Clinician Specialty: Vascular Surgeon
Patient: John Smith
Date of Procedure: 1 November 2024
Location:
Operating Theatre 3, St. Jude's Hospital
Procedure:
Right Femoral-Popliteal Bypass Graft
Heparin Administered:
5000 units IV
Assistants:
Dr. Sarah Jones, Nurse Emily White
Anaesthetist:
Dr. Thomas Kelly
Anaesthesia:
General anaesthesia
THEATRE NOTES
Patient supine on operating table, right leg externally rotated, prepped, draped
Standard groin incision to access common femoral artery
Tunnel created medially to bypass occluded segment
Distal anastomosis performed to popliteal artery
Arteriogram Performed
* Pre-intervention arteriogram:
* Right superficial femoral artery (SFA) completely occluded mid-thigh
* Patent profunda femoris artery
* Popliteal artery patent with good run-off to tibial vessels
Intervention
* Skin incision, dissection to expose common femoral artery
* Isolation of vessels, administration of heparin
* Arteriotomy performed in common femoral artery
* Saphenous vein harvested from ipsilateral leg
* Proximal anastomosis of graft to common femoral artery
* Tunnel creation to popliteal fossa
* Distal anastomosis of graft to popliteal artery
* Flow checked, no leaks identified
* Wound closure in layers
(All notes should be listed without full stops at the end of the sentence.)
(Use British English spelling to generate all notes.)
(No full stops to be used after titles or initials.)
(All numbers to be in numerical format, not text.)
(Generate notes in telegraphic style. Use short phrases, no filler words. Omit articles such as the, a, an. Summarised, concise format preferred.)
Patient: [Full name of patient] (Only include if explicitly mentioned in transcript, contextual notes, or clinical note, else leave the placeholder blank and do not omit the heading.)
Date of Procedure: [Date of procedure] (Only include if explicitly mentioned in transcript, contextual notes, or clinical note, else leave the placeholder blank and do not omit the heading.)
Location:
[Location where the procedure was performed] (Only include if explicitly mentioned in transcript, contextual notes, or clinical note, else leave the placeholder blank and do not omit the heading.)
Procedure:
[Name and description of the procedure performed] (Only include if explicitly mentioned in transcript, contextual notes, or clinical note, else leave the placeholder blank and do not omit the heading.)
Heparin Administered:
[Whether heparin was administered and if so, the dosage] (Only include if explicitly mentioned in transcript, contextual notes, or clinical note, else write "None".)
Assistants:
[Name or names of the assistant or assistants present during the procedure] (Only include if explicitly mentioned in transcript, contextual notes, or clinical note, else leave the placeholder blank and do not omit the heading.)
Anaesthetist:
[Name of the anaesthetist] (Only include if explicitly mentioned in transcript, contextual notes, or clinical note, else leave the placeholder blank and do not omit the heading.)
Anaesthesia:
[Type of anaesthesia used] (Only include if explicitly mentioned in transcript, contextual notes, or clinical note, else leave the placeholder blank and do not omit the heading.)
THEATRE NOTES
[Summary of procedure details including patient positioning, access, and any relevant technical steps] (Only include if explicitly mentioned in transcript, contextual notes, or clinical note, else leave the placeholder blank and do not omit the heading.)
Arteriogram Performed
[Summarised description of arteriogram findings including vessels assessed and relevant findings] (Only include if explicitly mentioned in transcript, contextual notes, or clinical note, else omit this subheading and content entirely. Write as a multi-level list.)
Venogram Performed
[Summarised description of venogram findings including vessels assessed and relevant findings] (Only include if explicitly mentioned in transcript, contextual notes, or clinical note, else omit this subheading and content entirely. Write as a multi-level list.)
Intervention
[Summarised step-by-step description of the intervention performed] (Only include if explicitly mentioned in transcript, contextual notes, or clinical note, else omit this subheading and content entirely. Write as a multi-level list without full stops at the end of each step.)