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I'm typing a c-section op note. Is it pericolic ..sm

Posted By: Thank You on 2007-09-13
In Reply to:

Subject: I'm typing a c-section op note. Is it pericolic ..sm

"processes" were suctioned for blood clot?  Thank you in advance.


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Typing a C-section OP sm
Subject: Typing a C-section OP sm

This incision was extended bilaterally using s/l Danish scissors. 
C-section OP note...
Subject: C-section OP note...

s/l he is saying atanic contractions.  TIA!
s/l quick section GBM? see note.
Subject: s/l quick section GBM? see note.

Recurrent glioblastoma multiforme in left frontal area and possible left parieto-occipital area.  S/l Quick section compatible with glioblastoma multiforme.


No, the note I am typing is for a geriatric clinic. Thank you!
Subject: No, the note I am typing is for a geriatric clinic. Thank you!

x
typing a psych note - sounds like
Subject: typing a psych note - sounds like

doc says that patient's affect is rejected.  Can your affect be rejected? Never heard this one before. Just wanted to see if anyone else did. TIA
pericolic ?
Subject: pericolic ?


quick section (as in frozen section) is correct.
Subject: quick section (as in frozen section) is correct.

x
how about typing Past Medical History heading and then typing what he says under the heading nm
Subject: how about typing Past Medical History heading and then typing what he says under the heading nm

xx
C-section or cesarean section sm
Subject: C-section or cesarean section sm

Not cAesarean section - contrary to popular belief, it was not named after Julius Caesar.
C-section or cesarean section nm
Subject: C-section or cesarean section nm


Psych note Axis III s/l VPS and neuropathy. No health history in the note. Only meds listed psych
Subject: Psych note Axis III s/l VPS and neuropathy. No health history in the note. Only meds listed psych


Would someone look at this and tell me if I am typing this right? TIA
Subject: Would someone look at this and tell me if I am typing this right? TIA

 


Adenosine ECG stress test


Baseline pre-Adenosine EKG reveals A sensed V pace versus V pacing


That is the way I have been typing.
Subject: That is the way I have been typing.

It just seems that they never dictate it as Hodgkin disease and it starts to make one wonder.
When I have come across that in typing
Subject: When I have come across that in typing

they dictate ex-fix as slang/abbreviation for external fixator. I have had that come up even with a brand name associated, but it was not as you posted above. I would assume it is slang.
especially like typing your instead of
Subject: especially like typing your instead of

you are.oops.
Thank you! How about typing 1st, 2nd, 3rd, or first, second or third?
Subject: Thank you! How about typing 1st, 2nd, 3rd, or first, second or third?


noteworthy; note worthy; note-worthy
Subject: noteworthy; note worthy; note-worthy

Just wondering if there is any general rule about transcribing noteworthy.


Also, status post; status-post.


 


Thank you.


 


Would someone please tell me if I am typing the (e.g) correctly?
Subject: Would someone please tell me if I am typing the (e.g) correctly?


  1. I will see him back in three months to determine his LV systolic function by echocardiogram and then possibly consider other treatment (e.g.,  DC cardioversion and or pacing versus continued pharmacologic therapy.)

typing the staging
Subject: typing the staging

T1c-T2a NX MX

tumor staging is in the back of the stedman's oncology book
Been typing rad for yrs and have never used roman..
Subject: Been typing rad for yrs and have never used roman..

numerals.  Always arabic. 


However, you will see a variation on the typing of BIRADS depending on who you are typing it for.  The copyright lists it as BI-RADS, federal guidlines are supposed to dictate how it is typed but have worked for numerous centers that type it anywhere from BIRADS to BI-RADS to BiRADS.  Categories however should always be arabic (1, 2, 3, 4, 5 and 0)


I would say what you are typing is correct.
Subject: I would say what you are typing is correct.

Here is a definition that I found for isotype...

isotype. An immunoglobulin heavy or light chain class or subclass characterized by antigenic determinants (isotypic markers) in the constant region. Every normal individual expresses all of the isotypes of its species.

Pool would reflect that - to me...I could be wrong, but I, myself, would go with that you typed....Sorry I could not be more precise...
We WERE typing at the same time! I always
Subject: We WERE typing at the same time! I always

check to make sure there are no answers before I send one.
verbatim typing
Subject: verbatim typing

It would actually be "sub cu" with a space between the two, so I just learned in the last year since doing transcription for a bit over 20 years...lol..guess what it really comes down to is whatever QA thinks it should be,...but of course...she knows better than you...yeah right...NOT
Thanks. I have been typing it Aciphex
Subject: Thanks. I have been typing it Aciphex

for many years and no one has ever said anything. You always learn something new here. I will make a note of this.
Maybe not, been typing it for years though. nm
Subject: Maybe not, been typing it for years though. nm


been typing all day, tired and cannot think
Subject: been typing all day, tired and cannot think

I know this is stupid and I have typed it a million times but I am so tired right now I can't even think.  He says .... Myospan 500 mg ..... ?  Thanks. 
Typing numbers -
Subject: Typing numbers -

If they say "I wrote him for 38 Tylox"  I always put #38.  I think it is much more clear.  In some cases, someone could think it was a dosage amount.


XX


Think it is a docism. I myself have been typing it for so sm
Subject: Think it is a docism. I myself have been typing it for so sm

long I can't even remember!!  Did 4 years in a railroad hospital with lots and lots injuries, etc  All our ortho docs used it.
I'm typing rheumatology....
Subject: I'm typing rheumatology....

and this sentence is all I have to go by:

She was also given an intermittent course of s/l za-fax-in by her gastroenterologist.

He's very clear. There's a "z" sound at the beginning and a very clear "fax" in there. I've tried spelling zo-fax-en, zi-fax-in, etc., and even spelling with "x" at the beginning.

Thanks for your help.

mother typing?
Subject: mother typing?

Dr. states:  Patient has good understanding of English but his mothertying is Spanish.  Anyone ever heard of this?
What exactly are you typing, and if we could have the whole sentence, thanks...
Subject: What exactly are you typing, and if we could have the whole sentence, thanks...


I think we were typing that at the same time! thanks! :)
Subject: I think we were typing that at the same time! thanks! :)


2 nil incision? typing ?
Subject: 2 nil incision? typing ?

 


A launch "2 nil" incision was fashioned along the anterior portion of the common bile duct


&


 


A "#10 JP drain" was placed in the Morrison's pouch.


 


How do I type the #10 JP drain? and things like A 2 O self-suture?


typing numbers like 3rd, 4th
Subject: typing numbers like 3rd, 4th

When typing >>>>>The first, second and third portions>>> do you spell it out or do you put it as 1st, 2nd and 3rd portions of the stomach?
That's what I ended up typing. Thanks!!! nm
Subject: That's what I ended up typing. Thanks!!! nm


Please help. It is in the ROS section (SM)

There has been no eye inflammtion.  No problems with alopecia.  There has been no eye inflammation.  No s/l "sick ahm plot" complex or oral lesions.


Can't figure this out.  Thank you for any help you might be able to offer.


Chickadee


c-section
Subject: c-section

pt with McDonald's cerclage and frank breech presentation with sl-ancervical dilatation.


C-section
Subject: C-section

At the time of cord clamp sl-all I can hear is "sol" at the end 2 grams is given in the OR to the patient
C section
Subject: C section

PAST SURGICAL HISTORY:  C section or C-section ? 
C-section. nm.
Subject: C-section. nm.

nm
please help with OB C-section
Subject: please help with OB C-section

I don't usually type OP reports, but I got this one and need a little help with a C-section. It's a primary low-flap transverse C-section due to breech presentation.


He says the rectus muscles were separated and taken down. Then: The superior most aspect of the s/l "perineum" was nicked. Thought this should be peritoneum.


Then: Bowel floor s/l "was placed" a low marginal incision.


any help?


Doing a C-section, doc says SM
Subject: Doing a C-section, doc says SM

the IFE was attached and removed after vertex was delivered. What is IFE? Thanks.


C-section help
Subject: C-section help


The scalpel was then used to make curvilinear hysterotomy, through which the infant was delivered and was s/l dooley ? suctioned.


c-section - nm
Subject: c-section - nm


C-section with s/l DPS?
Subject: C-section with s/l DPS?


Status post primary low transverse cesarean section with s/l DPS.


Other diagnoses include:


Uterine pregnancy at 39 weeks and 1 day gestation. 


Breech presentation. 


Multiparous desiring permanent sterilization. 


Anemia.


c-section or C-section?
Subject: c-section or C-section?


It is great. you can just start typing a name
Subject: It is great. you can just start typing a name

in the search and pause, and a list pops down instantly. How quick is that?

Thank you!
Are you typing on a verbatim account?
Subject: Are you typing on a verbatim account?

If so, you will won't need to change decease to deceased. If the dictator is ESL, he probably used incorrect verbiage. Agree with other posters about lung CA.
Typing an op...median sternoscopy?
Subject: Typing an op...median sternoscopy?

can't find anything!!!  TYTYTY
OMG - not OP but I've been typing that wrong
Subject: OMG - not OP but I've been typing that wrong

oops.........learn something new everyday in this field - love it!! 
Yup not sure what your typing see the definition i left
Subject: Yup not sure what your typing see the definition i left

cystocele
sisctb-sTl 

Hernia of the bladder usually into the vagina and introitus. Syn: vesicocele.