
jess_Radiology_0264_chunk14of28.wav,jess,Impaired writing of name.CN: Flattened right nasolabial fold only. Motor: Mild weakness in RUE manifested by pronator drift.,Radiology,15,841,14,28
jess_Radiology_0265_chunk5of23.wav,jess,The right ECA is patent as well with the velocity measurement 0. 910 m/second.,Radiology,15,547,5,23
jess_Radiology_0265_chunk16of23.wav,jess,This should be further assessed with CTA for more precise measurement. The left proximal ICA/PSV 0.,Radiology,15,652,16,23
jess_Cardiovascular _ Pulmonary_0267_chunk5of20.wav,jess,Argon plasma coagulation to control bleeding in the trachea. 5.,Cardiovascular / Pulmonary,33,449,5,20
jess_Cardiovascular _ Pulmonary_0267_chunk12of20.wav,jess,", After informed consent was obtained from the patient, he was brought into the operating field. A rapid sequence induction was done.",Cardiovascular / Pulmonary,33,645,12,20
jess_Cardiovascular _ Pulmonary_0268_chunk6of8.wav,jess,"The coronary arteries appear to be normal in their origins. The aortic arch is left-sided and patent with normal descending aorta pulsatility.cardiovascular / pulmonary, 2-d echocardiogram, cardiac function, doppler, echocardiogram, multiple views, aortic valve, coronary arteries, descending aorta, great vessels, heart, hypertrophy, interatrial septum, intracardiac, pericardial effusion, tricuspid, vegetation, venous, pulmonaryNOTE,: Thesetranscribed medical transcription sample reports and examples are provided by various users andare for reference purpose only.",Cardiovascular / Pulmonary,33,3557,6,8
jess_Gastroenterology_0269_chunk3of36.wav,jess,", This is a 63-year-old white male patient with multiple medical problems including hypertension, diabetes, end-stage renal disease, coronary artery disease, and the patient is on hemodialysis, who has had recurrent episodes of epigastric right upper quadrant pain. The patient was found to have cholelithiasis on last admission.",Gastroenterology,23,1478,3,36
jess_Gastroenterology_0269_chunk9of36.wav,jess,Fascia was opened vertically and stay sutures were placed in the fascia. Peritoneal cavity was carefully entered.,Gastroenterology,23,603,9,36
jess_Gastroenterology_0269_chunk16of36.wav,jess,"Eventually, the gallbladder was identified, which was markedly scarred down and shrunk and appeared to have palpable stone in it. Dissection was further carried down to what was felt to be the common bile duct, which appeared to be somewhat larger than normal about a centimeter in size.",Gastroenterology,23,1303,16,36
jess_Gastroenterology_0270_chunk4of47.wav,jess,She underwent colonoscopy on 04/30/2007 by Dr. Y.,Gastroenterology,23,435,4,47
jess_Gastroenterology_0270_chunk9of47.wav,jess,"8 x 1. 7 cm, circumferential and invading in to the subserosal mucosa greater than 5 mm, 13 lymph nodes were negative for metastasis.",Gastroenterology,23,1030,9,47
jess_Gastroenterology_0270_chunk19of47.wav,jess,", No significant medical problem. She has had three miscarriages, all of them at about seven weeks.",Gastroenterology,23,491,19,47
jess_Radiology_0271_chunk1of10.wav,jess,", Digital screening mammogram. 51-year-old female presents for screening mammography.",Radiology,15,449,1,10
jess_Radiology_0271_chunk9of10.wav,jess,Lack of radiographic evidence of malignancy should not delay a biopsy if a clinically suspicious mass is present. 3.,Radiology,15,638,9,10
jess_Gastroenterology_0273_chunk8of17.wav,jess,"There was a similar lesion in the descending colon. Both of these appeared to be lipomatous, so no attempt was made to remove them.",Gastroenterology,23,666,8,17
jess_Gastroenterology_0273_chunk15of17.wav,jess,"Small rectal polyps, obliterated them. 4.",Gastroenterology,23,281,15,17
jess_Cardiovascular _ Pulmonary_0275_chunk10of22.wav,jess,", LVEDP of 11. There was no gradient across the aortic valve upon pullback.1.",Cardiovascular / Pulmonary,33,617,10,22
jess_Cardiovascular _ Pulmonary_0275_chunk12of22.wav,jess,The left main coronary artery is free of any disease. 3.,Cardiovascular / Pulmonary,33,428,12,22
jess_Cardiovascular _ Pulmonary_0275_chunk18of22.wav,jess,6. The right coronary artery is a dominant vessel and has mild luminal irregularities.,Cardiovascular / Pulmonary,33,561,18,22
jess_Gastroenterology_0277_chunk5of24.wav,jess,"The patient is married and is a nonsmoker, and lives with her husband, who is here with her.REVIEW OF SYSTEMS,Patient denies any fever or cough. She notes no blood in her vomitus or stool.",Gastroenterology,23,1058,5,24
jess_Gastroenterology_0277_chunk9of24.wav,jess,"Pharynx shows no erythema, tonsillar edema, or exudate. No enlarged anterior or posterior cervical lymph nodes.",Gastroenterology,23,694,9,24
jess_Gastroenterology_0277_chunk18of24.wav,jess,", Patient was given 2 L of normal saline wide open as well as Compazine 5 mg IV x2 doses with resolution of her nausea. She was given two capsules of Imodium with some apple juice, which she was able to keep down.",Gastroenterology,23,1163,18,24
jess_Radiology_0279_chunk9of16.wav,jess,Bilateral H-reflexes are absent. Needle EMG was performed on the right leg and lumbosacral paraspinal muscles and the left tibialis posterior using a concentric disposable needle.,Radiology,15,974,9,16
jess_Gastroenterology_0280_chunk6of10.wav,jess,The ileocecal valve looked normal. Preparation was fair allowing examination of 85% of mucosa after washing and cleaning with tap water through the scope.,Gastroenterology,23,911,6,10
jess_Gastroenterology_0281_chunk2of18.wav,jess,2. Periappendicitis.1.,Gastroenterology,23,225,2,18
jess_SOAP _ Chart _ Progress Notes_0282_chunk7of29.wav,jess,"5 one-half p.o. daily, coated aspirin daily, lovastatin 40 mg one-half tab p.o.",SOAP / Chart / Progress Notes,34,561,7,29
jess_Cardiovascular _ Pulmonary_0286_chunk9of29.wav,jess,"At the conclusion of the diagnostic evaluation, the patient had selective arteriography of her right femoral artery, which showed the right femoral artery to be free of significant atherosclerotic plaque. Did have a normal bifurcation into the superficial femoral and profunda femoris arteries and to have an arteriotomy that was in the common femoral artery away from the bifurcation.",Cardiovascular / Pulmonary,33,1905,9,29
jess_Cardiovascular _ Pulmonary_0286_chunk19of29.wav,jess,The distal right coronary artery has an approximate 40% stenosis. The posterior left ventricular branch has a proximal 50 to 60% stenosis.,Cardiovascular / Pulmonary,33,876,19,29
jess_Cardiovascular _ Pulmonary_0286_chunk28of29.wav,jess,"Aggressive antihyperlipidemic and antihypertensive control. The patient's goal LDL will be at or below 70 with triglyceride level at or below 150, and it is very imperative that the patient stop smoking.",Cardiovascular / Pulmonary,33,1212,28,29
jess_Cardiovascular _ Pulmonary_0287_chunk5of46.wav,jess,She had been noticing increasing symptoms of irritability and PMS around her menstrual cycle. She has been more impatient around that time.,Cardiovascular / Pulmonary,33,659,5,46
jess_Cardiovascular _ Pulmonary_0287_chunk14of46.wav,jess,", Significant for asthma, allergic rhinitis and cervical dysplasia. , She is married.",Cardiovascular / Pulmonary,33,491,14,46
jess_Cardiovascular _ Pulmonary_0287_chunk21of46.wav,jess,"Conjunctivae are clear. Pupils are equal, round and reactive to light.",Cardiovascular / Pulmonary,33,456,21,46
jess_Cardiovascular _ Pulmonary_0288_chunk1of42.wav,jess,", The patient states that she feels better. She is on IV amiodarone, the dosage pattern is appropriate for ventricular tachycardia.",Cardiovascular / Pulmonary,33,729,1,42
jess_Cardiovascular _ Pulmonary_0288_chunk10of42.wav,jess,"1, heart rate 60, respirations 14, room air saturation 98%, and blood pressure 108/60. The patient shows a normal sinus rhythm on the telemetry monitor with an occasional PAC.",Cardiovascular / Pulmonary,33,1114,10,42
jess_Cardiovascular _ Pulmonary_0288_chunk16of42.wav,jess,Lungs are clear bilaterally to auscultation. The incision is well healed and without evidence of significant cellulitis.,Cardiovascular / Pulmonary,33,617,16,42
jess_Cardiovascular _ Pulmonary_0288_chunk29of42.wav,jess,The patient has had ionized calcium checked at Munson that was normal at 4. 5 prior to her discharge.,Cardiovascular / Pulmonary,33,568,29,42
jess_Gastroenterology_0289_chunk8of24.wav,jess,"States use of no illicit drugs. There is no significant, contributory family medical history.",Gastroenterology,23,533,8,24
jess_Gastroenterology_0289_chunk24of24.wav,jess,We will proceed with Laparoscopic Cholecystectomy with intraoperative cholangiogram.nan,Gastroenterology,23,526,24,24
jess_SOAP _ Chart _ Progress Notes_0290_chunk17of18.wav,jess,"With regard to the radiculopathy, I believe this can be treated non-operatively to begin with. I am referring her for consideration of cervical epidural steroid injections.",SOAP / Chart / Progress Notes,34,869,17,18
jess_Cardiovascular _ Pulmonary_0291_chunk4of10.wav,jess,There is left apical scarring. There is no pleural effusion or pneumothorax.,Cardiovascular / Pulmonary,33,477,4,10
jess_Cardiovascular _ Pulmonary_0291_chunk5of10.wav,jess,There is lingular and right middle lobe mild atelectasis or fibrosis. Examination of the mediastinal windows disclosed normal inferior thyroid.,Cardiovascular / Pulmonary,33,939,5,10
jess_Gastroenterology_0292_chunk5of21.wav,jess,She says she has had no real change in her bowel habit but occasionally does have thin stools. On today's visit we reviewed her entire health history.,Gastroenterology,23,841,5,21
jess_Gastroenterology_0292_chunk8of21.wav,jess,She also had her gallbladder and appendix taken out in the 1970s at the same hospital. Medically she has no significant problems and no true medical illnesses.,Gastroenterology,23,855,8,21
jess_Cardiovascular _ Pulmonary_0293_chunk5of6.wav,jess,"A 8 Shiley tracheostomy tube was inserted, and tidal CO2 was confirmed when it was connected to the circuit. We then secured it in place using 0 silk suture.",Cardiovascular / Pulmonary,33,862,5,6
jess_Cardiovascular _ Pulmonary_0294_chunk1of11.wav,jess,", Dobutamine Stress Test. , Chest pain.",Cardiovascular / Pulmonary,33,274,1,11
jess_Cardiovascular _ Pulmonary_0294_chunk5of11.wav,jess,No symptoms were noted.1. Nondiagnostic dobutamine stress test.,Cardiovascular / Pulmonary,33,449,5,11
jess_Cardiovascular _ Pulmonary_0294_chunk10of11.wav,jess,Normal nuclear myocardial perfusion scan. 2.,Cardiovascular / Pulmonary,33,337,10,11
jess_SOAP _ Chart _ Progress Notes_0295_chunk6of49.wav,jess,"He was not treated for diarrhea for more than 3 years. , Includes chronic diarrhea as I mentioned before and chronic obstructive pulmonary disease secondary to heavy smoking.",SOAP / Chart / Progress Notes,34,827,6,49
jess_SOAP _ Chart _ Progress Notes_0295_chunk9of49.wav,jess,The patient smoked 1-1/2 packs for more than 40 years. He consumes 6 beers per day.,SOAP / Chart / Progress Notes,34,554,9,49
jess_SOAP _ Chart _ Progress Notes_0295_chunk13of49.wav,jess,"No hearing problems. The patient denies any difficulty swallowing, any nausea or vomiting, any burning sensation in the esophagus.",SOAP / Chart / Progress Notes,34,708,13,49
jess_SOAP _ Chart _ Progress Notes_0295_chunk24of49.wav,jess,No thyromegaly. Clear to auscultation and percussion bilaterally.,SOAP / Chart / Progress Notes,34,428,24,49
jess_SOAP _ Chart _ Progress Notes_0295_chunk25of49.wav,jess,"No wheezing, no rhonchi, no crackles. Regular rate and rhythm.",SOAP / Chart / Progress Notes,34,351,25,49
jess_SOAP _ Chart _ Progress Notes_0295_chunk36of49.wav,jess,Clear of rashes and lesions. No ulcers.,SOAP / Chart / Progress Notes,34,267,36,49
jess_SOAP _ Chart _ Progress Notes_0295_chunk43of49.wav,jess,Colonoscopy scheduled. The patient will need antibiotic prophylaxis prior to procedure because of valvular abnormality and we are not completely aware of what type of abnormality.,SOAP / Chart / Progress Notes,34,890,43,49
jess_Cardiovascular _ Pulmonary_0297_chunk7of39.wav,jess,"The rhythm was, as stated before, atrial fibrillation with slow atrioventricular conduction and an intraventricular conduction delay on the monitor strip. There was mild to moderate tricuspid regurgitation, mild pulmonic insufficiency.",Cardiovascular / Pulmonary,33,1324,7,39
jess_Cardiovascular _ Pulmonary_0297_chunk13of39.wav,jess,His diabetes was suspected to be complicated with neuropathy due to tingling in both feet. He received his immunizations with flu in 2005 but did not receive Pneumovax.,Cardiovascular / Pulmonary,33,995,13,39
jess_Cardiovascular _ Pulmonary_0297_chunk19of39.wav,jess,Hypertension and atrial fibrillation. Normal.GI: Colon bleeding.,Cardiovascular / Pulmonary,33,435,19,39
jess_Cardiovascular _ Pulmonary_0298_chunk6of21.wav,jess,"Dissection was carried down in a muscle-sparing fashion using Bovie electrocautery. The 5th rib was counted, and the 6th interspace was entered.",Cardiovascular / Pulmonary,33,750,6,21
jess_Radiology_0299_chunk4of9.wav,jess,"Left-sided port is seen with Groshong tip at the SVC/RA junction. No evidence for acute fracture, malalignment, or dislocation.1.",Radiology,15,813,4,9
jess_Cardiovascular _ Pulmonary_0300_chunk8of36.wav,jess,Zocor 20 mg once a day. 4.,Cardiovascular / Pulmonary,33,309,8,36
jess_Cardiovascular _ Pulmonary_0300_chunk21of36.wav,jess,No significant kyphoscoliosis on recumbent back exam. Lungs are clear to auscultation anteriorly.,Cardiovascular / Pulmonary,33,638,21,36
jess_Cardiovascular _ Pulmonary_0300_chunk27of36.wav,jess,"A is a 50-year-old gentleman with a history of paroxysmal atrial fibrillation in the past, more recently is having breakthrough atrial flutter despite flecainide and we had performed a transesophageal echocardiogram-guided cardioversion for him in late 12/20/09, who now has another recurrence within the past 41 hours or so. I have reviewed again with him in detail regarding risks, benefits, and alternatives of proceeding with cardioversion, which the patient is in favor of.",Cardiovascular / Pulmonary,33,2500,27,36
jess_Gastroenterology_0302_chunk19of36.wav,jess,"The abdomen was insufflated to 15 mmHg. After adequate insufflation was achieved, the laparoscopic camera was inserted into the abdomen and to visualize a distended gallbladder as well as omental adhesion adjacent to the gallbladder.",Gastroenterology,23,1359,19,36
jess_Gastroenterology_0302_chunk20of36.wav,jess,"Decision to proceed with laparoscopic cystectomy was decided. A subxiphoid transverse incision was created with a 10 blade scalpel and utilizing a bladed 12 mm trocar, the trocar was inserted under direct visualization into the abdomen.",Gastroenterology,23,1296,20,36
jess_Gastroenterology_0302_chunk35of36.wav,jess,She was extubated following procedure. She is seen to tolerate the procedure well and she will follow up with Dr.,Gastroenterology,23,610,35,36
jess_SOAP _ Chart _ Progress Notes_0303_chunk19of27.wav,jess,Cardiovascular: Regular rate and rhythm. Lungs: Clear.,SOAP / Chart / Progress Notes,34,400,19,27
jess_SOAP _ Chart _ Progress Notes_0303_chunk20of27.wav,jess,",On examination of the lumbar spine, he is minimally tender to palpation. There is no overt muscular spasm.",SOAP / Chart / Progress Notes,34,715,20,27
jess_Gastroenterology_0304_chunk14of19.wav,jess,She needs to keep her wound clean and dry. She is not to engage in any heavy lifting greater than 10 pounds x2 weeks.,Gastroenterology,23,603,14,19
jess_Cardiovascular _ Pulmonary_0305_chunk3of6.wav,jess,"Rest study was done and compared to previous dobutamine Myoview stress test done on Month DD, YYYY. The lung heart ratio is 0.",Cardiovascular / Pulmonary,33,841,3,6
jess_Cardiovascular _ Pulmonary_0305_chunk4of6.wav,jess,34. There appears to be a moderate size inferoapical perfusion defect of moderate degree.,Cardiovascular / Pulmonary,33,512,4,6
jess_Cardiovascular _ Pulmonary_0306_chunk4of31.wav,jess,"4. Pulse generator insertion, model Sigma.",Cardiovascular / Pulmonary,33,281,4,31
jess_Cardiovascular _ Pulmonary_0306_chunk21of31.wav,jess,"50 milliseconds, 1. 5 volts of voltage, 3.",Cardiovascular / Pulmonary,33,386,21,31
jess_Cardiovascular _ Pulmonary_0306_chunk29of31.wav,jess,There were no complications. The patient went to Recovery in satisfactory condition.,Cardiovascular / Pulmonary,33,421,29,31
leo_Cardiovascular _ Pulmonary_0309_chunk5of6.wav,leo,"With biphasic synchronized energy delivered was also unsuccessful with degeneration of the atrial flutter into atrial fibrillation. The patient was decided to be on wave control and amiodarone and reattempted cardioversion after anticoagulation for four to six weeks and because of the reduced LV function, the success of the rate without antiarrhythmic may be low.",Cardiovascular / Pulmonary,33,1702,5,6
leo_Cardiovascular _ Pulmonary_0310_chunk13of14.wav,leo,No evidence for clinically significant stenosis. 2.,Cardiovascular / Pulmonary,33,302,13,14
leo_Cardiovascular _ Pulmonary_0311_chunk4of33.wav,leo,"Monitoring during the procedure included continuous surface ECG, continuous pulse oximetry, and cycled cuff blood pressures, in addition to intravascular pressures. Using a percutaneous technique a 4-French 8 cm long double lumen central venous catheter was inserted in the left femoral vein and sutured into place.",Cardiovascular / Pulmonary,33,1590,4,33
leo_Cardiovascular _ Pulmonary_0311_chunk26of33.wav,leo,"2 mm. ,1.",Cardiovascular / Pulmonary,33,155,26,33
leo_Cardiovascular _ Pulmonary_0311_chunk28of33.wav,leo,Dilated cardiomyopathy. 3.,Cardiovascular / Pulmonary,33,218,28,33
leo_Cardiovascular _ Pulmonary_0312_chunk3of18.wav,leo,Jude mechanical valve. 3.,Cardiovascular / Pulmonary,33,204,3,18
leo_Cardiovascular _ Pulmonary_0312_chunk4of18.wav,leo,"Pericardial tamponade.POSTOPERATIVE DIAGNOSIS (ES):,1. Endocarditis.",Cardiovascular / Pulmonary,33,659,4,18
leo_Cardiovascular _ Pulmonary_0312_chunk10of18.wav,leo,We could see the effusion resolve on echocardiogram. The aortic valve appeared to have good movement in the leaflets with no perivalvular leaks.,Cardiovascular / Pulmonary,33,680,10,18
leo_Cardiovascular _ Pulmonary_0312_chunk14of18.wav,leo,The dissection was carried down into the pericardial space. Blood was evacuated without any difficulty.,Cardiovascular / Pulmonary,33,505,14,18
leo_Cardiovascular _ Pulmonary_0312_chunk16of18.wav,leo,The subcutaneous tissues were closed with a running Monocryl suture. A subdermal PDS followed by a subcuticular Monocryl suture were all performed.,Cardiovascular / Pulmonary,33,806,16,18
leo_Gastroenterology_0313_chunk1of8.wav,leo,", Chronic cholecystitis without cholelithiasis. ,Chronic cholecystitis without cholelithiasis.",Gastroenterology,23,547,1,8
leo_Cardiovascular _ Pulmonary_0314_chunk28of39.wav,leo,No in-stent restenosis was noted in D1.D2 and D3 are very small with luminal irregularities. Circumflex artery was diseased throughout the vessel.,Cardiovascular / Pulmonary,33,841,28,39
leo_Radiology_0315_chunk1of5.wav,leo,", Sequential axial CT images were obtained from the base of the brain to the thoracic inlet following the uneventful administration of 100 CC Optiray 320 intravenous contrast. Scans through the base of the brain are unremarkable.",Radiology,15,1282,1,5
leo_Cardiovascular _ Pulmonary_0316_chunk2of16.wav,leo,", Left thoracotomy with total pulmonary decortication and parietal pleurectomy. , After obtaining the informed consent, the patient was brought to the operating room, where he underwent a general endotracheal anesthetic using a double-lumen endotracheal tube.",Cardiovascular / Pulmonary,33,1233,2,16
leo_Cardiovascular _ Pulmonary_0316_chunk13of16.wav,leo,Two large chest tubes were placed. The cavity had been abundantly irrigated with warm saline.,Cardiovascular / Pulmonary,33,505,13,16
leo_Gastroenterology_0317_chunk6of7.wav,leo,The scope was removed without difficulty. The patient underwent endoscopic removal of esophageal foreign body.,Gastroenterology,23,582,6,7
leo_Cardiovascular _ Pulmonary_0318_chunk1of23.wav,leo,"PROCEDURES,1. Left heart catheterization.",Cardiovascular / Pulmonary,33,344,1,23
leo_Cardiovascular _ Pulmonary_0318_chunk8of23.wav,leo,"After informed consent was signed by the patient, the patient was taken to the cardiac catheterization laboratory. He was prepped and draped in the usual sterile manner.",Cardiovascular / Pulmonary,33,736,8,23
leo_Cardiovascular _ Pulmonary_0318_chunk13of23.wav,leo,"The patient was then transferred to telemetry in a stable condition. , Hemodynamic data shows aortic pressures of 100/56 with mean of 70 mmHg and the LV 100/0 with LVEDP of 10 mmHg.",Cardiovascular / Pulmonary,33,1240,13,23
leo_Gastroenterology_0320_chunk3of27.wav,leo,She has history of constipation. She normally passes stool every two days after giving an enema.,Gastroenterology,23,456,3,27
leo_Gastroenterology_0320_chunk15of27.wav,leo,"4, chloride 89, CO2 21, BUN 61, creatinine 2, AST 92 increased, ALT 62 increased, albumin 5. 3, total bilirubin 0.",Gastroenterology,23,1121,15,27
leo_Gastroenterology_0320_chunk23of27.wav,leo,Distended. Decreased bowel sounds.,Gastroenterology,23,204,23,27
leo_Gastroenterology_0322_chunk9of16.wav,leo,"Rectal examination was performed, which was normal. The scope was introduced and passed with minimal difficulty to the cecum.",Gastroenterology,23,575,9,16
leo_Gastroenterology_0322_chunk12of16.wav,leo,"In addition, there was a small sessile polyp, which was cold biopsied and recovered, and approximately an 8 mm pedunculated polyp. A snare was placed on the stalk of the polyp and divided with electrocautery.",Gastroenterology,23,1079,12,16
leo_Cardiovascular _ Pulmonary_0323_chunk22of51.wav,leo,"The estimated blood loss was less than 30 mL, and none was replaced. Heparin was administered following placement of all of the sheaths.",Cardiovascular / Pulmonary,33,680,22,51
leo_Cardiovascular _ Pulmonary_0323_chunk25of51.wav,leo,"Pullbacks, left pulmonary artery to main pulmonary artery, mean of 11 to mean of 12 main pulmonary artery to Glenn, mean of 12 to mean of 13 right pulmonary artery to Glenn, mean of 12 to mean of 13 ascending aorta 68/35 to descending aorta 62/35. Right and left pulmonary artery pressures are appropriate for this situation.",Cardiovascular / Pulmonary,33,1877,25,51
leo_Cardiovascular _ Pulmonary_0323_chunk42of51.wav,leo,5 mm. There is a small collateral off the innominate vein passing to the left upper lobe.,Cardiovascular / Pulmonary,33,477,42,51
leo_Cardiovascular _ Pulmonary_0323_chunk45of51.wav,leo,The right ventriculogram demonstrates a heavily pedunculated right ventricle with somewhat depressed right ventricular systolic function. The calculated ejection fraction from the LAO projection is only mildly diminished at 59%.,Cardiovascular / Pulmonary,33,1093,45,51
leo_Cardiovascular _ Pulmonary_0323_chunk48of51.wav,leo,"On some projections, there appears to be a partial duplication of the aortic arch, probably secondary to this patient's style of Norwood reconstruction. There is some filling of the right upper and left upper lobes from collateral blood flow, with the left being more opacified than the right.",Cardiovascular / Pulmonary,33,1282,48,51
leo_Cardiovascular _ Pulmonary_0323_chunk51of51.wav,leo,There is faint opacification of the left upper lung from collateral blood flow. The above-mentioned narrowing of the aortic arch is again noted.nan,Cardiovascular / Pulmonary,33,771,51,51
leo_SOAP _ Chart _ Progress Notes_0324_chunk6of11.wav,leo,"In the center is a tiny mark which could certainly be an insect or spider bite. There is no eschar there, but just a tiny marking.",SOAP / Chart / Progress Notes,34,589,6,11
leo_Radiology_0325_chunk2of39.wav,leo,"2. Tailor bunion deformity, right foot.1.",Radiology,15,365,2,39
leo_Radiology_0325_chunk5of39.wav,leo,", Local with MAC, local consisting of 20 mL of 0. 5% Marcaine plain.",Radiology,15,470,5,39
leo_Radiology_0325_chunk17of39.wav,leo,"This was then resected from his osseous attachments and a small tenotomy was performed. At this time, a small lateral capsulotomy was also performed.",Radiology,15,715,17,39
leo_Radiology_0325_chunk20of39.wav,leo,"045 inch K-wire was then driven across the first metatarsal head in order to act as an access dye. The patient was then placed in the frog-leg position, and two osteotomy cuts were made, one from the access guide to the plantar proximal position and one from the access guide to the dorsal proximal position.",Radiology,15,1457,20,39
leo_Radiology_0325_chunk30of39.wav,leo,The head was then shifted medially into a more corrected position. A 0.,Radiology,15,449,30,39
leo_Radiology_0325_chunk38of39.wav,leo,The patient was given a prescription for pain medications on nonsteroidal anti-inflammatory drugs and was educated on these. The patient tolerated the procedure and anesthesia well.,Radiology,15,841,38,39
leo_Cardiovascular _ Pulmonary_0326_chunk9of13.wav,leo,Systolic consistent with mild-to-moderate pulmonary hypertension. Peak velocity across the aortic valve is 3.,Cardiovascular / Pulmonary,33,610,9,13
leo_Cardiovascular _ Pulmonary_0326_chunk10of13.wav,leo,"0 with a peak gradient of 37, mean gradient of 19, valve area calculated at 1. 1 sq.",Cardiovascular / Pulmonary,33,638,10,13
leo_Cardiovascular _ Pulmonary_0326_chunk11of13.wav,leo,cm consistent with moderate aortic stenosis.1. Concentric hypertrophy of the left ventricle with normal function.,Cardiovascular / Pulmonary,33,638,11,13
leo_Cardiovascular _ Pulmonary_0326_chunk12of13.wav,leo,"2. Doppler study as above, most pronounced being moderate aortic stenosis, valve area of 1.",Cardiovascular / Pulmonary,33,596,12,13
leo_Cardiovascular _ Pulmonary_0326_chunk13of13.wav,leo,"1 sq. cm.cardiovascular / pulmonary, moderate aortic stenosis, annular calcification, concentric hypertrophy, aortic stenosis, echocardiogram, stenosis, valve, aortic,",Cardiovascular / Pulmonary,33,1226,13,13
leo_Gastroenterology_0327_chunk4of20.wav,leo,Specifics discussed. Preprocedure physical exam performed.,Gastroenterology,23,337,4,20
leo_Gastroenterology_0328_chunk4of6.wav,leo,"The rest of the colon through to the cecum was well visualized. The cecal strap, ileocecal valve, and light reflex in the right lower quadrant were all identified.",Gastroenterology,23,785,4,6
leo_Gastroenterology_0331_chunk13of17.wav,leo,Hypoattenuating mass in the lower uterine segment and cervix of uncertain etiology measuring approximately 4. 4 x 2.,Gastroenterology,23,659,13,17
leo_Gastroenterology_0331_chunk14of17.wav,leo,5 x 3. 4 cm.,Gastroenterology,23,190,14,17
leo_Gastroenterology_0331_chunk16of17.wav,leo,3. Prominent endometrium.,Gastroenterology,23,190,16,17
leo_Gastroenterology_0332_chunk8of14.wav,leo,"She has not been able to feed well and in fact has to now be NG tube fed. Her swallowing mechanism does not appear to be very functional, and therefore, it was felt that in order to aid in her home care that she would be better served with a gastrostomy.",Gastroenterology,23,1226,8,14
leo_Gastroenterology_0332_chunk10of14.wav,leo,The muscle was divided and the peritoneal cavity entered. The greater curvature of the stomach was grasped with a Babcock clamp and brought into the operative field.,Gastroenterology,23,715,10,14
leo_Cardiovascular _ Pulmonary_0334_chunk10of23.wav,leo,Utilizing both blunt and sharp dissections segment of the fistula was isolated ________ vessel loop. Transverse graftotomy was created.,Cardiovascular / Pulmonary,33,827,10,23
leo_Cardiovascular _ Pulmonary_0334_chunk11of23.wav,leo,A 4 Fogarty catheter passed proximally and distally restoring inflow and meager inflow. A fistulogram was performed and the above findings were noted.,Cardiovascular / Pulmonary,33,806,11,23
leo_Cardiovascular _ Pulmonary_0334_chunk18of23.wav,leo,The end of the insertion graft was cut to shape in length and sutured to the graft in an end-to-end fashion with continuous running 6-0 Prolene suture. Good backflow bleeding was confirmed.,Cardiovascular / Pulmonary,33,946,18,23
leo_Radiology_0336_chunk9of42.wav,leo,"5C,MS: A&O to person, place and time. Speech normal with logical lucid thought process.CN: mild optic disk pallor OS.",Radiology,15,883,9,42
leo_Radiology_0336_chunk15of42.wav,leo,Station: No pronator drift. Romberg's test not documented.,Radiology,15,400,15,42
leo_Radiology_0336_chunk34of42.wav,leo,The right peritrigonal region is more prominent than on prior study. The left centrum semiovale lesion has less enhancement than previously.,Radiology,15,652,34,42
leo_Cardiovascular _ Pulmonary_0337_chunk10of18.wav,leo,"Lidocaine 2% was used for infiltration anesthesia. Using modified Seldinger technique, a 6-French sheath was placed into the right common femoral artery and vein without complication.",Cardiovascular / Pulmonary,33,939,10,18
leo_SOAP _ Chart _ Progress Notes_0338_chunk2of30.wav,leo,"She noticed a lump in the breast in November of 2007. A mammogram was obtained dated 01/28/08, which showed a mass in the right breast.",SOAP / Chart / Progress Notes,34,841,2,30
leo_SOAP _ Chart _ Progress Notes_0338_chunk22of30.wav,leo,Status post a hysterectomy in 1981 for fibroids. They also removed one ovary.,SOAP / Chart / Progress Notes,34,484,22,30
leo_SOAP _ Chart _ Progress Notes_0338_chunk23of30.wav,leo,7. Status post a cholecystectomy in 1993.,SOAP / Chart / Progress Notes,34,288,23,30
leo_SOAP _ Chart _ Progress Notes_0338_chunk29of30.wav,leo,"Her husband is a high school chemistry teacher. ,Her father had prostate cancer.",SOAP / Chart / Progress Notes,34,414,29,30
leo_Radiology_0339_chunk7of9.wav,leo,"The radial, median and ulnar nerves are normal with no apparent ulnar neuritis.Lateral epicondylitis with severe tendinitis of the common extensor tendon origin and minimal deep surface fraying, without a discrete tendon tear. Periligamentous inflammation of the radial collateral ligamentous complex as described above with intrinsically normal ligaments.",Radiology,15,1737,7,9
leo_Radiology_0340_chunk1of7.wav,leo,",Thoracic Spine. , Injury.",Radiology,15,176,1,7
leo_Cardiovascular _ Pulmonary_0341_chunk2of10.wav,leo,"Resting heart rate of 67, blood pressure of 129/86. EKG, normal sinus rhythm.",Cardiovascular / Pulmonary,33,610,2,10
leo_Cardiovascular _ Pulmonary_0341_chunk9of10.wav,leo,"End-diastolic volume of 74, end-systolic volume of 31.1. Normal nuclear myocardial perfusion scan.",Cardiovascular / Pulmonary,33,722,9,10
leo_Cardiovascular _ Pulmonary_0343_chunk9of17.wav,leo,Arteriogram demonstrated no significant disease of the great vessels at their origins. There is demonstration of complete occlusion of the left common carotid artery approximately 3 cm distal to its origin.,Cardiovascular / Pulmonary,33,1023,9,17
leo_Cardiovascular _ Pulmonary_0343_chunk17of17.wav,leo,"The patient will be observed for at least 2-1/2 hours prior to being discharged to home.cardiovascular / pulmonary, carotid, arteriogram, bulb, carotid duplex, catheter, cerebral, distal, femoral artery, internal carotid artery, needle, occlusion, sheath, stenosis, vertebral arteries, vessels, cerebral arteriograms, carotid artery, artery, arteriograms, wire,",Cardiovascular / Pulmonary,33,2171,17,17
leo_Gastroenterology_0345_chunk7of15.wav,leo,The 5-mm scope was introduced at the umbilical port and the appendix was easily visualized. The base of the cecum was acutely inflamed but not perforated.,Gastroenterology,23,778,7,15
leo_Gastroenterology_0345_chunk11of15.wav,leo,"We then removed all ports under direct vision, and there was no bleeding from the abdominal trocar sites. The pneumoperitoneum was then deflated and the suprapubic fascial defect was closed with 0-Vicryl suture.",Gastroenterology,23,1142,11,15
leo_Cardiovascular _ Pulmonary_0346_chunk6of10.wav,leo,Maximum stress test EKG showed inverted T wave from V4 to V6. Normal response to Lexiscan.,Cardiovascular / Pulmonary,33,659,6,10
leo_Cardiovascular _ Pulmonary_0347_chunk14of15.wav,leo,There is a color Doppler suggestive of a patent foramen ovale with lipomatous hypertrophy of the interatrial septum. 11.,Cardiovascular / Pulmonary,33,687,14,15
leo_Gastroenterology_0349_chunk1of15.wav,leo,1. Odynophagia.,Gastroenterology,23,162,1,15
leo_Gastroenterology_0349_chunk2of15.wav,leo,2. Dysphagia.,Gastroenterology,23,141,2,15
leo_SOAP _ Chart _ Progress Notes_0350_chunk2of11.wav,leo,We talked at length about the continued plateau she has had with her weight. She gained a pound the month before and really has not been able to get her weight any farther down than she had when her lowest level was 136.,SOAP / Chart / Progress Notes,34,932,2,11
leo_Cardiovascular _ Pulmonary_0351_chunk1of30.wav,leo,",Abnormal echocardiogram findings and followup. Shortness of breath, congestive heart failure, and valvular insufficiency.",Cardiovascular / Pulmonary,33,624,1,30
leo_Cardiovascular _ Pulmonary_0351_chunk6of30.wav,leo,", History of hypertension, no history of diabetes mellitus, nonsmoker, cholesterol status unclear, no prior history of coronary artery disease, and family history noncontributory. ,Nonsignificant.",Cardiovascular / Pulmonary,33,1079,6,30
leo_Cardiovascular _ Pulmonary_0351_chunk14of30.wav,leo,No frequency or urgency. Arthritis and severe muscle weakness.,Cardiovascular / Pulmonary,33,407,14,30
leo_Cardiovascular _ Pulmonary_0351_chunk17of30.wav,leo,No significant carotid bruits appreciated. Air entry bilaterally fair.,Cardiovascular / Pulmonary,33,379,17,30
leo_Gastroenterology_0352_chunk1of19.wav,leo,", Bright red blood per rectum ,This 73-year-old woman had a recent medical history significant for renal and bladder cancer, deep venous thrombosis of the right lower extremity, and anticoagulation therapy complicated by lower gastrointestinal bleeding. Colonoscopy during that admission showed internal hemorrhoids and diverticulosis, but a bleeding site was not identified.",Gastroenterology,23,1779,1,19
leo_Gastroenterology_0352_chunk17of19.wav,leo,"5 sec ,The patient received 1 liter normal saline and diltiazem (a total of 20 mg intravenously and 30 mg orally) in the emergency department. Emergency department personnel made several attempts to place a nasogastric tube for gastric lavage, but were unsuccessful.",Gastroenterology,23,1422,17,19
leo_Cardiovascular _ Pulmonary_0353_chunk20of20.wav,leo,"Estimated blood loss was 250 cc.cardiovascular / pulmonary, carotid stenosis, cerebrovascular, platysmal, dacron patch, carotid endarterectomy, cerebrovascular accident, internal carotid, carotid, stenosis, carotids, endarterectomy",Cardiovascular / Pulmonary,33,1590,20,20
leo_Gastroenterology_0354_chunk3of34.wav,leo,"She states that she feels a bit like she did when she had her gallbladder removed nine years ago. Additionally, I should note that the patient is currently premenopausal with irregular menses, going anywhere from one to two months between cycles.",Gastroenterology,23,1142,3,34
leo_Gastroenterology_0354_chunk13of34.wav,leo,"She works as a medical transcriptionist. , Positive for an umbilical hernia, but otherwise negative with the exception of what is noted above.PHYSICAL EXAMINATION, Reveals a morbidly obese female who is alert and oriented x3, pleasant and well groomed, and in mild discomfort.",Gastroenterology,23,1422,13,34
leo_Gastroenterology_0354_chunk21of34.wav,leo,She has a positive Rovsing sign and a positive obturator sign. She is tender in the right lower quadrant with mild rebound and no guarding.,Gastroenterology,23,750,21,34
leo_SOAP _ Chart _ Progress Notes_0355_chunk3of15.wav,leo,"The patient comes to clinic unaccompanied. , Levothyroxine 200 mcg q.d.",SOAP / Chart / Progress Notes,34,421,3,15
leo_SOAP _ Chart _ Progress Notes_0355_chunk11of15.wav,leo,",The patient's chief complaint is her weight. She brings in a packet of information on HCZ Diovan and also metabolic assessment that was done at the key.",SOAP / Chart / Progress Notes,34,701,11,15
leo_SOAP _ Chart _ Progress Notes_0355_chunk13of15.wav,leo,She had family reunion in Iowa once in four days out there. She continues to volunteer Hospital and is walking and enjoying her summer.,SOAP / Chart / Progress Notes,34,715,13,15
leo_Gastroenterology_0356_chunk16of31.wav,leo,"Surgical consult also requested and blood culture and urine culture also ordered. The same day, the patient was seen by Dr.",Gastroenterology,23,708,16,31
leo_Gastroenterology_0356_chunk22of31.wav,leo,"5 mg 1 tablet p.o. daily, Plavix 75 mg p.o.",Gastroenterology,23,449,22,31
leo_Gastroenterology_0356_chunk28of31.wav,leo,"daily, Vicodin 1 tablet p.o. q.",Gastroenterology,23,309,28,31
leo_Gastroenterology_0356_chunk29of31.wav,leo,"6 hours p.r.n. as needed, and Levaquin 250 mg p.o.",Gastroenterology,23,498,29,31
leo_Radiology_0357_chunk3of19.wav,leo,"He was intubated and ventilated in the field, and then transferred to UIHC.PMH/FHX/, unremarkable. none, BP 127/91 HR69 RR30,MS: unconscious and intubated,Glasgow coma scale=4,CN: Pupils 6/6 fixed.",Radiology,15,1667,3,19
leo_Radiology_0357_chunk7of19.wav,leo,Right ventricular collection of blood. Right cerebral intraparenchymal hemorrhage.,Radiology,15,393,7,19
leo_Radiology_0357_chunk9of19.wav,leo,"Air within the soft tissues in the left infra temporal region. C-spine XR, Abdominal/Chest CT were unremarkable.",Radiology,15,708,9,19
leo_SOAP _ Chart _ Progress Notes_0358_chunk10of34.wav,leo,"There has been no blood in the stool. He is not having any abdominal pain, just some nausea.",SOAP / Chart / Progress Notes,34,498,10,34
leo_SOAP _ Chart _ Progress Notes_0358_chunk13of34.wav,leo,"7, pulse 68, and respirations 16. General exam: The patient is nontoxic and in no acute distress.",SOAP / Chart / Progress Notes,34,652,13,34
leo_SOAP _ Chart _ Progress Notes_0358_chunk14of34.wav,leo,There is no labored breathing. Psychiatric: He is alert and oriented times 3.,SOAP / Chart / Progress Notes,34,498,14,34
leo_SOAP _ Chart _ Progress Notes_0358_chunk19of34.wav,leo,"Extremities: No edema, cyanosis, or clubbing. ,1.",SOAP / Chart / Progress Notes,34,365,19,34
leo_Cardiovascular _ Pulmonary_0360_chunk6of54.wav,leo,Other findings were not significantly changed including pericardial effusion description. She has a history of longstanding hypertension.,Cardiovascular / Pulmonary,33,589,6,54
leo_Cardiovascular _ Pulmonary_0360_chunk13of54.wav,leo,Labetalol 100 mg p.o. b.i.d.,Cardiovascular / Pulmonary,33,281,13,54
leo_Cardiovascular _ Pulmonary_0360_chunk24of54.wav,leo,",Unable to obtain as the patient becomes quite sleepy when I am talking. , Unable to obtain as the patient becomes quite sleepy when I am talking.",Cardiovascular / Pulmonary,33,652,24,54
leo_Cardiovascular _ Pulmonary_0360_chunk40of54.wav,leo,03 on 05/18/07. White blood cell count 9.,Cardiovascular / Pulmonary,33,421,40,54
leo_SOAP _ Chart _ Progress Notes_0362_chunk10of30.wav,leo,"There was possibility of subchondral fracture and some swelling of her suprapatellar bursa on the right side. This morning, she denied any headache, back pain or neck pain.",SOAP / Chart / Progress Notes,34,876,10,30
leo_SOAP _ Chart _ Progress Notes_0362_chunk16of30.wav,leo,She is alert and oriented x3. Her pupils are equal and reactive.,SOAP / Chart / Progress Notes,34,435,16,30
leo_SOAP _ Chart _ Progress Notes_0362_chunk21of30.wav,leo,Her hip flexors and extenders are also strong and equal bilaterally. Extension and flexion of the knee bilaterally and ankles also are strong.,SOAP / Chart / Progress Notes,34,729,21,30
leo_SOAP _ Chart _ Progress Notes_0362_chunk30of30.wav,leo,"2. We will obtain an orthopedic consult secondary to her fall to evaluate her x-rays and function.soap / chart / progress notes, community acquired pneumonia, copd exacerbation, home o2, acute on chronic, pneumonia, exacerbation, copd",SOAP / Chart / Progress Notes,34,1548,30,30
leo_Cardiovascular _ Pulmonary_0363_chunk4of28.wav,leo,No murmur was appreciated. Soft and nontender.,Cardiovascular / Pulmonary,33,302,4,28
leo_Cardiovascular _ Pulmonary_0363_chunk5of28.wav,leo,Bowel sounds are positive. He has 2+ pedal swelling.,Cardiovascular / Pulmonary,33,330,5,28
leo_Cardiovascular _ Pulmonary_0363_chunk13of28.wav,leo,"Acute pulmonary edema, resolved. 3.",Cardiovascular / Pulmonary,33,260,13,28
leo_Cardiovascular _ Pulmonary_0363_chunk19of28.wav,leo,6. Bilateral perfusion secondary to congestive heart failure.,Cardiovascular / Pulmonary,33,365,19,28
leo_Cardiovascular _ Pulmonary_0363_chunk24of28.wav,leo,10. Tobacco smoking disorder.,Cardiovascular / Pulmonary,33,204,24,28
leo_Gastroenterology_0364_chunk5of15.wav,leo,", She is status post a tonsillectomy as well as ear tubes. , Questionable kidney stone.",Gastroenterology,23,463,5,15
leo_Cardiovascular _ Pulmonary_0367_chunk24of24.wav,leo,"2 cm2 consistent with moderate aortic stenosis. Reevaluation in two to three years with transthoracic echocardiogram will be recommended.cardiovascular / pulmonary, aortic valve replacement, stenotic valve, thrombus, stenosis, ventricular, esophageal, peak velocity, valve replacement, aortic valve, aortic, transesophageal, valve, oropharynx, atrium, interrogation, atrial, moderate,",Cardiovascular / Pulmonary,33,2360,24,24
leo_Radiology_0368_chunk1of9.wav,leo,", Ultrasound of pelvis. Menorrhagia.",Radiology,15,239,1,9
leo_Radiology_0368_chunk9of9.wav,leo,"MRI of the pelvis could be performed for further evaluation to evaluate for possible uterine fibroid embolization.radiology, pelvis, mri, menorrhagia, ultrasound, adnexa, echo complex, endometrial, fibroids, ovary, uterine fibroid, uterus, ultrasound of pelvis",Radiology,15,1569,9,9
leo_Gastroenterology_0369_chunk1of22.wav,leo,", Acute appendicitis. Acute suppurative appendicitis.",Gastroenterology,23,316,1,22
leo_Gastroenterology_0369_chunk18of22.wav,leo,There was a small adhesion appreciated in the region of the surgical site. This was taken down with blunt dissection without difficulty.,Gastroenterology,23,575,18,22
leo_SOAP _ Chart _ Progress Notes_0371_chunk4of17.wav,leo,"5 with a platelet count of 484,000. His bone marrow biopsy showed a normal cellular bone marrow however, there were 10% plasma cells and we proceeded with the workup for a plasma cell dyscrasia.",SOAP / Chart / Progress Notes,34,1121,4,17
leo_SOAP _ Chart _ Progress Notes_0371_chunk12of17.wav,leo,and Warfarin 2. 5 mg q.d.,SOAP / Chart / Progress Notes,34,281,12,17
leo_SOAP _ Chart _ Progress Notes_0371_chunk17of17.wav,leo,"He is married. , His brother had prostate cancer.nan",SOAP / Chart / Progress Notes,34,323,17,17
leo_Cardiovascular _ Pulmonary_0372_chunk14of20.wav,leo,There is no clot or mass seen. 7.,Cardiovascular / Pulmonary,33,302,14,20
leo_Cardiovascular _ Pulmonary_0374_chunk17of18.wav,leo,2. Echodensity involving the aortic valve suggestive of endocarditis and vegetation.,Cardiovascular / Pulmonary,33,533,17,18
leo_Cardiovascular _ Pulmonary_0375_chunk8of25.wav,leo,The sternum was divided in the midline. Retrosternal attachments were taken down.,Cardiovascular / Pulmonary,33,407,8,25
leo_Cardiovascular _ Pulmonary_0375_chunk12of25.wav,leo,"The ascending aorta was cross clamped. Cold-blood potassium cardioplegia was given antegrade, a total of 10 cc/kg.",Cardiovascular / Pulmonary,33,701,12,25
leo_Gastroenterology_0376_chunk8of25.wav,leo,Status post Whipple's pancreaticoduodenectomy. Esophagogastroduodenoscopy with biopsies.,Gastroenterology,23,652,8,25
leo_Gastroenterology_0376_chunk10of25.wav,leo,She is currently using Nexium. She has continued postprandial dyspepsia and reflux symptoms.,Gastroenterology,23,547,10,25
leo_Gastroenterology_0376_chunk11of25.wav,leo,"To evaluate this, the patient was boarded for EGD. The patient gave informed consent for the procedure.",Gastroenterology,23,505,11,25
leo_Gastroenterology_0376_chunk22of25.wav,leo,Insufflated air was removed with withdrawal of the scope. The patient's diet will be adjusted to postgastrectomy-type diet.,Gastroenterology,23,610,22,25
leo_SOAP _ Chart _ Progress Notes_0377_chunk3of10.wav,leo,She denied having any trauma. She states that the pain is bothering her.,SOAP / Chart / Progress Notes,34,365,3,10
leo_Gastroenterology_0379_chunk10of19.wav,leo,No hiatal hernia was noted. Pyloric valve appeared normal.,Gastroenterology,23,372,10,19
leo_Gastroenterology_0379_chunk19of19.wav,leo,",Histologic evaluation and CLO testing. I will contact the parents next week with biopsy results and further management plans will be discussed at that time.gastroenterology, esophagus, stomach, duodenum, rectal polyp, polypectomy snare, olympus gif-160, endoscope was advanced, clo testing, polyp head, terminal ileum, polypectomy, biopsies, esophagogastroduodenoscopy, ileum, mucosa, colonoscopy,",Gastroenterology,23,2206,19,19
leo_Cardiovascular _ Pulmonary_0380_chunk2of21.wav,leo,", Coronary bypass graft x2 utilizing left internal mammary artery, the left anterior descending, reverse autogenous reverse autogenous saphenous vein graft to the obtuse marginal. Total cardiopulmonary bypass, cold-blood potassium cardioplegia, antegrade for myocardial protection.",Cardiovascular / Pulmonary,33,1548,2,21
leo_Cardiovascular _ Pulmonary_0380_chunk19of21.wav,leo,Good hemostasis was noted. A single mediastinal chest tube and bilateral pleural Blake drains were placed.,Cardiovascular / Pulmonary,33,540,19,21
leo_Cardiovascular _ Pulmonary_0380_chunk20of21.wav,leo,"The sternum was closed with figure-of-eight stainless steel wire plus two 5-mm Mersiline tapes. The linea alba was closed with figure-of-eight of 1 Vicryl, the sternal fascia closed with running 1 Vicryl, the subcu closed with running 2-0 Dexon, skin with running 4-0 Dexon subcuticular stitch.",Cardiovascular / Pulmonary,33,1597,20,21
leo_Gastroenterology_0382_chunk9of10.wav,leo,2. Screening colonoscopy in 2 years.,Gastroenterology,23,274,9,10
leo_Cardiovascular _ Pulmonary_0383_chunk12of13.wav,leo,Poor exercise capacity due to cardiovascular deconditioning. 4.,Cardiovascular / Pulmonary,33,372,12,13
leo_Gastroenterology_0384_chunk5of30.wav,leo,"wt loss over the last 2 wks. He does have nausea with only one episode of non-bilious, non-bloody emesis on day of admission.",Gastroenterology,23,785,5,30
leo_Gastroenterology_0384_chunk13of30.wav,leo,"He only drinks alcohol socially, no more than 1 drink every few weeks. He is married and has 3 healthy children.",Gastroenterology,23,631,13,30
leo_Gastroenterology_0384_chunk17of30.wav,leo,"9-102. 7 BP 136/86 Pulse 117 RR 12 98% sat on room air,Gen: Well-developed, well-nourished, no apparent distress.",Gastroenterology,23,1002,17,30
leo_Gastroenterology_0384_chunk27of30.wav,leo,Skin: No jaundice. No skin rashes or lesions.CT Abdomen with contrast ( 11/29/03 ): There is a 6x6 cm multilobular hypodense mass seen at the level of the hepatic hilum and caudate lobe which is resulting in mass effect with dilatation of the intrahepatic radicals of the left lobe of the liver.,Gastroenterology,23,1758,27,30
leo_Cardiovascular _ Pulmonary_0385_chunk3of52.wav,leo,"In the emergency department of XYZ, the patient described six to seven seconds of sharp chest pain without radiation, without associated symptoms. Electrocardiogram was obtained, which showed nonspecific ST-segment flattening in the high lateral leads I, aVL.",Cardiovascular / Pulmonary,33,1373,3,52
leo_Cardiovascular _ Pulmonary_0385_chunk20of52.wav,leo,6. Cystoscopies times several.,Cardiovascular / Pulmonary,33,232,20,52
leo_Cardiovascular _ Pulmonary_0385_chunk28of52.wav,leo,Detrol 4 mg q.h.s. 3.,Cardiovascular / Pulmonary,33,295,28,52
leo_Cardiovascular _ Pulmonary_0385_chunk34of52.wav,leo,She knows nothing of her father's history. She has no siblings.,Cardiovascular / Pulmonary,33,344,34,52
leo_Cardiovascular _ Pulmonary_0385_chunk37of52.wav,leo,", The patient is able to walk one block or less prior to the onset of significant leg pain. She ever denies any cardiac symptoms with this degree of exertion.",Cardiovascular / Pulmonary,33,771,37,52
leo_Cardiovascular _ Pulmonary_0385_chunk44of52.wav,leo,"Remarkable for past medical history. Negative for tic, tremor, transient ischemic attack (TIA), seizure, or stroke.",Cardiovascular / Pulmonary,33,736,44,52
leo_Cardiovascular _ Pulmonary_0385_chunk49of52.wav,leo,Oxygen saturation on 2 L nasal cannula was 94%. Exam is benign.,Cardiovascular / Pulmonary,33,561,49,52
leo_Gastroenterology_0386_chunk5of13.wav,leo,5 mg of Versed with adequate sedation. Rectal exam revealed no external lesions.,Gastroenterology,23,498,5,13
leo_SOAP _ Chart _ Progress Notes_0388_chunk2of12.wav,leo,Laparoscopic fundoplication and gastrostomy was done because of the need for enteral feeding access and to protect her airway at a time when it is either going to heal enough to improve and allow decannulation or eventually prove that she will need laryngotracheoplasty. Dr.,SOAP / Chart / Progress Notes,34,1387,2,12
leo_SOAP _ Chart _ Progress Notes_0388_chunk8of12.wav,leo,"Her belly is soft and nontender. All of her laparoscopic trocar sites are healing with a normal amount of induration, but there is no evidence of hernia or infection.",SOAP / Chart / Progress Notes,34,792,8,12
leo_SOAP _ Chart _ Progress Notes_0389_chunk2of30.wav,leo,2. Enlarged fibroid uterus.,SOAP / Chart / Progress Notes,34,218,2,30
leo_SOAP _ Chart _ Progress Notes_0389_chunk10of30.wav,leo,Thickened endometrium per ultrasound of a 2 cm lining. 6.,SOAP / Chart / Progress Notes,34,379,10,30
leo_SOAP _ Chart _ Progress Notes_0389_chunk14of30.wav,leo,2 x 6. 2 x 5.,SOAP / Chart / Progress Notes,34,253,14,30
leo_SOAP _ Chart _ Progress Notes_0389_chunk22of30.wav,leo,There is a good descend. There appears to be no adnexal abnormalities.,SOAP / Chart / Progress Notes,34,379,22,30
leo_SOAP _ Chart _ Progress Notes_0389_chunk29of30.wav,leo,"Therefore, we reinserted the hysteroscope. It appeared that there was an appropriate curettage and that all areas of suspicion were indeed removed.",SOAP / Chart / Progress Notes,34,715,29,30
leo_Gastroenterology_0390_chunk2of22.wav,leo,", Open cholecystectomy. , Epidural with local.",Gastroenterology,23,267,2,22
leo_Cardiovascular _ Pulmonary_0391_chunk7of35.wav,leo,No history of diabetes mellitus. Nonsmoker.,Cardiovascular / Pulmonary,33,295,7,35
leo_Cardiovascular _ Pulmonary_0391_chunk17of35.wav,leo,Chest pain. No congestive heart failure.,Cardiovascular / Pulmonary,33,225,17,35
leo_Cardiovascular _ Pulmonary_0391_chunk27of35.wav,leo,PMI displaced. S1 and S2 regular.,Cardiovascular / Pulmonary,33,281,27,35
leo_Cardiovascular _ Pulmonary_0391_chunk29of35.wav,leo,Pulses palpable. No clubbing or cyanosis.,Cardiovascular / Pulmonary,33,309,29,35
leo_Cardiovascular _ Pulmonary_0392_chunk8of66.wav,leo,"Defibrillation threshold testing x2. ,18.",Cardiovascular / Pulmonary,33,309,8,66
leo_Cardiovascular _ Pulmonary_0392_chunk12of66.wav,leo,4. Benadryl 50 mg.,Cardiovascular / Pulmonary,33,246,12,66
leo_Cardiovascular _ Pulmonary_0392_chunk15of66.wav,leo,"Risks including but not limited to bleeding, infection, vascular injury, cardiac perforation, stroke, myocardial infarction, the need for urgent cardiovascular surgery, and death were discussed with the patient. The patient agreed both verbally and via written consent.",Cardiovascular / Pulmonary,33,1345,15,66
leo_Cardiovascular _ Pulmonary_0392_chunk22of66.wav,leo,The dilator and wire were removed. A defibrillation lead was then advanced down into the atrium.,Cardiovascular / Pulmonary,33,463,22,66
leo_Cardiovascular _ Pulmonary_0392_chunk27of66.wav,leo,An active pacing lead was then advanced down to the right atrium and the peel-away sheath was removed. The lead was parked until a later time.,Cardiovascular / Pulmonary,33,694,27,66
leo_Cardiovascular _ Pulmonary_0392_chunk41of66.wav,leo,"2. Right atrial lead, manufacturer Guidant, model 4470, serial 12345.",Cardiovascular / Pulmonary,33,631,41,66
leo_Cardiovascular _ Pulmonary_0392_chunk47of66.wav,leo,2. Right ventricular lead impedance 685 ohms.,Cardiovascular / Pulmonary,33,407,47,66
leo_Cardiovascular _ Pulmonary_0392_chunk49of66.wav,leo,Pacing threshold 0. 6 volt at 0.,Cardiovascular / Pulmonary,33,260,49,66
leo_Cardiovascular _ Pulmonary_0392_chunk55of66.wav,leo,"9 seconds. Energy delivered 17 joules, successful with lead impedance of 39 ohms.",Cardiovascular / Pulmonary,33,512,55,66
leo_Cardiovascular _ Pulmonary_0392_chunk65of66.wav,leo,3. Device interrogation in the morning.,Cardiovascular / Pulmonary,33,225,65,66
leo_Gastroenterology_0393_chunk17of19.wav,leo,NPO except ice chips today. 2.,Gastroenterology,23,260,17,19
leo_Radiology_0394_chunk8of10.wav,leo,2. Mild left atrial enlargement.,Radiology,15,246,8,10
leo_SOAP _ Chart _ Progress Notes_0396_chunk1of7.wav,leo,",The patient has attended physical therapy from 11/16/06 to 11/21/06. The patient has 3 call and cancels and 3 no shows.",SOAP / Chart / Progress Notes,34,764,1,7
leo_Cardiovascular _ Pulmonary_0397_chunk11of17.wav,leo,"Right coronary artery: The right coronary artery is a large, dominant vessel which gives off large posterior descending and posterolateral left ventricular branches. There are luminal irregularities, less than 25%, within the proximal to mid vessel.",Cardiovascular / Pulmonary,33,1261,11,17
leo_Cardiovascular _ Pulmonary_0400_chunk6of11.wav,leo,Resting myocardial perfusion SPECT imaging was carried out with 10. 9 mCi of Tc-99m Myoview.,Cardiovascular / Pulmonary,33,694,6,11
leo_Gastroenterology_0401_chunk1of23.wav,leo,", CT of the abdomen and pelvis without contrast. , Lower abdominal pain.",Gastroenterology,23,771,1,23
leo_Gastroenterology_0401_chunk3of23.wav,leo,6 cm nodular density at the left posterior sulcus. Noncontrast technique limits evaluation of the solid abdominal organs.,Gastroenterology,23,673,3,23
leo_Gastroenterology_0401_chunk21of23.wav,leo,"5. Low-attenuation lesions in the spleen may represent cyst, that are incompletely characterized on this examination.",Gastroenterology,23,617,21,23
leo_Radiology_0402_chunk11of29.wav,leo,"HTN and multiple malignancies of unknown type. Homosexual, in monogamous relationship with an HIV infected partner for the past 3 years.",Radiology,15,806,11,29
leo_Radiology_0402_chunk13of29.wav,leo,"5/3. 0 and ""equally reactive to light."" Mild horizontal nystagmus on rightward gaze.",Radiology,15,645,13,29
leo_Radiology_0402_chunk15of29.wav,leo,Sensory/Coord/Gait/Station/Reflexes: not done. Gen Penil ulcerations.,Radiology,15,554,15,29
leo_Gastroenterology_0403_chunk14of64.wav,leo,"She had history of alcohol abuse. Father deceased at age 45, also has a history of alcohol abuse, cardiac disease, and hypertension.",Gastroenterology,23,750,14,64
leo_Gastroenterology_0403_chunk19of64.wav,leo,"8, pulse 106, respiratory rate 18, blood pressure 162/97, saturation 99 on room air. African American female, not in acute respiratory distress, but uncomfortable, and showing some signs of back discomfort.",Gastroenterology,23,1366,19,64
leo_Gastroenterology_0403_chunk29of64.wav,leo,No other signs of skin infection. Neurological exam: Cranial nerves II through XII grossly intact.,Gastroenterology,23,610,29,64
leo_Gastroenterology_0403_chunk36of64.wav,leo,"1, albumin 3. 1, globulin 5.",Gastroenterology,23,295,36,64
leo_Gastroenterology_0403_chunk44of64.wav,leo,"Differential diagnosis may include foreign body, achalasia, Candida infection, or CMV esophagitis. We will treat according to the EGD findings.",Gastroenterology,23,834,44,64
leo_Gastroenterology_0403_chunk60of64.wav,leo,"We will restrain from using heparin or Lovenox. , The patient was examined by Dr.",Gastroenterology,23,449,60,64
leo_Gastroenterology_0404_chunk1of26.wav,leo,", Nissen fundoplication. , After informed consent was obtained detailing the risks of infection, bleeding, esophageal perforation and death, the patient was brought to the operative suite and placed supine on the operating room table.",Gastroenterology,23,1086,1,26
leo_Gastroenterology_0404_chunk7of26.wav,leo,"The remaining trocars were then placed into the abdomen taking care to make the incisions along Langer's line, spreading the subcutaneous tissue with a tonsil clamp, and confirming the entry site by depressing the abdominal wall prior to insertion of the trocar. A total of 4 other 10/11 mm trocars were placed.",Gastroenterology,23,1464,7,26
leo_Gastroenterology_0404_chunk15of26.wav,leo,"The dissection plane between it and the left aspect of the esophagus was freed. The gastrophrenic ligament was incised, beginning the mobilization of the gastric pouch.",Gastroenterology,23,785,15,26
leo_SOAP _ Chart _ Progress Notes_0405_chunk2of5.wav,leo,The right great toenail is ingrown on the lateral nail border only. There is mild redness and granulation tissue growing on the borders of the toes.,SOAP / Chart / Progress Notes,34,743,2,5
leo_Cardiovascular _ Pulmonary_0406_chunk3of36.wav,leo,3. Posterior leaflet abscess resection.,Cardiovascular / Pulmonary,33,281,3,36
leo_Cardiovascular _ Pulmonary_0406_chunk4of36.wav,leo,",General endotracheal anesthesia,Aortic cross-clamp time was ** minutes. Cardiopulmonary bypass time total was ** minutes.",Cardiovascular / Pulmonary,33,799,4,36
leo_Cardiovascular _ Pulmonary_0406_chunk17of36.wav,leo,Next a 15-blade scalpel was used to open the left atrium. The left atrium was decompressed with pump sucker.,Cardiovascular / Pulmonary,33,617,17,36
leo_Cardiovascular _ Pulmonary_0406_chunk21of36.wav,leo,"Prior to doing so, care was taken to remove any debris and abscess-type material. The pledgeted stitch was lowered into place and tied.",Cardiovascular / Pulmonary,33,715,21,36
leo_Radiology_0407_chunk12of12.wav,leo,"Moderate to moderately advanced atrophy.radiology, severe headaches, chiari malformation, cerebral ischemic change, mri head without contrast, cerebellar hemisphere, superior portion, mri head, cerebellar, infarction, ischemic",Radiology,15,1366,12,12
leo_SOAP _ Chart _ Progress Notes_0409_chunk19of59.wav,leo,The patient has a history of smoking two packs per day of cigarettes for approximately 25 pounds. She also has a history of recurrent atypical chest pain for which she has been evaluated.,SOAP / Chart / Progress Notes,34,862,19,59
leo_SOAP _ Chart _ Progress Notes_0409_chunk26of59.wav,leo,4. Seroquel 20 mg by mouth nightly.,SOAP / Chart / Progress Notes,34,323,26,59
leo_SOAP _ Chart _ Progress Notes_0409_chunk52of59.wav,leo,The patient had no REM sleep. The patient had no periodic limb movements during sleep.,SOAP / Chart / Progress Notes,34,442,52,59
leo_Gastroenterology_0411_chunk7of22.wav,leo,The patient drinks alcohol socially. Significant for hypertension and strokes.,Gastroenterology,23,379,7,22
leo_Gastroenterology_0411_chunk21of22.wav,leo,The patient will be scheduled for the colonoscopy at Sample Hospital and the full report will be forwarded to your office. Thank you very much for allowing me to participate in the care of your patient.,Gastroenterology,23,827,21,22
leo_Gastroenterology_0411_chunk22of22.wav,leo,"Sincerely yours,Sample Doctor, MDnan",Gastroenterology,23,309,22,22
dan_Cardiovascular _ Pulmonary_0413_chunk3of31.wav,dan,"1% lidocaine solution was used to infiltrate the skin overlying the left subclavian vein. Once adequate anesthesia had been obtained, a thin-walled 18-gauze Argon needle was used to cannulate the left subclavian vein.",Cardiovascular / Pulmonary,33,1359,3,31
dan_Cardiovascular _ Pulmonary_0413_chunk11of31.wav,dan,"The guidewire and dilator were then removed. Next, a ventricular pacemaker lead was advanced through the sheath and into the vascular lumen and under fluoroscopic guidance guided down into the right atrium.",Cardiovascular / Pulmonary,33,1317,11,31
dan_Cardiovascular _ Pulmonary_0413_chunk19of31.wav,dan,The deep tissues were closed utilizing 2-0 Chromic suture in an interrupted stitch fashion. A 4-0 undyed Vicryl was then used to close the subcutaneous tissue in a continuous subcuticular stitch.,Cardiovascular / Pulmonary,33,1261,19,31
dan_Gastroenterology_0414_chunk3of27.wav,dan,"She was seen 3 to 4 days ago at ABC ER and underwent evaluation and discharged and had a CT scan at that time and she was told it was ""normal."" She was given oral antibiotics of Cipro and Flagyl. She has had no nausea and vomiting, but has had persistent associated anorexia.",Gastroenterology,23,1842,3,27
dan_Gastroenterology_0414_chunk6of27.wav,dan,She has had no definite fevers or chills and no history of jaundice. The patient denies any significant recent weight loss.,Gastroenterology,23,764,6,27
dan_Gastroenterology_0414_chunk15of27.wav,dan,"Generally nondistended and soft. She is focally tender in the left lower quadrant to deep palpation with a palpable fullness or mass and focally tender, but no rebound tenderness.",Gastroenterology,23,1114,15,27
dan_Gastroenterology_0415_chunk23of28.wav,dan,The abdomen was then aspirated. There was no evidence of bleeding.,Gastroenterology,23,393,23,28
dan_Gastroenterology_0415_chunk27of28.wav,dan,Sterile dressing was applied. The patient tolerated the procedure well.,Gastroenterology,23,435,27,28
dan_Cardiovascular _ Pulmonary_0416_chunk7of11.wav,dan,"Cardiac perfusion reviewed, showed a large area of moderate-to-severe intensity in the inferior wall and small-to-medium area of severe intensity at the apex and inferoapical wall. Both defects showed no change on the resting indicative of a fixed defect in the inferior and inferoapical wall consistent with old inferior inferoapical MI.",Cardiovascular / Pulmonary,33,2360,7,11
dan_Cardiovascular _ Pulmonary_0416_chunk10of11.wav,dan,No reversible ischemia identified. 3.,Cardiovascular / Pulmonary,33,344,10,11
dan_Radiology_0417_chunk14of21.wav,dan,"5cm in size, extending to the posterior subtalar facet joint consistent with a ganglion of either posterior subtalar facet origin or arising from the flexor hallucis longus tendon sheath. There is mild tenosynovitis of the Achilles tendon with mild fusiform enlargement of the non-insertional Watershed zone of the Achilles tendon but there is no demonstrated tendon tear or tenosynovitis.",Radiology,15,2423,14,21
dan_Cardiovascular _ Pulmonary_0418_chunk10of16.wav,dan,There were no complications.1. Cardiac output was 4.,Cardiovascular / Pulmonary,33,400,10,16
dan_Cardiovascular _ Pulmonary_0420_chunk11of31.wav,dan,"Other review of systems is unremarkable.I reviewed his past medical history, past surgical history, and family history. , He has quit smoking, but unfortunately was positive for cocaine during last hospital stay in 01/08.",Cardiovascular / Pulmonary,33,1401,11,31
dan_Cardiovascular _ Pulmonary_0420_chunk25of31.wav,dan,I have also added Aldactone 25 mg p.o. daily for survival advantage.,Cardiovascular / Pulmonary,33,540,25,31
dan_Cardiovascular _ Pulmonary_0423_chunk4of5.wav,dan,"Using sterile technique and with ultrasound as a guide, a pleural catheter was inserted and serosanguinous fluid was withdrawn, a total of 1 L. The patient tolerated the procedure well.",Cardiovascular / Pulmonary,33,1128,4,5
dan_SOAP _ Chart _ Progress Notes_0424_chunk25of44.wav,dan,"NovoLog 25/50. Fatigue, occasional rectal bleeding, and obesity.",SOAP / Chart / Progress Notes,34,568,25,44
dan_SOAP _ Chart _ Progress Notes_0424_chunk31of44.wav,dan,Mild lower extremity edema. Mild dryness.,SOAP / Chart / Progress Notes,34,365,31,44
dan_SOAP _ Chart _ Progress Notes_0424_chunk32of44.wav,dan,Grossly intact. White count 4.,SOAP / Chart / Progress Notes,34,309,32,44
dan_SOAP _ Chart _ Progress Notes_0424_chunk37of44.wav,dan,"2. He is slightly anemic, may be iron deficient.",SOAP / Chart / Progress Notes,34,372,37,44
dan_SOAP _ Chart _ Progress Notes_0424_chunk38of44.wav,dan,He has had recurrent rectal bleeding. I told him to take multivitamin with iron and see how that helps the anemia.,SOAP / Chart / Progress Notes,34,638,38,44
dan_Cardiovascular _ Pulmonary_0426_chunk13of20.wav,dan,The inner cannula was then removed from the tracheostomy and a nasogastric tube was placed down the lumen of the tracheostomy tube as a guidewire. The tracheostomy tube was then removed over the nasogastric tube and the operative field was suctioned.,Cardiovascular / Pulmonary,33,1366,13,20
dan_Cardiovascular _ Pulmonary_0426_chunk14of20.wav,dan,"With the guidewire in place and with adequate visualization, a new 6 Shiley with proximal extension was then passed over the nasogastric tube guidewire and carefully inserted into the trachea. The guidewire was then removed and the inner cannula was then placed into the tracheostomy.",Cardiovascular / Pulmonary,33,1513,14,20
dan_Cardiovascular _ Pulmonary_0426_chunk15of20.wav,dan,The patient was then reconnected to the ventilator and was noted to have normal tidal volumes. The patient had a tidal volume of 500 and was returning 500 cc to 510 cc.,Cardiovascular / Pulmonary,33,1100,15,20
dan_Gastroenterology_0427_chunk25of41.wav,dan,"The abdomen was then deflated. Utilizing ________ 10 blade scalpel, a midline incision was created from the xiphoid down to level of the pubic symphysis.",Gastroenterology,23,1009,25,41
dan_Gastroenterology_0427_chunk40of41.wav,dan,NG tube and Foley catheter were left in place. The patient tolerated this procedure well with exception of hypoxemia which resolved by the conclusion of the case.,Gastroenterology,23,960,40,41
dan_Cardiovascular _ Pulmonary_0428_chunk2of12.wav,dan,",Lexiscan, unable to walk on a treadmill. , Resting heart rate of 96, blood pressure of 141/76.",Cardiovascular / Pulmonary,33,827,2,12
dan_Cardiovascular _ Pulmonary_0428_chunk9of12.wav,dan,Myocardial perfusion scan demonstrates homogeneous and uniform distribution of the tracer uptake. There is no evidence of reversible or fixed defect.,Cardiovascular / Pulmonary,33,974,9,12
dan_Cardiovascular _ Pulmonary_0430_chunk8of25.wav,dan,She has one brother with asthma. Negative for use of alcohol or tobacco.Bones and Joints: She has had continued difficulty with lower back pain particularly with standing which usually radiates down her right leg.,Cardiovascular / Pulmonary,33,1296,8,25
dan_Cardiovascular _ Pulmonary_0430_chunk15of25.wav,dan,Blood pressure: 144/72. Pulse: 80.,Cardiovascular / Pulmonary,33,463,15,25
dan_Cardiovascular _ Pulmonary_0430_chunk16of25.wav,dan,Temperature: 97. 5 degrees.,Cardiovascular / Pulmonary,33,323,16,25
dan_Cardiovascular _ Pulmonary_0430_chunk21of25.wav,dan,Hypertension. She is advised to continue with the same medication.,Cardiovascular / Pulmonary,33,393,21,25
dan_Cardiovascular _ Pulmonary_0430_chunk25of25.wav,dan,"She still is being evaluated for this and possibly will have surgery in the near future.cardiovascular / pulmonary, progress note, hypertension, spinal stenosis, syncope, spinal, stenosis, infarction, orthopnea,",Cardiovascular / Pulmonary,33,1443,25,25
dan_SOAP _ Chart _ Progress Notes_0432_chunk2of19.wav,dan,"Since that time, her respiratory status has been quite good. She has had no major respiratory difficulties however, starting yesterday she began with increasing back and joint pain and as a result a deep breath has caused some back discomfort.",SOAP / Chart / Progress Notes,34,1289,2,19
dan_Gastroenterology_0433_chunk12of23.wav,dan,"A Jackson-Pratt drain, which was left in place in two places showed serosanguineous fluid. White blood cell count was down to 7500 and bilirubin decreased to 2.",Gastroenterology,23,1156,12,23
dan_Cardiovascular _ Pulmonary_0434_chunk1of11.wav,dan,",1. Right spontaneous pneumothorax secondary to barometric trauma.",Cardiovascular / Pulmonary,33,498,1,11
dan_Radiology_0435_chunk1of9.wav,dan,", Ultrasound Abdomen. , Elevated liver function tests.",Radiology,15,372,1,9
dan_SOAP _ Chart _ Progress Notes_0436_chunk3of19.wav,dan,"She continues to have pain with deep inspiration and resolving dysphagia. She has no heartburn, cough, hemoptysis, rash, or palpable rib pain.",SOAP / Chart / Progress Notes,34,953,3,19
dan_SOAP _ Chart _ Progress Notes_0436_chunk4of19.wav,dan,", Dilantin 100 mg four times a day, phenobarbital 30 mg three times per day, levothyroxine 0. 025 mg p.o.",SOAP / Chart / Progress Notes,34,1044,4,19
dan_SOAP _ Chart _ Progress Notes_0436_chunk5of19.wav,dan,"q. day, Tylenol with Codeine b.i.d.",SOAP / Chart / Progress Notes,34,337,5,19
dan_SOAP _ Chart _ Progress Notes_0436_chunk10of19.wav,dan,b.i.d. oxaprozin 600 mg p.o.,SOAP / Chart / Progress Notes,34,372,10,19
dan_SOAP _ Chart _ Progress Notes_0436_chunk12of19.wav,dan,b.i.d. and Asacol p.r.n.,SOAP / Chart / Progress Notes,34,316,12,19
dan_Cardiovascular _ Pulmonary_0437_chunk7of10.wav,dan,No ventricular tachycardia was seen. 5.,Cardiovascular / Pulmonary,33,323,7,10
dan_Cardiovascular _ Pulmonary_0437_chunk9of10.wav,dan,The longest RR interval was 1. 1 second.,Cardiovascular / Pulmonary,33,435,9,10
dan_Cardiovascular _ Pulmonary_0438_chunk1of26.wav,dan,", The patient is a 5-1/2-year-old, who recently presented with a cardiac murmur diagnosed due to a patent ductus arteriosus. An echocardiogram from 09/13/2007 demonstrated a 3.",Cardiovascular / Pulmonary,33,1359,1,26
dan_Cardiovascular _ Pulmonary_0438_chunk14of26.wav,dan,"After angiography, two normal-appearing renal collecting systems were visualized. The catheters and sheaths were removed and topical pressure applied for hemostasis.",Cardiovascular / Pulmonary,33,960,14,26
dan_Cardiovascular _ Pulmonary_0438_chunk16of26.wav,dan,", Oxygen consumption was assumed to be normal. Mixed venous saturation was normal with a slight increased saturation of the branch pulmonary arteries due to left-to-right shunt through the ductus arteriosus.",Cardiovascular / Pulmonary,33,1142,16,26
dan_Cardiovascular _ Pulmonary_0438_chunk24of26.wav,dan,"Patent ductus arteriosus.SURGERIES (INTERVENTIONS): ,Coil embolization of patent ductus arteriosus. ,The case to be discussed at Combined Cardiology/Cardiothoracic Surgery case conference.",Cardiovascular / Pulmonary,33,1380,24,26
dan_Radiology_0440_chunk1of25.wav,dan,"CC:, Found unresponsive.HX: , 39 y/o RHF complained of a severe HA at 2AM 11/4/92. It was unclear whether she had been having HA prior to this.",Radiology,15,1282,1,25
dan_Radiology_0440_chunk13of25.wav,dan,Trace corneal reflexes bilaterally. No gag reflex.,Radiology,15,449,13,25
dan_SOAP _ Chart _ Progress Notes_0442_chunk2of10.wav,dan,"The patient states that this pain is well controlled. He has had no fevers, chills or night sweats.",SOAP / Chart / Progress Notes,34,617,2,10
dan_SOAP _ Chart _ Progress Notes_0442_chunk4of10.wav,dan,"He has had no numbness or tingling. , On exam, his pin sites had no erythema.",SOAP / Chart / Progress Notes,34,610,4,10
dan_Cardiovascular _ Pulmonary_0443_chunk15of29.wav,dan,The table was rotated to the right to allow gravity to aid in our retraction of the bowel. Prep was performed.,Cardiovascular / Pulmonary,33,638,15,29
dan_Cardiovascular _ Pulmonary_0443_chunk26of29.wav,dan,"There was no evidence of bleeding. At this point, the camera was switched to one of the subcostal ports and the primary port in the periumbilical region was closed under direct vision using 0 Vicryl suture.",Cardiovascular / Pulmonary,33,1247,26,29
dan_Gastroenterology_0444_chunk5of18.wav,dan,"The procedure, indications, alternatives available, and complications i.e. bleeding, perforation, infection, adverse medication reactions, possible need for blood transfusion, and surgery associated complication occur were discussed with the mother who understood and indicated this.",Gastroenterology,23,1835,5,18
dan_Gastroenterology_0445_chunk10of11.wav,dan,I irrigated out the abdomen. I then closed the fascia of the umbilicus with interrupted 0 Vicryl suture utilizing Carter-Thomason and closed the skin of all incisions with a running Monocryl.,Gastroenterology,23,1135,10,11
dan_Cardiovascular _ Pulmonary_0446_chunk3of12.wav,dan,Tumor cells show no reactivity with cytokeratin AE1/AE3. No significant reactivity with CAM5.,Cardiovascular / Pulmonary,33,792,3,12
dan_Cardiovascular _ Pulmonary_0446_chunk4of12.wav,dan,2 and no reactivity with cytokeratin-20 are seen. Tumor cells show partial reactivity with cytokeratin-7.,Cardiovascular / Pulmonary,33,757,4,12
dan_Radiology_0447_chunk9of13.wav,dan,Systolic consistent with mild-to-moderate pulmonary hypertension. Peak velocity across the aortic valve is 3.,Radiology,15,715,9,13
dan_Cardiovascular _ Pulmonary_0449_chunk16of32.wav,dan,Hypotension. I would aggressively try and fluid replete the patient giving him another liter of fluids.,Cardiovascular / Pulmonary,33,694,16,32
dan_Cardiovascular _ Pulmonary_0449_chunk19of32.wav,dan,Presumably this is from increased congestion. This is certainly concerning.,Cardiovascular / Pulmonary,33,505,19,32
dan_Cardiovascular _ Pulmonary_0449_chunk31of32.wav,dan,Fingerstick blood glucoses are reviewed and are at target. We will continue current management.,Cardiovascular / Pulmonary,33,617,31,32
dan_Radiology_0450_chunk24of27.wav,dan,Aortic valve sclerosis with mild-to-moderate aortic insufficiency. 5.,Radiology,15,540,24,27
dan_Cardiovascular _ Pulmonary_0453_chunk3of31.wav,dan,Cardiac enzymes were indeterminate. She was evaluated by Dr.,Cardiovascular / Pulmonary,33,442,3,31
dan_Cardiovascular _ Pulmonary_0453_chunk18of31.wav,dan,", Left ventriculography demonstrated well-preserved left ventricular systolic function. Mild inferobasilar hypokinesis was noted.",Cardiovascular / Pulmonary,33,855,18,31
dan_Gastroenterology_0454_chunk13of20.wav,dan,"The patient's nausea, vomiting, and diarrhea did resolve during his hospital course. Was placed on IV fluids initially and on hospital day 2 fluids were discontinued and was started on clear liquid diet and diet was advanced slowly, and the patient was able to tolerate p.o.",Gastroenterology,23,1639,13,20
dan_Gastroenterology_0454_chunk15of20.wav,dan,The patient was also started on prednisone as per GI recommendations. He was started on 60 mg p.o.,Gastroenterology,23,666,15,20
dan_Gastroenterology_0454_chunk20of20.wav,dan,"He was instructed to take tapered dose of prednisone for 4 weeks as per the GI recommendations.gastroenterology, nausea, vomiting, diarrhea, gastrointestinal bleed, mesentery, hemoglobin, hematocrit, gastrointestinal, periumbilical, gastroenteritis, hemorrhoids",Gastroenterology,23,1786,20,20
dan_Cardiovascular _ Pulmonary_0455_chunk3of29.wav,dan,She never had treated hypertension. She said the blood pressure came down.,Cardiovascular / Pulmonary,33,442,3,29
dan_Cardiovascular _ Pulmonary_0455_chunk5of29.wav,dan,"She has not had chest pain, however, during any of the other previous symptoms and spells. Does not smoke, lipids unknown.",Cardiovascular / Pulmonary,33,736,5,29
dan_SOAP _ Chart _ Progress Notes_0456_chunk2of19.wav,dan,"She is scheduled to see a gastroenterologist in the near future. She is taking Econopred 8 times a day to the right eye and Nevanac, OD, three times a day.",SOAP / Chart / Progress Notes,34,988,2,19
dan_SOAP _ Chart _ Progress Notes_0456_chunk6of19.wav,dan,"In the left eye, she has an area of sectoral scleral hyperemia superonasally in the left eye. The cornea on the right eye shows a paracentral area of mild corneal edema.",SOAP / Chart / Progress Notes,34,1114,6,19
dan_SOAP _ Chart _ Progress Notes_0456_chunk8of19.wav,dan,"In the left eye, the anterior chamber is deep and quiet. She has a posterior chamber intraocular lens, well centered and in sulcus of the left eye.",SOAP / Chart / Progress Notes,34,974,8,19
dan_Gastroenterology_0458_chunk1of24.wav,dan,", Symptomatic cholelithiasis. , Symptomatic cholelithiasis.",Gastroenterology,23,470,1,24
dan_Gastroenterology_0458_chunk11of24.wav,dan,"Using these, the gallbladder was grasped and retraced cephalad. Adhesions were taken down over the cystic duct and the duct was circumferentially dissected and clipped at the gallbladder cystic duct junction.",Gastroenterology,23,1289,11,24
dan_Gastroenterology_0458_chunk15of24.wav,dan,The duct was doubly clipped and divided. The artery was divided and cauterized.,Gastroenterology,23,512,15,24
dan_Gastroenterology_0458_chunk16of24.wav,dan,The gallbladder was taken out of the gallbladder fossa. It was then placed in Endocatch bag and left in the abdomen.,Gastroenterology,23,638,16,24
dan_Cardiovascular _ Pulmonary_0462_chunk9of60.wav,dan,"A separate port of arterial access was obtained in the left femoral artery utilizing a 5-French sheath. Percutaneous access into the right jugular vein was attempted, but unsuccessful.",Cardiovascular / Pulmonary,33,1170,9,60
dan_Cardiovascular _ Pulmonary_0462_chunk14of60.wav,dan,Probing of the superior vena cava facilitated access into the right lower pulmonary artery. The angiogram in the right pulmonary artery showed a diminutive right lower pulmonary artery and severe long segment proximal stenosis.,Cardiovascular / Pulmonary,33,1408,14,60
dan_Cardiovascular _ Pulmonary_0462_chunk36of60.wav,dan,"4 Woods units. Following stent implantation in the right caval pulmonary anastomosis and right pulmonary artery, there was a slight increase in the Glenn venous pressures to 16 mmHg.",Cardiovascular / Pulmonary,33,1282,36,60
dan_Cardiovascular _ Pulmonary_0462_chunk40of60.wav,dan,Angiogram within the innominate vein following stent implantation demonstrated appropriate stent position without significant distortion of the innominate vein or proximal cava. There appeared unobstructed contrast flow to the right lower pulmonary artery of a 1-mmHg mean pressure gradient.,Cardiovascular / Pulmonary,33,1772,40,60
dan_Cardiovascular _ Pulmonary_0462_chunk41of60.wav,dan,"There was absence of contrast filling of the right middle and right upper pulmonary artery. Final angiogram with a contrast injection in the left superior vena cava showed a forward flow through the right Glenn, a good contrast filling of the right lower pulmonary artery, and a widely patent left Glenn negative contrast washout of the proximal right pulmonary artery and left pulmonary artery presumably due to aortopulmonary collateral flow.",Cardiovascular / Pulmonary,33,2521,41,60
dan_Cardiovascular _ Pulmonary_0462_chunk45of60.wav,dan,Atrioventricular septal defect. 4.,Cardiovascular / Pulmonary,33,351,45,60
dan_Cardiovascular _ Pulmonary_0463_chunk5of13.wav,dan,All questions were answered and consent was obtained. The patient was sterilely prepped and draped.,Cardiovascular / Pulmonary,33,638,5,13
dan_Cardiovascular _ Pulmonary_0463_chunk9of13.wav,dan,The dilator was then removed from the guidewire and a triple lumen catheter was then inserted over the guidewire with the guidewire held at all times. The wire was then carefully removed.,Cardiovascular / Pulmonary,33,1023,9,13
dan_Gastroenterology_0464_chunk8of21.wav,dan,"He also has a history of adenomatous polyps and presents for surveillance of this process. Informed consent was obtained after explanation of the procedures, as well as risk factors of bleeding, perforation, and adverse medication reaction.",Gastroenterology,23,1415,8,21
dan_Gastroenterology_0464_chunk21of21.wav,dan,Continue fiber with avoidance of stimulant laxatives.nan,Gastroenterology,23,449,21,21
dan_Cardiovascular _ Pulmonary_0465_chunk4of26.wav,dan,", History of hypertension, no history of diabetes mellitus, ex-smoker, cholesterol status elevated, no history of established coronary artery disease, and family history positive. , Positive for coronary artery disease.",Cardiovascular / Pulmonary,33,1380,4,26
dan_Cardiovascular _ Pulmonary_0465_chunk17of26.wav,dan,Atraumatic and normocephalic. Neck veins flat.,Cardiovascular / Pulmonary,33,386,17,26
dan_Cardiovascular _ Pulmonary_0466_chunk5of17.wav,dan,2 L and 1. 9 L of pleural effusion drained.,Cardiovascular / Pulmonary,33,407,5,17
dan_Cardiovascular _ Pulmonary_0466_chunk16of17.wav,dan,The patient was then brought in the supine position and extubated and brought to recovery room in stable condition. Dr.,Cardiovascular / Pulmonary,33,694,16,17
dan_Gastroenterology_0467_chunk4of11.wav,dan,The profundus and the cardia of the stomach were unremarkable. The pylorus was concentric.,Gastroenterology,23,575,4,11
dan_Gastroenterology_0468_chunk3of9.wav,dan,"The tip of the endoscope was introduced into the esophagus, and the entire length of the esophagus was dotted with numerous, white, punctate lesions, suggestive of eosinophilic esophagitis. There were come concentric rings present.",Gastroenterology,23,1408,3,9
dan_Gastroenterology_0468_chunk9of9.wav,dan,"There was no evidence of stricture, Barrett, or other abnormalities in the upper GI tract.gastroenterology, length of the esophagus, food impacted, lower esophagus, upper endoscopy, entire length, eosinophilic esophagitis, egd, dysphagia, solids, impacted, endoscopy, mucosal, endoscope, biopsies, barrett, stomach, stricture, eosinophilic, esophagitis, esophagus,",Gastroenterology,23,2766,9,9
dan_Cardiovascular _ Pulmonary_0469_chunk9of26.wav,dan,"There was stenosis in the mid-venous limb of the graft. , The patient is an 81-year-old African-American female who presents with an occluded left forearm loop graft.",Cardiovascular / Pulmonary,33,1030,9,26
dan_Cardiovascular _ Pulmonary_0469_chunk21of26.wav,dan,Fogarty balloon and thrombectomy was also performed well enough into this way. There was good venous back bleeding following this.,Cardiovascular / Pulmonary,33,729,21,26
dan_Cardiovascular _ Pulmonary_0469_chunk22of26.wav,dan,"The area was checked for any stenosis with the dilators and none was present. Next, a 6-0 Prolene suture was used in a running fashion to close the graft.",Cardiovascular / Pulmonary,33,883,22,26
dan_Radiology_0470_chunk3of13.wav,dan,There is no retracted tendon or muscular atrophy (series 6 images 6-17). Normal infraspinatus tendon.,Radiology,15,820,3,13
dan_Radiology_0470_chunk6of13.wav,dan,There are degenerative changes in the greater tuberosity of the humerus but there is no fracture or subluxation. There is degeneration of the superior labrum and there is a small nondisplaced tear in the posterior superior labrum at the one to two o’clock position (series 6 images 12-14 series 3 images 8-10 series 9 images 5-8).,Radiology,15,2108,6,13
dan_Radiology_0470_chunk11of13.wav,dan,"There is no retracted tendon or muscular atrophy, but there may be a small tear along the anterior edge of the tendon at the level of the rotator interval, and this associated partial tearing of the superior most fibers of the subscapularis tendon. There is also a high-grade partial tear of the long biceps tendon as it courses under the transverse humeral ligament.",Radiology,15,2171,11,13
dan_Gastroenterology_0472_chunk1of19.wav,dan,", Colonoscopy. The patient is a 56-year-old female.",Gastroenterology,23,393,1,19
dan_Gastroenterology_0474_chunk3of23.wav,dan,"The fascia was then cleared of subcutaneous tissue using a tonsil clamp. A 1-2 cm incision was then made in the fascia, gaining entry into the abdominal cavity without incident.",Gastroenterology,23,1156,3,23
dan_Gastroenterology_0474_chunk10of23.wav,dan,"Several attempts at passing the cholangiocatheter into the ductotomy were made. Despite numerous attempts at several angles, the cholangiocatheter could not be inserted into the cystic duct.",Gastroenterology,23,1135,10,23
dan_SOAP _ Chart _ Progress Notes_0475_chunk3of14.wav,dan,He has been working with physical therapy two to three times a week. He has had no drainage or fever.,SOAP / Chart / Progress Notes,34,575,3,14
dan_Cardiovascular _ Pulmonary_0476_chunk5of64.wav,dan,"She has had stress test done in our office on September 10, 2008, which shows evidence of a small apical infarct, no area of ischemia, and compared to study of December of 2005, there is no significant change. She had a transthoracic echocardiogram done in our office on August 29, 2008, which showed normal left ventricular size and systolic function, dilated right ventricle with septal flattening of the left ventricle consistent with right ventricular pressure overload, left atrial enlargement, severe tricuspid regurgitation with estimated PA systolic pressure between 75-80 mmHg consistent with severe pulmonary hypertension, structurally normal aortic and mitral valve.",Cardiovascular / Pulmonary,33,3515,5,64
dan_Cardiovascular _ Pulmonary_0476_chunk6of64.wav,dan,She also has had some presumed atrial arrhythmias that have not been sustained. She follows with Dr.,Cardiovascular / Pulmonary,33,659,6,64
dan_Cardiovascular _ Pulmonary_0476_chunk11of64.wav,dan,Tramadol 50 mg p.o. q.i.d.,Cardiovascular / Pulmonary,33,442,11,64
dan_Cardiovascular _ Pulmonary_0476_chunk15of64.wav,dan,ProAir HFA. 6.,Cardiovascular / Pulmonary,33,253,15,64
dan_Cardiovascular _ Pulmonary_0476_chunk20of64.wav,dan,p.r.n. 10.,Cardiovascular / Pulmonary,33,190,20,64
dan_Cardiovascular _ Pulmonary_0476_chunk25of64.wav,dan,Theo-24 200 mg p.o. 2 in the morning.,Cardiovascular / Pulmonary,33,456,25,64
dan_Cardiovascular _ Pulmonary_0476_chunk27of64.wav,dan,14. Vitamin D 400 units twice daily.,Cardiovascular / Pulmonary,33,421,27,64
dan_Cardiovascular _ Pulmonary_0476_chunk32of64.wav,dan,"b.i.d. , To medications are listed as:,1.",Cardiovascular / Pulmonary,33,372,32,64
dan_Cardiovascular _ Pulmonary_0476_chunk33of64.wav,dan,LEVAQUIN. 2.,Cardiovascular / Pulmonary,33,197,33,64
dan_Cardiovascular _ Pulmonary_0476_chunk42of64.wav,dan,"6, blood pressure 137/67 to 142/75, pulse 92, respiratory rate 16, O2 saturation 93-89%. On general exam, she is an elderly, chronically ill appearing woman in no acute distress.",Cardiovascular / Pulmonary,33,1660,42,64
dan_Cardiovascular _ Pulmonary_0476_chunk57of64.wav,dan,"This ECG appears similar to the ones she has had done previously in our office including on June 11, 2009, although the T wave changes are a bit more prominent, which is a nonspecific finding. , She is an 81-year-old woman with severe O2 requiring chronic obstructive pulmonary disease with evidence of right heart overload, as well as known coronary artery disease status post single-valve bypass in 1971 suffering a right hip fracture for whom a right hip replacement is being considered.",Cardiovascular / Pulmonary,33,2899,57,64
dan_Cardiovascular _ Pulmonary_0478_chunk15of30.wav,dan,"Next, a 3. 75 x 13 mm noncompliant balloon was advanced into the margin of the stent and two inflations at 20 atmospheres were done for 20 seconds.",Cardiovascular / Pulmonary,33,1100,15,30
dan_Cardiovascular _ Pulmonary_0478_chunk17of30.wav,dan,"At this point, wire was removed. Final images confirmed initial stent results, no evidence of dissection, perforation, or complications.",Cardiovascular / Pulmonary,33,932,17,30
dan_Cardiovascular _ Pulmonary_0478_chunk18of30.wav,dan,"Next, an angled pigtail catheter was advanced into the left ventricular cavity. LV pressure was measured.",Cardiovascular / Pulmonary,33,694,18,30
dan_Cardiovascular _ Pulmonary_0478_chunk20of30.wav,dan,"Right femoral artery access site was imaged and Angio-Seal deployed to attain excellent hemostasis. The patient tolerated the procedure very well without complications.DIAGNOSTIC FINDINGS,1.",Cardiovascular / Pulmonary,33,1226,20,30
dan_Cardiovascular _ Pulmonary_0478_chunk26of30.wav,dan,Inferolateral wall hypokinesis. No significant mitral regurgitation.,Cardiovascular / Pulmonary,33,526,26,30
dan_Cardiovascular _ Pulmonary_0479_chunk16of25.wav,dan,Reflexes: 1+ on right and 2+ on left with bilateral Babinski signs.HCT 11/4/92: Large heterogeneous mass in the right temporal-parietal region causing significant parenchymal distortion and leftward subfalcine effect . There is low parenchymal density within the white matter.,Cardiovascular / Pulmonary,33,1898,16,25
dan_Cardiovascular _ Pulmonary_0479_chunk21of25.wav,dan,She did not undergo thoracic biopsy due to poor condition. She received 3000 cGy cranial XRT in ten fractions and following this was discharged to a rehabilitation center.,Cardiovascular / Pulmonary,33,1177,21,25
dan_Cardiovascular _ Pulmonary_0479_chunk22of25.wav,dan,"In March, 1993 the patient exhibited right ptosis, poor adduction and abduction OD, 4/4 strength in the upper extremities and 5-/5- strength in the lower extremities. She was ambulatory with an ataxic gait.",Cardiovascular / Pulmonary,33,1520,22,25
dan_Cardiovascular _ Pulmonary_0479_chunk23of25.wav,dan,"She was admitted on 7/12/93 for lower cervical and upper thoracic pain, paraparesis and T8 sensory level. MRI brainstem/spine on that day revealed decreased T1 signal in the C2, C3, C6 vertebral bodies, increased T2 signal in the anterior medulla, and tectum, and spinal cord (C7-T3).",Cardiovascular / Pulmonary,33,1709,23,25
dan_Gastroenterology_0481_chunk9of9.wav,dan,"pylori, forceps, antral biopsies, ge junction, esophagogastroduodenoscopy, pylori, esophagus, antral,",Gastroenterology,23,932,9,9
dan_Cardiovascular _ Pulmonary_0482_chunk8of45.wav,dan,Plavix 75 mg p.o. daily.,Cardiovascular / Pulmonary,33,302,8,45
dan_Cardiovascular _ Pulmonary_0482_chunk11of45.wav,dan,Isosorbide mononitrate 60 mg p.o. daily.,Cardiovascular / Pulmonary,33,456,11,45
dan_Cardiovascular _ Pulmonary_0482_chunk26of45.wav,dan,"Negative for depression, anxiety, or mood swings. All other systems reviewed are negative.PHYSICAL EXAMINATION, Her blood pressure in the office was 188/94, heart rate 70, respiratory rate 18 to 20, and saturations 99% on room air.",Cardiovascular / Pulmonary,33,1891,26,45
dan_Cardiovascular _ Pulmonary_0482_chunk32of45.wav,dan,Swallow is intact. Positive JVD at 45 degrees.,Cardiovascular / Pulmonary,33,470,32,45
dan_Cardiovascular _ Pulmonary_0482_chunk33of45.wav,dan,Heart tones are distant. S1 and S2.,Cardiovascular / Pulmonary,33,372,33,45
dan_Cardiovascular _ Pulmonary_0482_chunk36of45.wav,dan,Capillary refill is somewhat sluggish. Breath sounds are clear with some bilateral basilar diminishment.,Cardiovascular / Pulmonary,33,610,36,45
dan_Cardiovascular _ Pulmonary_0482_chunk38of45.wav,dan,Diaphragmatic excursions are limited. AP diameter is expanded.,Cardiovascular / Pulmonary,33,463,38,45
dan_Radiology_0483_chunk6of6.wav,dan,"8 cm consistent with 33 weeks, 0 days gestation,AC: 29. 7 cm consistent with 33 weeks, 5 days gestation,FL:nan",Radiology,15,1268,6,6
dan_Cardiovascular _ Pulmonary_0484_chunk6of23.wav,dan,No anatomic lesions were demonstrated. The patient was prepared for left thoracotomy rotated to his right side with a double lumen endotracheal tube in place with an NG tube and a Foley catheter.,Cardiovascular / Pulmonary,33,1226,6,23
dan_Cardiovascular _ Pulmonary_0484_chunk16of23.wav,dan,"Using sharp and blunt dissection, the bronchus through the left upper lobe was freed proximal. Using the TA 50, the bronchus was then cut free allowing the lung to fall superiorly at which time direction was carried out to the pulmonary artery where the tumor was in close proximity at this time.",Cardiovascular / Pulmonary,33,1709,16,23
dan_Cardiovascular _ Pulmonary_0484_chunk17of23.wav,dan,A Potts clamp arterial was then placed over the artery and shaving off the tumor and the apical posterior artery was then accomplished. The anterior artery was seen in the clamp also and was separated and ligated and separated.,Cardiovascular / Pulmonary,33,1310,17,23
dan_Cardiovascular _ Pulmonary_0484_chunk22of23.wav,dan,"After reexamination, no bleeding was seen with three pericostal sutures of 1 chromic double strength. A 2-0 Polydek was then used to close the chest wall muscle the anterior as well as latissimus dorsi 000 chromic subcutaneous tissue skin clips to the skin.",Cardiovascular / Pulmonary,33,1779,22,23
dan_Cardiovascular _ Pulmonary_0485_chunk3of69.wav,dan,3. Anemia.,Cardiovascular / Pulmonary,33,169,3,69
dan_Cardiovascular _ Pulmonary_0485_chunk7of69.wav,dan,"Colon cancer, status post right hemicolectomy. 2.",Cardiovascular / Pulmonary,33,442,7,69
dan_Cardiovascular _ Pulmonary_0485_chunk21of69.wav,dan,from 0. 8 units per hour from 6 a.m.,Cardiovascular / Pulmonary,33,386,21,69
dan_Cardiovascular _ Pulmonary_0485_chunk27of69.wav,dan,"CT of the abdomen and pelvis revealed no metastasis, a CT of the chest revealed possible lung metastasis. Later in hospital course, the patient developed a septic-like picture likely secondary to hospital-acquired pneumonia.",Cardiovascular / Pulmonary,33,1373,27,69
dan_Cardiovascular _ Pulmonary_0485_chunk34of69.wav,dan,"The dosage increases can begin on an outpatient basis.DISCHARGE INSTRUCTIONS/ , The patient was discharged to home. She was told to shy away from strenuous activity.",Cardiovascular / Pulmonary,33,974,34,69
dan_Cardiovascular _ Pulmonary_0485_chunk41of69.wav,dan,Phenergan syrup 6. 25 mg p.o.,Cardiovascular / Pulmonary,33,386,41,69
dan_Cardiovascular _ Pulmonary_0485_chunk42of69.wav,dan,q. 4h.,Cardiovascular / Pulmonary,33,225,42,69
dan_Cardiovascular _ Pulmonary_0485_chunk47of69.wav,dan,7. Lamictal 100 mg p.o.,Cardiovascular / Pulmonary,33,400,47,69
dan_Cardiovascular _ Pulmonary_0485_chunk62of69.wav,dan,"The medications listed above, one listed as p.o. are to be administered via the J-tube.",Cardiovascular / Pulmonary,33,582,62,69
dan_Cardiovascular _ Pulmonary_0485_chunk64of69.wav,dan,She was given a lab sheet to have a CBC with diff as well as a CMP to be drawn prior to her appointment with Dr. X.,Cardiovascular / Pulmonary,33,743,64,69
dan_Cardiovascular _ Pulmonary_0486_chunk8of34.wav,dan,Temperature is 100. 0 per tympanic membrane.,Cardiovascular / Pulmonary,33,428,8,34
dan_Cardiovascular _ Pulmonary_0486_chunk9of34.wav,dan,"Oximetry is 98% on room air. Height is 128 cm, which is an increase of 1.",Cardiovascular / Pulmonary,33,771,9,34
dan_Cardiovascular _ Pulmonary_0486_chunk18of34.wav,dan,"A flu shot was given. , X, RN, BSN, did note that the patient was doing quite well.",Cardiovascular / Pulmonary,33,589,18,34
dan_Cardiovascular _ Pulmonary_0486_chunk28of34.wav,dan,",1. Give flu vaccine 0.",Cardiovascular / Pulmonary,33,274,28,34
dan_Cardiovascular _ Pulmonary_0487_chunk3of18.wav,dan,There was a suggestion of a bilateral lower lobe pneumonitis or pneumonia. She has been on Zosyn for the infection.,Cardiovascular / Pulmonary,33,694,3,18
dan_Cardiovascular _ Pulmonary_0487_chunk5of18.wav,dan,"She was ""immune"" to oxycodone. She had been on tramadol before and was placed back on that.",Cardiovascular / Pulmonary,33,603,5,18
dan_Cardiovascular _ Pulmonary_0487_chunk11of18.wav,dan,"Breathing remained somewhat labored and she had some diffuse scattered rhonchi, which certainly changed from this a.m. Additional Narcan was given as well as some medications to reverse a possible benzodiazepine toxicity.",Cardiovascular / Pulmonary,33,1289,11,18
dan_Cardiovascular _ Pulmonary_0487_chunk13of18.wav,dan,"An ECG was obtained, which shows a sinus tachycardia, noted to have ischemic abnormalities. In light of the acute decompensation, she was then transferred to the ICU.",Cardiovascular / Pulmonary,33,1107,13,18
dan_Cardiovascular _ Pulmonary_0488_chunk2of39.wav,dan,"He was taken to Emergency Department where he got some Xopenex, given a prescription for amoxicillin and discharged home. They were home for about an hour when he began to get worse and they drove here to Children's Hospital.",Cardiovascular / Pulmonary,33,1247,2,39
dan_Cardiovascular _ Pulmonary_0488_chunk7of39.wav,dan,"No rashes have been seen. , As noted above.",Cardiovascular / Pulmonary,33,337,7,39
dan_Cardiovascular _ Pulmonary_0488_chunk28of39.wav,dan,We gave 20 mL/kg bolus of normal saline over one hour. The child was given Solu-Medrol 2 mg/kg IV.,Cardiovascular / Pulmonary,33,967,28,39
dan_Cardiovascular _ Pulmonary_0488_chunk30of39.wav,dan,No evidence of pneumothorax. No evidence of focal pneumonia.,Cardiovascular / Pulmonary,33,498,30,39
dan_Cardiovascular _ Pulmonary_0488_chunk31of39.wav,dan,"After 3 unit dose of albuterol/Atrovent breathing treatments, there was much better air exchange bilaterally but still with inspiratory/expiratory wheezes and high-dose continuous albuterol was started at that time. The child was monitored closely while on high-dose albuterol and slowly showed improvement resulting in only expiratory wheezes after one hour.",Cardiovascular / Pulmonary,33,2234,31,39
dan_Cardiovascular _ Pulmonary_0488_chunk33of39.wav,dan,"The child's color improved with oxygen therapy, and the capillary refill was always less than 2 seconds. The child has failed outpatient therapy at this time.",Cardiovascular / Pulmonary,33,925,33,39
dan_Cardiovascular _ Pulmonary_0488_chunk35of39.wav,dan,"The child has a normal level of alertness however, has not had any vomiting here. I spoke with Dr.",Cardiovascular / Pulmonary,33,589,35,39
dan_Cardiovascular _ Pulmonary_0488_chunk36of39.wav,dan,"X, on call for hospitalist service. She has come down and evaluated the patient.",Cardiovascular / Pulmonary,33,547,36,39
dan_Gastroenterology_0489_chunk6of10.wav,dan,The patient otherwise tolerated the procedure well. There were no complications.,Gastroenterology,23,463,6,10
dan_Radiology_0490_chunk1of16.wav,dan,"CC: ,Difficulty with speech.HX:, This 84 y/o RHF presented with sudden onset word finding and word phonation difficulties. She had an episode of transient aphasia in 2/92 during which she had difficulty with writing, written and verbal comprehension, and exhibited numerous semantic and phonemic paraphasic errors of speech.",Radiology,15,2066,1,16
dan_Radiology_0490_chunk16of16.wav,dan,"The DPH dosage was adjusted appropriately.radiology, ct brain, ct, difficulty with speech, hct, subdural hemorrhage, hemorrhage, phonation difficulties, subdural, transient fluent aphasia, phonemic paraphasic errors, hematoma, carotid, speech,",Radiology,15,1828,16,16
dan_Radiology_0492_chunk1of11.wav,dan,"INTENSITY-MODULATED RADIATION THERAPY,Intensity-modulated radiation therapy is a complex set of procedures which requires appropriate positioning and immobilization typically with customized immobilization devices. The treatment planning process requires at least 4 hours of physician time.",Radiology,15,1877,1,11
dan_Gastroenterology_0493_chunk4of20.wav,dan,"Small amount of fresh blood within the hiatal hernia. No definite source of bleeding seen.PLAN,1.",Gastroenterology,23,666,4,20
dan_Gastroenterology_0493_chunk10of20.wav,dan,"Risks, benefits, and alternatives including, but not limited to risk of bleeding, infection, perforation, adverse reaction to medication, failure to identify pathology, pancreatitis, and death explained to the patient and his wife, who accepted all risks. The patient was prepped in the left lateral position.",Gastroenterology,23,1989,10,20
dan_Gastroenterology_0493_chunk15of20.wav,dan,"There was a small amount of bright red blood near the fundus, but a source could not be identified due to the clot burden. Because of this, the gastroscope was withdrawn.",Gastroenterology,23,869,15,20
dan_Cardiovascular _ Pulmonary_0494_chunk5of33.wav,dan,", The patient was taken to the operating room, placed in a supine position, and prepped and draped in the usual sterile manner with Betadine solution. A longitudinal incision was made after a Betadine-coated drape was placed over the incisional area.",Cardiovascular / Pulmonary,33,1415,5,33
dan_Cardiovascular _ Pulmonary_0494_chunk8of33.wav,dan,Hemostasis was obtained with electrocautery. The abdomen was entered above the umbilicus and then this was extended with care inferiorly as the patient has undergone previous abdominal surgery.,Cardiovascular / Pulmonary,33,1093,8,33
dan_Cardiovascular _ Pulmonary_0495_chunk3of11.wav,dan,", Multiple transaxial images utilized in 10 mm sections were obtained through the chest. Intravenous contrast was administered.",Cardiovascular / Pulmonary,33,827,3,11
dan_Cardiovascular _ Pulmonary_0495_chunk8of11.wav,dan,The right kidney demonstrates a solitary cyst in the mid pole of the right kidney.1. Greater than twenty pulmonary nodules demonstrated on the right side to include pulmonary nodules within the parietal as well as various visceral pleura with adjacent consolidation most likely representing pulmonary neoplasm.,Cardiovascular / Pulmonary,33,1772,8,11
dan_SOAP _ Chart _ Progress Notes_0496_chunk4of11.wav,dan,Clear. A soft systolic murmur in the aortic area.,SOAP / Chart / Progress Notes,34,379,4,11
dan_SOAP _ Chart _ Progress Notes_0496_chunk6of11.wav,dan,Status shortness of breath responding well to medical management. 2.,SOAP / Chart / Progress Notes,34,470,6,11
dan_SOAP _ Chart _ Progress Notes_0497_chunk11of19.wav,dan,",4. Degenerative arthritis.",SOAP / Chart / Progress Notes,34,218,11,19
dan_SOAP _ Chart _ Progress Notes_0497_chunk12of19.wav,dan,",5. Hyperlipidemia.",SOAP / Chart / Progress Notes,34,232,12,19
dan_SOAP _ Chart _ Progress Notes_0497_chunk19of19.wav,dan,"She is to follow-up with Ophthalmology and Podiatry for diabetic evaluation and to return for follow-up as directed.soap / chart / progress notes, general medicine, accu-chek, heent: unremarkable, hyperlipidemia, hypertension, lungs: clear, niddm, neck: unremarkable, progress note, soap, coronary artery bypass graft, follow-up labs, glucose monitoring, coronary artery",SOAP / Chart / Progress Notes,34,10000,19,19
dan_Cardiovascular _ Pulmonary_0498_chunk30of46.wav,dan,She has a variable first and second heart sounds. No murmurs today.,Cardiovascular / Pulmonary,33,449,30,46
dan_Cardiovascular _ Pulmonary_0498_chunk35of46.wav,dan,"Chronic atrial fibrillation, anticoagulated and the plan is rate control. 2.",Cardiovascular / Pulmonary,33,568,35,46
dan_Cardiovascular _ Pulmonary_0498_chunk44of46.wav,dan,", I have restarted her Lasix at 80 mg daily and I have asked her to return in about 10 days to the heart failure clinic. There, I would like them to recheck her heart rate and if still elevated, and she is truly on 150 mg of metoprolol twice a day, one could switch her amlodipine from 5 mg daily to diltiazem 120 mg daily.",Cardiovascular / Pulmonary,33,2164,44,46
dan_Cardiovascular _ Pulmonary_0499_chunk7of45.wav,dan,The patient was taken to the Cardiac Catheterization Suite where the right femoral region was prepped and draped in the usual sterile fashion. 1% lidocaine solution was then used to infiltrate the skin overlying the right femoral artery.,Cardiovascular / Pulmonary,33,1415,7,45
dan_Cardiovascular _ Pulmonary_0499_chunk15of45.wav,dan,"Pullback was then performed, which failed to reveal an LVAO gradient. The catheter was then removed.",Cardiovascular / Pulmonary,33,610,15,45
dan_Cardiovascular _ Pulmonary_0499_chunk34of45.wav,dan,"There are very small obtuse marginal branches, which are diffusely diseased. The RCA is a small vessel with luminal irregularities throughout.",Cardiovascular / Pulmonary,33,862,34,45
dan_Cardiovascular _ Pulmonary_0499_chunk36of45.wav,dan,"Saphenous vein graft to the obtuse marginal branches is a Y-graft, which bifurcates to the first obtuse marginal and the obtuse marginal branch. The saphenous vein graft to the obtuse marginal branches is widely patent without any evidence of hemodynamically significant disease.1.",Cardiovascular / Pulmonary,33,1926,36,45
dan_Cardiovascular _ Pulmonary_0499_chunk39of45.wav,dan,Left internal mammary artery graft to the left anterior descending artery is patent. 4.,Cardiovascular / Pulmonary,33,617,39,45
dan_Cardiovascular _ Pulmonary_0499_chunk44of45.wav,dan,Risk factor modification was discussed with the patient including diet control as well as tobacco cessation. 4.,Cardiovascular / Pulmonary,33,694,44,45
dan_Gastroenterology_0500_chunk6of14.wav,dan,A careful exam of the anal canal and perianal area demonstrated a jagged 8-mm opening at the anorectal junction posteriorly (12 o'clock position). Some purulent material could be expressed through the opening.,Gastroenterology,23,1366,6,14
dan_Cardiovascular _ Pulmonary_0503_chunk1of17.wav,dan,",Tracheal stenosis and metal stent complications. ,Tracheal stenosis and metal stent complications.",Cardiovascular / Pulmonary,33,701,1,17
dan_Cardiovascular _ Pulmonary_0503_chunk5of17.wav,dan,5. Three metallic stents in place in the proximal trachea.,Cardiovascular / Pulmonary,33,414,5,17
dan_Cardiovascular _ Pulmonary_0504_chunk1of26.wav,dan,"PREOPERATIVE DIAGNOSIS,1. Aortoiliac occlusive disease bilaterally.",Cardiovascular / Pulmonary,33,554,1,26
dan_Cardiovascular _ Pulmonary_0504_chunk4of26.wav,dan,"Dementia. , Aortobifemoral bypass surgery utilizing a bifurcated Hemashield graft.",Cardiovascular / Pulmonary,33,610,4,26
dan_Cardiovascular _ Pulmonary_0504_chunk10of26.wav,dan,We used a 10-blade scalpel to make a midline laparotomy incision. Dissection was carried down to the level of the fascia using Bovie electrocautery.,Cardiovascular / Pulmonary,33,827,10,26
dan_Cardiovascular _ Pulmonary_0504_chunk13of26.wav,dan,"We, as mentioned, placed our Omni retractor and then turned our attention to performing our anastomosis. Full-dose heparin was given.",Cardiovascular / Pulmonary,33,820,13,26
dan_Cardiovascular _ Pulmonary_0504_chunk18of26.wav,dan,We incised the common femoral artery and lengthened our arteriotomy in the vessel both proximally and distally. We then footed the graft down onto the common femoral artery to the level of the SFA and constructed our anastomosis using 6-0 Prolene in a running fashion.,Cardiovascular / Pulmonary,33,1562,18,26
dan_Cardiovascular _ Pulmonary_0505_chunk15of32.wav,dan,"No nausea, no vomiting, hematemesis or melena. No frequency or urgency.",Cardiovascular / Pulmonary,33,631,15,32
dan_Cardiovascular _ Pulmonary_0505_chunk26of32.wav,dan,Arthritic changes. None significant.,Cardiovascular / Pulmonary,33,323,26,32
dan_Cardiovascular _ Pulmonary_0505_chunk32of32.wav,dan,2. We will also obtain an echocardiogram to assess valves such as whether she had a prior valve surgery versus coronary artery bypass surgery.nan,Cardiovascular / Pulmonary,33,953,32,32
dan_Cardiovascular _ Pulmonary_0506_chunk12of20.wav,dan,3. Bypass graft LIMA to the left anterior descending artery patent throughout the body as well the anastomotic site.,Cardiovascular / Pulmonary,33,806,12,20
dan_Cardiovascular _ Pulmonary_0506_chunk15of20.wav,dan,Vein graft to what appears to be obtuse marginal vessel was patent with a small caliber obtuse marginal 1 vessel. 5.,Cardiovascular / Pulmonary,33,799,15,20
dan_Cardiovascular _ Pulmonary_0506_chunk20of20.wav,dan,"Native right coronary artery is patent, mild disease. , Medical treatment.cardiovascular / pulmonary, chest pain, coronary artery disease, bypass surgery, heart catheterization, lima, lad, obtuse marginal vessel, vein graft, obtuse marginal, marginal vessel, coronary artery, catheterization, coronary, artery, obtuse, marginal, bypass, vessel, graft",Cardiovascular / Pulmonary,33,2724,20,20
dan_Cardiovascular _ Pulmonary_0507_chunk29of47.wav,dan,Final angiogram with injection in the main pulmonary artery showed a competent Contegra valve. A brisk flow through the proximal branch stents with the improved caliber of the branch pulmonary artery lumens.,Cardiovascular / Pulmonary,33,1163,29,47
dan_Cardiovascular _ Pulmonary_0507_chunk32of47.wav,dan,Tetralogy of Fallot with the pulmonary atresia. 3.,Cardiovascular / Pulmonary,33,379,32,47
dan_Cardiovascular _ Pulmonary_0507_chunk40of47.wav,dan,4. Unifocalization of branch pulmonary arteries.,Cardiovascular / Pulmonary,33,407,40,47
dan_Cardiovascular _ Pulmonary_0507_chunk46of47.wav,dan,"Balloon dilation of left pulmonary artery. , The case will be discussed at Combined Cardiology and Cardiothoracic Surgery Case Conference and conservative outpatient management will be pursued.",Cardiovascular / Pulmonary,33,1135,46,47
dan_Radiology_0508_chunk4of6.wav,dan,He has suffered no recent flu-like illness. Past medical and family histories are unremarkable.,Radiology,15,603,4,6
dan_Radiology_0508_chunk5of6.wav,dan,He was on no medications. Unremarkable except for mild distal vibratory sensation loss in the toes (R>L).,Radiology,15,722,5,6
dan_Cardiovascular _ Pulmonary_0510_chunk8of13.wav,dan,"Epiglottis area, epiglottic folds, false cords, true vocal folds with some mild edema, but otherwise, without ulcers, masses, or lesions, and the supraglottic and glottic airway were widely patent. The larynx was manually suspended and a 5 x 30 pediatric rigid bronchoscope was passed through the vocal folds.",Cardiovascular / Pulmonary,33,2059,8,13
dan_SOAP _ Chart _ Progress Notes_0512_chunk15of19.wav,dan,The patient has adenoidal facies as noted previously. Laboratories: The patient forgot to bring his smart card in for downloading today.,SOAP / Chart / Progress Notes,34,834,15,19
dan_Cardiovascular _ Pulmonary_0513_chunk7of28.wav,dan,"Received fresh labeled with patient's name, designated 'right upper lobe', is a 16. 0 x,14.",Cardiovascular / Pulmonary,33,771,7,28
dan_Cardiovascular _ Pulmonary_0513_chunk12of28.wav,dan,"8 cm subpleural firm ill-defined mass, 2. 2 cm from the bronchial margin and 1.",Cardiovascular / Pulmonary,33,743,12,28
dan_Gastroenterology_0514_chunk2of13.wav,dan,",The liver, spleen, pancreas, adrenal glands, and kidneys are unremarkable. Punctate calcifications in the gallbladder lumen likely represent a gallstone.",Gastroenterology,23,1037,2,13
dan_Gastroenterology_0514_chunk9of13.wav,dan,Resolution of the previously seen subcutaneous fluid collection. 2.,Gastroenterology,23,484,9,13