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**INSTITUTION
OPERATIVE REPORT
ACCOUNT #: **ID-NUM
SURGEON: **NAME[WWW XXX], M.D.
SURGERY DATE: **DATE[Nov 27 05]
DISCHARGE DATE:
PROCEDURES:
TITLE OF OPERATION: IRRIGATION AND DEBRIDEMENT OF LEFT KNEE.
ANESTHESIA: General.
PREOPERATIVE DIAGNOSIS(ES): SEPTIC ARTHRITIS, LEFT KNEE.
POSTOPERATIVE DIAGNOSIS(ES): SEPTIC ARTHRITIS, LEFT KNEE.
HISTORY AND INDICATIONS: The patient is a **AGE[in 60s]-year-old female with a history of end-stage renal disease and hemodialysis with vasculopathy who by history, examination, and laboratory studies had a septic arthritis of the left knee.
DESCRIPTION OF OPERATION: The patient was identified as the patient. She was taken to the operating room where she was placed supine on a table. Anesthesia had attempted to place a block; however, this did not work and therefore she needed to be intubated. After successful intubation, a nonsterile tourniquet was carefully placed high in the left thigh. The left leg was then prepped and draped in the usual sterile fashion while making sure to isolate the left foot on which she had surgery a few days prior. The leg was elevated for 120 seconds and then the tourniquet was inflated. A small approximately 5 cm parapatellar arthrotomy was performed sharply with a knife. This was taken down into the joint sharply. Immediately significant amount of cloudy-looking fluid came out of the knee. This was sent for culture. After evacuating the fluid, the knee was pulse irrigated with 3 L of solution. After this, we reexamined the knee. There was no further sign of purulence. The skin bleeders were coagulated. Again, 3 more liters of pulse irrigation were used to clean out the knee. After successfully accomplishing this, the arthrotomy was closed with 0 Vicryl in a watertight fashion. The skin was then closed carefully with interrupted 3-0 nylon sutures. A sterile consisting of Xeroform, 4x4's, Webril, and Ace wrap were applied.
There were no complications during this procedure. She was brought to the PACU in a stable condition.
___________________________________
D: **DATE[Nov 27 2007] 18:23:27
R: **DATE[Nov 28 2007] 09:54:34/ga
Cc: t [Report de-identified (Safe-harbor compliant) by De-ID v.6.22.06.0]
EMERGENCY DEPARTMENT
ACCOUNT #: **ID-NUM
PRIMARY CARE PHYSICIAN: MEDICAL **NAME[TTT]
Tooth pain.
This is a **AGE[in 20s]-year-old gentleman with a history of facial reconstructive surgery following an MVA back in 2003, who presents to the emergency department complaining of right upper tooth pain. The patient states that, yesterday, he was at work and got hit in the jaw with a hoist. The patient states that his tooth broke off. Throughout the day, he began having more and more severe pain in the right upper jaw. He was unable to eat anything today secondary to the pain. He denies any pain in the remainder of the jaw, ear, or sinus area. He denies any fevers or chills. He denies any recent illnesses. He denies any chest pain or shortness of breath.
Facial reconstructive surgery following a motor vehicle accident in 2003.
None.
NO KNOWN DRUG ALLERGIES.
The patient smokes about one-half pack per day. He denies any other drug or alcohol use.
Review of systems is negative except for those in the HPI.
His vital signs are stable. His temperature is 36.7. The rest of his vitals were stable.
HEENT examination revealed a broken first molar on the right upper jaw. This is tender to palpation. He also had some tenderness over the outer gum line as well as the inner gum line. There is no obvious bleeding or drainage from the area. He denied any tenderness along the remainder of the jaw. There is also a small superficial abrasion on the outer corner of the bottom lip.
Lungs: Clear to auscultation bilaterally.
This is a **AGE[in 20s]-year-old gentleman, who comes in with right tooth pain after being hit in the face by a hoist yesterday. OMFS came down to evaluate the patient and felt that he could be discharged and would need to be followed up with a regular dentist to perhaps have that tooth pulled. The patient was given Percocet for pain. He was also given a prescription for Pen VK 500 mg q.i.d. times ten days since there were some roots that were exposed.
The patient was discharged home in stable condition. He is to follow up with the **INSTITUTION within the next one to four days to have the tooth evaluated.
___________________________________
**INITIALS
T: **DATE[Feb 02 2007] 07:01:00
Cc:
Electronically Signed by **NAME[CCC WWW] **DATE[Feb 04 2007] 11:03:47 AM