Procedure Notes

The abscess is anesthetized in a field block with [-0.5% Sensorcaine-]. Good analgesia is obtained. The wound is incised with an 11 blade scalpel. Approximately [-30 cc-] of purulent material was expelled. This is sent for culture. The wound is then explored. [-It is then packed with quarter inch gauze.-] It is covered with 4 x 4 dressings in a bulky fashion. The patient tolerates this well.

Procedure: The patient verbally consents to a dental block. The tooth is prepped with viscous lidocaine. It is then injected with Bupivicaine [-0.5%-] and epinephrine, approximately 2 cc. The patient tolerates this well and has near complete resolution of pain.

Procedure: The affected tooth is cleaned and dried. Cement is mixed and applied over the exposed nerve root. The patient tolerates this well. Gauze is placed in the cheeks to assist with drying of the cement.

The patient verbally consents to a wound repair. Side and sight are verified. Patient identification is verified. [-The wound is anesthetized with marcaine 0.5% for a regional block.-] It is then copiously irrigated.

It is approximated using simple Dermabond. Good approximation is achieved. Hemostasis is maintained.

Wound care instructions provided.

Consent: Verbal consent obtained. Risks and benefits: risks, benefits and alternatives were discussed.
Verbal Consent given by: patient. Imaging studies available
Patient identity confirmed: verbally with patient and arm band
Injury location: [-toe-]
Location details: [-left great toe-]
Injury type: dislocation
Pre-procedure neurovascular assessment: neurovascularly intact
Pre-procedure distal perfusion: normal
Pre-procedure neurological function: normal
Pre-procedure range of motion: reduced
Local anesthesia used: yes
Anesthesia: digital block
Local anesthetic: [-bupivacaine 0.5% without epinephrine-]
Manipulation performed: yes
Reduction successful: yes
X-ray confirmed reduction: yes
Post-procedure distal perfusion: normal
Post-procedure neurological function comment: unable to assess secondary to digital block.
Post-procedure range of motion: normal
Patient tolerance: Patient tolerated the procedure well with no immediate complications

The patient verbally consents to a wound repair. Side and sight are verified. Patient identification is verified. The wound is anesthetized with [-marcaine 0.5%-] for a [-regional-] block. It is then copiously irrigated.

The wound measures [-*** cm-]. It is approximated using simple interrupted sutures with [-5-0-] Ethilon. Total number [-3-]. Good approximation is achieved. Hemostasis is maintained. It is dressed with Bacitracin and a bulky dressing.

Wound care instructions provided.

The patient's parents verbally consent to the procedure. Elbow easily reduced with extension and hyperpronation, with the typical click about the radial head appreciated; after a few minutes of observation the child began using the affected arm normally.

Procedure:
Ring removal. Patient is lathered in K-Y jelly, and attempts to remove the ring caused pain, but are unsuccessful. Patient verbally consents to removal of the ring. The ring cutters are utilized, with regular breaks to cool the ring using water. The ring is cut, it is then separated using pliers and the ring separating tool. Patient tolerates the procedure well. Afterward, maintains circulation and sensation in the finger.