DEX summary
The patient was admitted to the Orthopaedic Arthroplasty service following _________. The patient tolerated the
procedure without complications and was transferred to the PACU in stable condition. Please see operative
report for details.
The following is a postoperative course by systems:
1) Neuro: Post operatively pain was controlled with a PCA with a transition to PO pain meds once tolerating
PO’s.
2) Cardiac: There were no cardiac issues
3) Pulmonary: The patient was gradually weaned from oxygen via nasal canula to room air.
4) Endocrine: There were no endocrine issues.
5) Renal/FEN: The patient was on IV fluids until they were tolerating an oral diet on postoperative day number
one.
6) Infectious Disease: The patient received peri-operative antibiotics in the form of cefazolin.
7) Prophylaxis: The patient received Lovenox for DVT prophylaxis starting on postoperative day number one.
There were no signs or symptoms of a DVT
8) Orthopedic: The dressing was clean, dry, and intact without evidence of drainage; and the extremity was NVI
distally throughout. The patient made steady progress with PT. At the time of discharge they were able to
ambulate with assist at the time of discharge..
9) Hematology: The patient’s hematocrit was stable and he/she did not require transfusion.
The patient was discharged home in stable condition with written precautionary instructions and instructions for
the appropriate follow-up care.
MON
jts conference (white 10) 7 am. OR with Freiberg all day.
Tomford may have day surg cases--if freiberg away, cover tomford cases.
TUES
jts conference (white 10) 7 am. OR with Tomford all day.
WED
gr/core/anatomy. then OR with Freiberg rest of afternoon.
THURS jts conference (white 10) 7 am. OR with Tomford all day.
FRIDAY jts conference (white 10) 7 am. OR with Freiberg all day (usually operates every other Friday)
if freiberg away, then join Dr. Tomford in clinic.
Freiberg-- no pca's. no dilaudid. Foley out pod 0. lovenox. drains for knees only. d/c drain on pod1 (regardless of output
on primaries). pain regimen---toradol, oxycontin, percocet, darvocet (ambien for sleep).
Freiberg uses anterolateral approach. Tomford uses posterior approach.
Dr. Freiberg saw the patient and the radiographs with me and agreed with the evaluation and above listed treatment plan.
FREIBERG:
Hospital Course:
On / /2009 the patient was brought to the operating room by Dr. Freiberg for an elective:
. There were no
complications during the case and she tolerated the procedure well. Please see the dictated operative note for full details.
She was transferred to the postanesthesia care unit in stable condition. After recovery in the PACU she was transferred
to the floor. The patient received 24 hours of prophylactic IV antibiotics. He remained hemodynamically stable. Vital signs
stable. Afebrile. The patient tolerated anticoagulation with Lovenox postoperatively for DVT prophylaxis. The Hemovac,
Foley catheter and IV fluids were discontinued on POD #1. Dressing changes began on POD#1. The incision remained
clean, dry and intact without erythema or purulent drainage. The Physical Therapy service was consulted and worked with
the patient throughout the hospitalization. He was cleared by PT for discharge home with services/rehab on POD #3. By
the time of discharge, the patient was tolerating a regular diet with pain well controlled on oral pain medication.
KNEE
Please call Dr. Freiberg, your PCP or report to the EW if you have any nausea, vomiting, fever greater than 101.5,
swelling, chest pain, shortness of breath, increased pain/redness/drainage from your incision sites, numbness/tingling, or
any other concerning symptoms.
ACTIVITY: weight-bearing as tolerated.
MEDICATIONS: Take all medications as prescribed and resume home medications. Take a stool softener if taking
narcotic pain medications. Stool softeners work better if you drink adequate amounts of fluid, ideally water. Try and drink
6-8 glasses of water a day, unless otherwise contraindicated. If you are taking a stool softener but have not had a bowel
movement in 3 days, please call the office and we will recommend alternatives. Taper down pain medication use as
tolerated. No driving or operating heavy machinery while using narcotic pain medications.
ANTICOAGULATION: Continue Lovenox as prescribed for DVT/PE prophylaxis. Also continue to wear your TED
stockings until your follow-up visit. Not only do these help prevent blood clots, they help reduce swelling. Common
symptoms of DVT include: localized pain, swelling, calf tenderness, redness or discoloration of the skin. PE symptoms
include: shortness of breath, rapid pulse, sweating, chest pain that worsens with inspiration, coughing up blood, light
headedness, feelings of apprehension. If you experience any of these symptoms call the office or go to the closest ER.
WOUND CARE: Keep your incision clean and dry. You can shower but should not tub-bath or submerge your incision.
Prior to any wound care please wash and dry your hands. Place a dry sterile dressing over the wound each day if there is
drainage, otherwise you can leave it open to air. The visiting nurse or rehab facility can remove the staples on POD 14
and place steri-strips across the wound. Leave the Steri-strips in place until they fall off on their own.
Please follow-up with Dr. Freiberg in orthopedic clinic in about 4 weeks from day of surgery, call 617-726-8575 to make an
appointment
HIP
Please call Dr. Freiberg, your PCP or report to the EW if you have any nausea, vomiting, fever greater than 101.5,
swelling, chest pain, shortness of breath, increased pain/redness/drainage from your incision sites, numbness/tingling, or
any other concerning symptoms.
ACTIVITY: Weight-bearing as tolerated with anterolateral hip dislocation precautions as demonstrated by physical
therapy.
MEDICATIONS: Take all medications as prescribed and resume home medications. Take a stool softener if taking
narcotic pain medications. Stool softeners work better if you drink adequate amounts of fluid, ideally water. Try and drink
6-8 glasses of water a day, unless otherwise contraindicated. If you are taking a stool softener but have not had a bowel
movement in 3 days, please call the office and we will recommend alternatives. Taper down pain medication use as
tolerated. No driving or operating heavy machinery while using narcotic pain medications.
ANTICOAGULATION: Continue Lovenox/ Coumadin as prescribed for DVT/PE prophylaxis. Also continue to wear your
TED stockings until your follow-up visit. (IF GETTING DC’D WITH COUMADIN ADD NAME/NUMBER OF WHO IS
FOLLOWING PT/INR AND WHEN NEXT LABS ARE DUE) Not only do these help prevent blood clots, they help reduce
lower extremity swelling. Common symptoms of DVT include: localized pain, swelling, calf tenderness, redness or
discoloration of the skin. PE symptoms include: shortness of breath, rapid pulse, sweating, chest pain that worsens with
inspiration, coughing up blood, light headedness, feelings of apprehension. If you experience any of these symptoms call
the office or go to the closest ER.
WOUND CARE: Keep your incision clean and dry. You can shower but should not tub-bath or submerge your incision.
Prior to any wound care please wash and dry your hands. Place a dry sterile dressing over the wound each day if there is
drainage, otherwise you can leave it open to air. The visiting nurse or rehab facility can remove the staples on POD 14
and place steri-strips across the wound. Leave the Steri-strips in place until they fall off on their own.
Please follow-up with Dr. Freiberg in orthopedic clinic in about 6 weeks from day of surgery, call 617-726-8575 to make an
appointment
OR:
The patient was admitted to the Orthopaedic Arthroplasty following _________. The patient tolerated the procedure
without complications and was transferred to the PACU in stable condition. Please see operative report for details.
The following is a postoperative course by systems:
1) Neuro: Post operatively pain was controlled with a PCA with a transition to PO pain meds once tolerating PO’s.
2) Cardiac: There were no cardiac issues
3) Pulmonary: The patient was gradually weaned from oxygen via nasal canula to room air.
4) Endocrine: There were no endocrine issues.
5) Renal/FEN: The patient was on IV fluids until they were tolerating an oral diet on postoperative day number one.
6) Infectious Disease: The patient received peri-operative antibiotics in the form of cefazolin.
7) Prophylaxsis: The patient received Lovenox for DVT prophylaxis starting on postoperative day number one. There
were no signs or symptoms of a DVT.
8) Orthopedic: The dressing was clean, dry, and intact without evidence of drainage; and the extremity was NVI distally
throughout. The patient made steady progress with PT. At the time of discharge they were able to ambulate with assist at
the time of discharge..
The patient was discharged home in stable condition with written precautionary instructions and instructions for the
appropriate follow-up care.
TOMFORD:
Indications
80-year-old woman with right knee pain and osteoarthritis. Failed maximal medical management. Following clinical and
radiographic evaluation, determined to be a good candidate for total knee replacement. Following a detialed discussion of
the risks and benifts of surgery, she elected to go ahead with TKA.
Hospital Course:
The patient tolerated the scheduled procedure well and without complication. Please see the dictated operative note for
full details. The patient was transferred to the floor after recovery in the PACU on the operative day. The patient received
24 hours of prophylactic IV antibiotics The patient's postoperative course was unremarkable. On POD #1 the Hemovac
was removed. The dressing was changed daily. The incision remained clean, dry and intact without erythema, eccymosis,
fluctuance or drainage. The patient successfully weaned from the PCA to PO pain medications. On POD#2 the Foley
catheter was removed, the patient is able to void spontanesouly without difficulty. Anticoagulation was maintained on
Lovenox/Coumadin for DVT prophylaxis and will continue Lovenox for 14 days postoperatively. Following the 14 days of
Lovenox, the patient will be on aspirin 325mg for 30 days. At the time of discharge, the patient was tolerating a regular
diet with pain well controlled on oral pain medication. The Physical Therapy service was consulted and worked with the
patient throughout the hospitalization. The patient was cleared by PT for discharge home with services /rehab.
KNEE
Please call Dr. Tomford, your PCP or report to the EW if you have any nausea, vomiting, fever greater than 101.5,
swelling, chest pain, shortness of breath, increased pain/redness/drainage from your incision sites, numbness/tingling, or
any other concerning symptoms.
ACTIVITY: weight-bearing as tolerated.
MEDICATIONS: Take all medications as prescribed and resume home medications. Please take a stool softener if taking
narcotic pain medications. Taper down pain medication use as tolerated. No driving nor operating heavy machinery while
using narcotic pain medications.
Continue Lovenox for a total of 14 days post-operatively as prescribed. You should then take aspirin 325mg each day for
30 days after the Lovenox course is completed.
WOUND CARE: Keep your incision clean and dry. You can shower but should not tub-bath or submerge your incision.
Please place a dry sterile dressing to the wound each day if there is drainage, otherwise you can leave it open to air.
Remove staples on POD 14 and place steri-strips across the wound.
Please follow-up with Dr. Tomford in orthopedic clinic in about 4 weeks from day of surgery, call 617-726-8532 to make an
appointment
HIP
Please call Dr. Tomford, your PCP or report to the EW if you have any nausea, vomiting, fever greater than 101.5,
swelling, chest pain, shortness of breath, increased pain/redness/drainage from your incision sites, numbness/tingling, or
any other concerning symptoms.
ACTIVITY: partial/full weight-bearing with posterior hip dislocation precautions as demonstrated by physical therapy.
MEDICATIONS: Take all medications as prescribed and resume home medications, please take a stool softener if taking
narcotic pain medications, please taper down pain medication use as tolerated. No driving nor operating heavy machinery
while using narcotic pain medications.
Continue lovenox for a total of 10 days post-operatively as prescribed. You should then take aspirin 81mg each day for 30
days after the lovenox course is completed.
WOUND CARE: Keep your incision clean and dry. You can shower but should not tub-bath or submerge your incision.
Please place a dry sterile dressing to the wound each day if there is drainage, otherwise you can leave it open to air.
Remove staples on POD 14 and place steri-strips across the wound.
Please follow-up with Dr. Tomford in orthopedic clinic in about 4 weeks from day of surgery, call 617-726-8532 to make an
appointment