audio_file: Scribe Academy Plus - 20160106 - Cardiovascular. Worsened chronic dyspnea. EKG. [tIpJghdUjCg].mp3

annotator: Clement

ground_truth:
SPEAKER S1: Well, got some of your labs back and there are no real surprises. Your chest X-ray shows a lot of fluid in it, and I think you kind of knew you were retaining fluid in the legs and so on. Are you feeling any better with the medication and with the Lasix?
SPEAKER S2: Just a little. I feel like I'm breathing a little better.
SPEAKER S1: Okay, well, you're still pretty short of breath and your oxygenation isn't exactly where we would like it. So we're going to get you admitted [initially?] to the ICU, okay? Just so they can keep a close eye on you. I'm going to talk to my scribe here for a second and have them record your EKG findings and get the admission going. What do you need for the EKG? Right. Uh, rate is 110.
SPEAKER S2: Rhythm.
SPEAKER S1: Rhythm is normal. Sinus.
SPEAKER S2: Axis.
SPEAKER S1: Axis is left. Axis ectopy on.
SPEAKER S2: Conduction.
SPEAKER S1: Left bundle branch.
SPEAKER S2: Block P waves. Normal Q waves.
SPEAKER S1: Poor R wave progression.
SPEAKER S2: St-t wave changes.
SPEAKER S1: Nonspecific [-specific?] St-t wave changes diffusely.
SPEAKER S2: Comparison.
SPEAKER S1: There is an old EKG from 315 [-15?] 2013 which shows similar changes. Clinical impression old left bundle branch block. Nonspecific [-specific?] St-t changes. Tach


audio_file: Scribe Academy Plus - 20160827 - SAH [QGSAP5jzb1c].mp3

annotator: Umar

ground_truth:
SPEAKER S1: Hi there, I'm doctor B.
SPEAKER S2: Hi doc.
SPEAKER S1: This is my scribe K. He's helping me out today. Tell me what brought you in to see us?
SPEAKER S2: Well, first off, let me tell you. I've had migraines my entire life. I normally take some imitrex and follow up with neurology when they get really bad. But this one, this one's something different. I was at work earlier today and it was just the worst headache of my life. It was on either side of my head and I felt really nauseous. I went to the bathroom. I threw up, looked in the mirror and couldn't see straight. Really blurry. I just felt dizzy. So they sent me home. When I got home and sat down and was trying to relax, my [nef?] got my neck got really stiff. It was really painful to move it. Um, tried some more imitrex and some Motrin, but it doesn't really seem to help.
SPEAKER S1: Okay. Um, what time did this start?
SPEAKER S2: Um, probably around eight hours ago.
SPEAKER S1: Okay. And what were you doing when it started?
SPEAKER S2: Just my normal work at the desk. Just typing  on my computer.
SPEAKER S1: And has it been constant, or does it come and go?
SPEAKER S2: It's constant.
SPEAKER S1: Constant. And, um, would you describe it as progressive or sudden onset?
SPEAKER S2: It was very sudden.
SPEAKER S1: Very sudden onset. Okay. And do you have any symptoms that radiate anywhere, the pain or anything?
SPEAKER S2: Um not really. It just kind of localized on either side of my head.
SPEAKER S1: Okay. And how would you describe it on a scale of 1 to 10, with 10 being the worst pain you can imagine?
SPEAKER S2: An 8 or a 9.
SPEAKER S1: Okay. And can you kind of describe the characteristics of it?
SPEAKER S2: Um, it's kind of throbbing, kind of going along with the pulse. The light makes it much, much worse.
SPEAKER S1: Okay. And you said you do have some nausea and vomiting.
SPEAKER S2: Correct.
SPEAKER S1: Have you had any other associated symptoms like a fever or chills? Sweats?
SPEAKER S2: No, not so far.
SPEAKER S1: Have you had a rash?
SPEAKER S2: No.
SPEAKER S1: Okay. Have you been around anybody else who's been sick with similar symptoms?
SPEAKER S2: No.
SPEAKER S1: Okay. And I'm just going to kind of go through some other questions as well. Just let me know if you've had any of these things. Um, any vision changes.
SPEAKER S2: Yes.
SPEAKER S1: Tell me about that.
SPEAKER S2: It became really blurry. I was looking in the mirror and I couldn't see straight.
SPEAKER S1: Okay. Um, but not like your vision loss. Just more blurry.
SPEAKER S2: Correct.
SPEAKER S1: Okay. Um, any congestion, like nasal congestion or sore throat?
SPEAKER S2: No.
SPEAKER S1: Okay. Um, you said you had neck stiffness. Any cough or congestion?
SPEAKER S2: No.
SPEAKER S1: Okay. Any weakness anywhere? Like one arm, one leg or difficulty speaking?
SPEAKER S2: Not that I've noticed.
SPEAKER S1: Okay. And any you said nausea. Do you have any belly pain or diarrhea?
SPEAKER S2: No.
SPEAKER S1: Okay. And any other symptoms that I didn't ask about?
SPEAKER S2: Um, not that I can think of.
SPEAKER S1: Okay. Let's do a physical exam here. I know the light's kind of bothering you, so you just have to bear with me here
SPEAKER S2: Okay.
SPEAKER S1: If you can just pick one spot and stare at it. And I'm going to look in your eye.
SPEAKER S2: Mhm.
SPEAKER S1: Sorry. I know. Just try to keep your eyes open. I'll just help you here. Okay? And just keep staring at the wall. Okay. I am concerned that you might have some papilledema, which is a little bit of fuzziness around the optic fundus. So we'll have to get a Cat scan for that. Um, watch my finger. Does look like he has a little bit of, uh, beats of nystagmus bilaterally. Just look straight ahead again. Look up a little bit more. Thanks. Okay. His pupils are equal and reactive. Can you just look at me for a second? Okay. Looking at my nose and using your side vision, can you cover one eye? Okay. Tell me when you can see my vision and or my finger and how many fingers I'm holding up.
SPEAKER S2: One.
SPEAKER S1: Okay.
SPEAKER S2: Two.
SPEAKER S1: Okay.
SPEAKER S2: One.
SPEAKER S1: Okay.
SPEAKER S2: Two.
SPEAKER S1: Okay, good. Let's do the same thing with the other eye. Looking at me. Just using your side vision.
SPEAKER S2: One.
SPEAKER S1: Good.
SPEAKER S2: Two.
SPEAKER S1: Okay.
SPEAKER S2: One.
SPEAKER S1: Uh-huh.
SPEAKER S2: two.
SPEAKER S1: Okay, so his visual fields are full. Um, we'll have to get a vision test on you. We'll have the nurse get that. Um, like with the reading chart, just because you're having some blurry vision. But overall, it seems like you're able to see in all in all fields, which is good. Um, I would like to have you make some faces with me. Raise your eyebrows up. Puffy [your?] cheeks out. Stick your tongue out. Give me a big smile. Okay. Can you feel me touch here? [Uh?] [-huh.?] Does it feel the same on both sides? Mhm. [-huh.?] Okay, good. How about here? Yep. Same on both sides. How about [here??] here? Same on both sides. Yep. Okay, good. Hold your arms up. Turn your palms this way and close your eyes and keep your arms up. Okay. Open your eyes and then shrug your shoulders. Okay, so his cranial nerves two through 12 are grossly intact. His sensation is intact. He does not have any pronator [or?] drift. Touch your nose and then touch my finger. Okay. Can you do with that? Good. Normal finger. Nose. Can you take one leg and act like you're scratching your other leg? Do the same with the other. Okay, good. Normal heel shin. I'm going to lay this bed flat. Okay. Okay.
SPEAKER S2: Oh, that hurts my neck.
SPEAKER S1: Positive. Kernig's. Negative. Brudzinski. All right. Just relax your arm. Just let me hold it. Sometimes it's easier said than done. Just relax. Relax, relax. Let me hold your arm. Okay. Okay. This one. Okay, good. So. Plus two brachioradialis. Can you turn around this way and hang your feet over the side of the bed there. Kind of let him dangle. Scoot forward just a little bit more. There you go. And then take your hands and pull them together like that and then pull them apart. Good. Okay, good. Plus two. Bilateral patellar reflexes. [okay?] You can go ahead and make yourself comfortable. Well, here's the thing. I'm concerned that you could have something going on with the papilledema. So I think we need to do a Cat scan of your brain. Okay. So we'll start with a Cat scan of your brain just to make sure you don't have anything internally that's obviously bleeding or a mass or anything like that. We'll get some basic labs. So we'll get a CBC, a BMP. Um, I think we should get some medications to try to treat your symptoms so we can maybe try some Benadryl and Compazine. And I like to wait and see. As far as what other pain medications we might give, possibly some decadron or, um, depacon for migraine use. Um, but I want to get the Cat scan first and I don't want to give [you?] any blood thinners. We may end up needing to do a lumbar puncture to look for blood. Sometimes what you have, um, could cause a bleed in the brain. And so what we would do is do a lumbar puncture. So we would need to get CSF. Um get the CSF panel for an order a lumbar puncture to the bedside. Um so what that involves is, you know, anesthetizing the area getting um, and taking some spinal fluid out and then sending it to the lab for testing to see if there's any blood, if there would need to be some sort of intervention. I know that's a lot. Do you have any questions?
SPEAKER S2: Um, do you think I can get something for nausea?
SPEAKER S1: Yes. We can give you some Zofran. Zofran, four milligrams IV, Po or IV times one now. All right.
SPEAKER S2: Thank you.
SPEAKER S1: Thank you. Okay. Can we get a CBC, [a?] bmp pt, inr [a?] CT of the head without contrast and a CT of the head and neck with contrast. We'll also get an EKG. Have the nursing order put in for an LP kit to the bedside, and then go ahead and get the CSF panel. Let's give him something for his symptoms. Let's give him some [some?] Compazine, ten milligrams IV and some Benadryl 50mg [milligrams?] IV. We're rolling. All right, so the EKG, it is a normal sinus rhythm. It's actually a little bit Tachycardic rate is 110. The axis is normal. Um there's no significant Q waves. There is a no widening of the QRS. So that's normal. There are some nonspecific inverted T waves diffusely. Um so overall normal sinus tachycardia with inverted T waves. Thank you.


ground_truth:
SPEAKER S1: Hi there, I'm doctor B.
SPEAKER S2: Hi doc.
SPEAKER S1: This is my scribe K. He's helping me out today. Tell me what brought you in to see us?
SPEAKER S2: Well, first off, let me tell you. I've had migraines my entire life. I normally take some imitrex and follow up with neurology when they get really bad. But this one, this one's something different. I was at work earlier today and it was just the worst headache of my life. It was on either side of my head and I felt really nauseous. I went to the bathroom. I threw up, looked in the mirror and couldn't see straight. Really blurry. I just felt dizzy. So they sent me home. When I got home and sat down and was trying to relax, my [nef?] got my neck got really stiff. It was really painful to move it. Um, tried some more imitrex and some Motrin, but it doesn't really seem to help.
SPEAKER S1: Okay. Um, what time did this start?
SPEAKER S2: Um, probably around eight hours ago.
SPEAKER S1: Okay. And what were you doing when it started?
SPEAKER S2: Just my normal work at the desk. Just typing  on my computer.
SPEAKER S1: And has it been constant, or does it come and go?
SPEAKER S2: It's constant.
SPEAKER S1: Constant. And, um, would you describe it as progressive or sudden onset?
SPEAKER S2: It was very sudden.
SPEAKER S1: Very sudden onset. Okay. And do you have any symptoms that radiate anywhere, the pain or anything?
SPEAKER S2: Um not really. It just kind of localized on either side of my head.
SPEAKER S1: Okay. And how would you describe it on a scale of 1 to 10, with 10 being the worst pain you can imagine?
SPEAKER S2: An 8 or a 9.
SPEAKER S1: Okay. And can you kind of describe the characteristics of it?
SPEAKER S2: Um, it's kind of throbbing, kind of going along with the pulse. The light makes it much, much worse.
SPEAKER S1: Okay. And you said you do have some nausea and vomiting.
SPEAKER S2: Correct.
SPEAKER S1: Have you had any other associated symptoms like a fever or chills? Sweats?
SPEAKER S2: No, not so far.
SPEAKER S1: Have you had a rash?
SPEAKER S2: No.
SPEAKER S1: Okay. Have you been around anybody else who's been sick with similar symptoms?
SPEAKER S2: No.
SPEAKER S1: Okay. And I'm just going to kind of go through some other questions as well. Just let me know if you've had any of these things. Um, any vision changes.
SPEAKER S2: Yes.
SPEAKER S1: Tell me about that.
SPEAKER S2: It became really blurry. I was looking in the mirror and I couldn't see straight.
SPEAKER S1: Okay. Um, but not like your vision loss. Just more blurry.
SPEAKER S2: Correct.
SPEAKER S1: Okay. Um, any congestion, like nasal congestion or sore throat?
SPEAKER S2: No.
SPEAKER S1: Okay. Um, you said you had neck stiffness. Any cough or congestion?
SPEAKER S2: No.
SPEAKER S1: Okay. Any weakness anywhere? Like one arm, one leg or difficulty speaking?
SPEAKER S2: Not that I've noticed.
SPEAKER S1: Okay. And any you said nausea. Do you have any belly pain or diarrhea?
SPEAKER S2: No.
SPEAKER S1: Okay. And any other symptoms that I didn't ask about?
SPEAKER S2: Um, not that I can think of.
SPEAKER S1: Okay. Let's do a physical exam here. I know the light's kind of bothering you, so you just have to bear with me here
SPEAKER S2: Okay.
SPEAKER S1: If you can just pick one spot and stare at it. And I'm going to look in your eye.
SPEAKER S2: Mhm.
SPEAKER S1: Sorry. I know. Just try to keep your eyes open. I'll just help you here. Okay? And just keep staring at the wall. Okay. I am concerned that you might have some papilledema, which is a little bit of fuzziness around the optic fundus. So we'll have to get a Cat scan for that. Um, watch my finger. Does look like he has a little bit of, uh, beats of nystagmus bilaterally. Just look straight ahead again. Look up a little bit more. Thanks. Okay. His pupils are equal and reactive. Can you just look at me for a second? Okay. Looking at my nose and using your side vision, can you cover one eye? Okay. Tell me when you can see my vision and or my finger and how many fingers I'm holding up.
SPEAKER S2: One.
SPEAKER S1: Okay.
SPEAKER S2: Two.
SPEAKER S1: Okay.
SPEAKER S2: One.
SPEAKER S1: Okay.
SPEAKER S2: Two.
SPEAKER S1: Okay, good. Let's do the same thing with the other eye. Looking at me. Just using your side vision.
SPEAKER S2: One.
SPEAKER S1: Good.
SPEAKER S2: Two.
SPEAKER S1: Okay.
SPEAKER S2: One.
SPEAKER S1: Uh-huh.
SPEAKER S2: two.
SPEAKER S1: Okay, so his visual fields are full. Um, we'll have to get a vision test on you. We'll have the nurse get that. Um, like with the reading chart, just because you're having some blurry vision. But overall, it seems like you're able to see in all in all fields, which is good. Um, I would like to have you make some faces with me. Raise your eyebrows up. Puff your cheeks out. Stick your tongue out. Give me a big smile. Okay. Can you feel me touch here?
SPEAKER S2: Uh-huh.
SPEAKER S1: Does it feel the same on both sides?
SPEAKER S2: Mm-huh
SPEAKER S1: Okay, good. How about here?
SPEAKER S2: Yep.
SPEAKER S1: Same on both sides. How about here? Same on both sides.
SPEAKER S2: Yep.
SPEAKER S1: Okay, good. Hold your arms up. Turn [your?] palms this way and close your eyes and keep your arms up. Okay. Open your eyes and then shrug your shoulders. Okay, so his cranial nerves 2 through 12 are grossly intact. His sensation is intact. He does not have any pronator  drift. Touch your nose and then touch my finger. Okay. Can you do with that? Good. Normal finger. Nose. Can you take one leg and act like you're scratching your other leg? Do the same with the other. Okay, good. Normal heel shin. I'm going to lay this bed flat. Okay. Okay.
SPEAKER S2: Oh, that hurts my neck.
SPEAKER S1: So he has a positive kernig's. Okay.  Negative brudzinski. All right. Just relax your arm. Just let me hold it. Sometimes it's easier said than done. Just relax. Relax, relax. Let me hold your arm. Okay. Okay. This one. Okay, good. So. Plus two brachioradialis. Can you turn around this way and hang your feet over the side of the bed there. Kind of let em dangle. Scoot forward just a little bit more. There you go. And then take your hands and pull them together like that and then pull them apart. Good. Okay, good. Plus two bilateral patellar reflexes. [okay?] You can go ahead and make yourself comfortable. Well, here's the thing. I'm concerned that you could have something going on with the papilledema. So I think we need to do a Cat scan of your brain. Okay. So we'll start with a Cat scan of your brain just to make sure you don't have anything internally that's obviously bleeding or a mass or anything like that. We'll get some basic labs. So we'll get a CBC, a BMP. Um, I think we should get some medications to try to treat your symptoms so we can maybe try some Benadryl and Compazine. And I like to wait and see. As far as what other pain medications we might give, possibly some decadron or, um, depacon for migraine use. Um, but I want to get the Cat scan first and I don't want to give you any blood thinners. We may end up needing to do a lumbar puncture to look for blood. Sometimes what you have, um, could cause a bleed in the brain. And so what we would do is do a lumbar puncture. So we would need to get CSF. Um get the CSF panel for uh and order a lumbar puncture to the bedside. Um so what that involves is, you know, anesthetizing the area getting um, and taking some spinal fluid out and then sending it to the lab for testing to see if there's any blood, if there would need to be some sort of intervention. I know that's a lot. Do you have any questions?
SPEAKER S2: Um, do you think I can get something for nausea?
SPEAKER S1: Yes. We can give you some Zofran. Zofran, 4 milligrams IV, Po or IV times 1 now. All right.
SPEAKER S2: Thank you.
SPEAKER S1: Thank you. Okay. Can we get a CBC, a BMP, PT, INR, a CT of the head without contrast and a CTA of the head and neck with contrast. We'll also get an EKG. Have the nursing order put in for an LP kit to the bedside, and then go ahead and get the CSF panel. Let's give him something for his symptoms. Let's give him some Compazine, 10 milligrams IV and some Benadryl 50 milligrams IV. We're rolling. All right, so the EKG, it is a normal sinus rhythm. It's actually a little bit Tachycardiac rate is 110. The axis is normal. Um there's no significant Q waves. There is a no widening of the QRS. So that's normal. There are some nonspecific inverted T waves diffusely. Um so overall normal sinus tachycardia with inverted T waves. Thank you.


audio_file: Scribe Academy Plus - 20160107 - Final Exam. Chest Pain. HPI PE Orders Disposition EKG. [btolHkAJDCY].mp3

ground_truth:
SPEAKER S1: Hi, I'm doctor Kwiatek.
SPEAKER S2: Chris.
SPEAKER S1: [I?] saw from your chart that you're having some chest pain. Can you tell me a little bit about that?
SPEAKER S2: Um. Well, it's just kind of like this tightness and squeezing on the left side of my chest. Um, and I've had it since yesterday, but it worsened this morning.
SPEAKER S1: Okay. And, uh, what were you doing when it started yesterday?
SPEAKER S2: Uh, well, I was getting home from work.
SPEAKER S1: What kind of work do you do?
SPEAKER S2: Uh, I'm a semi truck driver, so I load the trucks up and then drive throughout the country, obviously.
SPEAKER S1: Okay. So you sit for a long period of time when you're.
SPEAKER S2: mm-hmm.
SPEAKER S1: Do you have a history of any heart or lung problems?
SPEAKER S2: Mhm.
SPEAKER S1: Is there any cough with it?
SPEAKER S2: Uhm, no.
SPEAKER S1: Any shortness of breath with it?
SPEAKER S2: Not really. It hurts more when I breathe, though.
SPEAKER S1: Does [it?] make it worse when you take a deep breath.
SPEAKER S2: Mhm.
SPEAKER S1: Um. Have you taken anything for it?
SPEAKER S2: mm-mm.
SPEAKER S1: Okay. I'm going to ask you some questions about possible risk factors for heart problems. Do you have a family history of coronary artery disease, heart attacks, anything like that in somebody under age 55?
SPEAKER S2: Uh, no. Just hypertension.
SPEAKER S1: Okay. And you personally, do you have a history of high blood pressure?
SPEAKER S2: mm-mm.
SPEAKER S1: How about diabetes?
SPEAKER S2: mm-mm.
SPEAKER S1: How about cholesterol?
SPEAKER S2: Not that I know of.
SPEAKER S1: Okay, so this chest pain [it/he?] says located in the left side is kind of tight. Feeling worse when you take a deep breath? Does it radiate anywhere?
SPEAKER S2: No, it just kind of stays right there.
SPEAKER S1: Did you get anything when it first started? Like nausea, break out in a sweat or get short of breath at that time?
SPEAKER S2: Uh, no.
SPEAKER S1: Okay. Um, do you have any leg pain or swelling that you noticed?
SPEAKER S2: Uh, not any more than usual.
SPEAKER S1: So we just have a little bit of what? Pain or swelling [or?]?
SPEAKER S2: Yeah, just a little bit of swelling, and then it's just sore from all the boxes and stuff.
SPEAKER S1: All right. Have you been sick with anything recently? Have you had a fever or chills? Haven't had any belly pain. Diarrhea, urinary symptoms, unusual rash, difficulty swallowing, change in your vision, anything like that. [No.?] So everything else has been pretty normal. [Mm?] [-hmm.?] Okay. Anything else that I haven't asked that you think that I should know about? [Mm?] [-hmm.?] All right. Well, let's take a look at you here. Open your mouth [not?] [going?] [to?] [get?] [sick.?] [Can?] [you?] [come?] [up?] for me real big. Take a look up. Turn your head. Okay. Go ahead and sit forward for me. Deep breaths. Again. And. Again. That's over here. [Mm?] [-hmm.?] All right. Go ahead and lie back. Any soreness there.
SPEAKER S2: Just a little bit on that side.
SPEAKER S1: So minimal. Um chest wall tenderness in the left parasternal area. S4 gallop. That's already [under?] here in the belly at all?
SPEAKER S2: No.
SPEAKER S1: Radial pulses are symmetric. Trace pedal edema. Are you saw in the calves a little bit? Not really.
SPEAKER S2: It's more like the knees and ankles and stuff. Okay.
SPEAKER S1: Well we're going to rule out a few things here. Um, we don't really have a lot in the way of risk factors for [a?] heart. And it's been going on since yesterday. So [scribe,?] I think we'll put in for a single EKG with a single troponin. But I want to rule out also, um, some other things that could happen, like with sitting for a long time pulmonary embolism. So we're going to get a few tests related to that. We'll get a D-dimer. [-dimer.?] So a CBC a basic troponin D-dimer. [-dimer.?] Those will be our blood tests. We've got the EKG, we want to get a PA and lateral chest X-ray, [-ray.?] but also let's get an ultrasound of both of the legs to rule out any clots there. And let's also get a Cat scan of the chest with IV contrast PE protocol to rule out any issues there. Meanwhile, I'm going to give you Toradol 30 IV and hopefully that'll [will?] help out with the pain while we're getting this done. Any questions? No. Okay. Well, Chris, I got everything back. So I brought my scribe in because we're going to do your discharge here while I'm talking to you. So first of all, the good news. The EKG was fine. And scribe, if you could put in just [a?] normal EKG on him, uh, you can get the times off of [the?] EKG. There's no old one, but his rate was 76 on there and everything else was normal. So that was fine. In your troponin, which is your heart enzyme is fine. So no issue there. I was a little bit more concerned about a possible clot to the lung like we had talked about. But because you sit all day and so on, but all of those tests came back fine as well. So I think this is probably from lifting stuff. It's probably more muscular pain there. Um, remember I talked to [you.?] the nurse who told me about your smoking and I came in and talked to you about that before. So I'm just going to have my scribe go ahead and put in the chart, all of the smoking stuff, and we'll give you some information on how to quit smoking. Like I had already spoken to you about, but for comfort right now, I want to send you home, um, with a, with a couple of prescriptions. So scribe, if you could put in for diagnosis in addition to the smoking stuff. I'll go ahead and put in, uh, chest wall pain and a prescription for Naprosyn, which is an anti inflammatory for you. That'll [will?] be 500mg [milligrams?] twice a day for ten days. And then in addition to that, I'm going to provide you with a muscle relaxer because I think a lot of this is sore muscles. So put in for norflex and that'll [will?] be 100mg [milligrams?] twice a day, also for ten days. And then you don't have a physician I saw. So we have what we call [a?] transition clinic that you can go to for follow up. And they'll help you get into a physician, but they'll follow you up initially. So [scribe,?] if you could make follow up for three days from now at the transition clinic, that would be awesome. And I think that pretty much covers anything that you have. Any questions?
SPEAKER S2: Can I drive on those medications?
SPEAKER S1: You can drive on the naprosyn, the anti-inflammatory, [-inflammatory.?] the other one. Some people find makes them drowsy, so I don't advise it.
SPEAKER S2: Okay.
SPEAKER S1: Okay then. Good luck to you.
SPEAKER S3: Thank you. [You're?] [welcome.?]


audio_file: Scribe Academy Plus - 20190801 - Seizure [7iCWJJezZdo].mp3

ground_truth:
SPEAKER S1: Hi, I'm doctor Kwiatek.
SPEAKER S2: Chris.
SPEAKER S1: [I?] saw from your chart that you're having some chest pain. Can you tell me a little bit about that?
SPEAKER S2: Um. Well, it's just kind of like this tightness and squeezing on the left side of my chest. Um, and I've had it since yesterday, but it worsened this morning.
SPEAKER S1: Okay. And, uh, what were you doing when it started yesterday?
SPEAKER S2: Uh, well, I was getting home from work.
SPEAKER S1: What kind of work do you do?
SPEAKER S2: Uh, I'm a semi truck driver, so I load the trucks up and then drive throughout the country, obviously.
SPEAKER S1: Okay. So you sit for a long period of time when you're.
SPEAKER S2: mm-hmm.
SPEAKER S1: Do you have a history of any heart or lung problems?
SPEAKER S2: Mhm.
SPEAKER S1: Is there any cough with it?
SPEAKER S2: Uhm, no.
SPEAKER S1: Any shortness of breath with it?
SPEAKER S2: Not really. It hurts more when I breathe, though.
SPEAKER S1: Does [it?] make it worse when you take a deep breath.
SPEAKER S2: Mhm.
SPEAKER S1: Um. Have you taken anything for it?
SPEAKER S2: mm-mm.
SPEAKER S1: Okay. I'm going to ask you some questions about possible risk factors for heart problems. Do you have a family history of coronary artery disease, heart attacks, anything like that in somebody under age 55?
SPEAKER S2: Uh, no. Just hypertension.
SPEAKER S1: Okay. And you personally, do you have a history of high blood pressure?
SPEAKER S2: mm-mm.
SPEAKER S1: How about diabetes?
SPEAKER S2: mm-mm.
SPEAKER S1: How about cholesterol?
SPEAKER S2: Not that I know of.
SPEAKER S1: Okay, so this chest pain [it/he?] says located in the left side is kind of tight. Feeling worse when you take a deep breath? Does it radiate anywhere?
SPEAKER S2: No, it just kind of stays right there.
SPEAKER S1: Did you get anything when it first started? Like nausea, break out in a sweat or get short of breath at that time?
SPEAKER S2: Uh, no.
SPEAKER S1: Okay. Um, do you have any leg pain or swelling that you noticed?
SPEAKER S2: Uh, not any more than usual.
SPEAKER S1: So we just have a little bit of what? Pain or swelling [or?]?
SPEAKER S2: Yeah, just a little bit of swelling, and then it's just sore from all the boxes and stuff.
SPEAKER S1: All right. Have you been sick with anything recently? Have you had a fever or chills? Haven't had any belly pain. Diarrhea, urinary symptoms
SPEAKER S2: mm-mm.
SPEAKER S1: Unusual rash, difficulty swallowing, change in your vision, anything like that.
SPEAKER S2: No.
SPEAKER S1: So everything else has been pretty normal.
SPEAKER S2: mm-hmm
SPEAKER S1: Okay. Anything else that I haven't asked that you think that I should know about?
SPEAKER S2: mm-mm
SPEAKER S1: All right. Well, let's take a look at you here. Open your mouth for me real big. Take a look up. Turn your head. Okay. Go ahead and sit forward for me. Deep breaths. Again. That's over here.
SPEAKER S2: mm-hmm
SPEAKER S1: All right. Go ahead and lie back. Any soreness there.
SPEAKER S2: Just a little bit on that side.
SPEAKER S1: So minimal. Um chest wall tenderness in the left parasternal area. S4 gallop. That's already [under?] here in the belly at all?
SPEAKER S2: No.
SPEAKER S1: Radial pulses are symmetric. Trace pedal edema. Are you saw in the calves a little bit? Not really.
SPEAKER S2: It's more like the knees and ankles and stuff. Okay.
SPEAKER S1: Well we're going to rule out a few things here. Um, we don't really have a lot in the way of risk factors for [a?] heart. And it's been going on since yesterday. So [scribe,?] I think we'll put in for a single EKG with a single troponin. But I want to rule out also, um, some other things that could happen, like with sitting for a long time pulmonary embolism. So we're going to get a few tests related to that. We'll get a D-dimer. [-dimer.?] So a CBC a basic troponin D-dimer. [-dimer.?] Those will be our blood tests. We've got the EKG, we want to get a PA and lateral chest X-ray, [-ray.?] but also let's get an ultrasound of both of the legs to rule out any clots there. And let's also get a Cat scan of the chest with IV contrast PE protocol to rule out any issues there. Meanwhile, I'm going to give you Toradol 30 IV and hopefully that'll [will?] help out with the pain while we're getting this done. Any questions? No. Okay. Well, Chris, I got everything back. So I brought my scribe in because we're going to do your discharge here while I'm talking to you. So first of all, the good news. The EKG was fine. And scribe, if you could put in just [a?] normal EKG on him, uh, you can get the times off of [the?] EKG. There's no old one, but his rate was 76 on there and everything else was normal. So that was fine. In your troponin, which is your heart enzyme is fine. So no issue there. I was a little bit more concerned about a possible clot to the lung like we had talked about. But because you sit all day and so on, but all of those tests came back fine as well. So I think this is probably from lifting stuff. It's probably more muscular pain there. Um, remember I talked to [you.?] the nurse who told me about your smoking and I came in and talked to you about that before. So I'm just going to have my scribe go ahead and put in the chart, all of the smoking stuff, and we'll give you some information on how to quit smoking. Like I had already spoken to you about, but for comfort right now, I want to send you home, um, with a, with a couple of prescriptions. So scribe, if you could put in for diagnosis in addition to the smoking stuff. I'll go ahead and put in, uh, chest wall pain and a prescription for Naprosyn, which is an anti inflammatory for you. That'll [will?] be 500mg [milligrams?] twice a day for ten days. And then in addition to that, I'm going to provide you with a muscle relaxer because I think a lot of this is sore muscles. So put in for norflex and that'll [will?] be 100mg [milligrams?] twice a day, also for ten days. And then you don't have a physician I saw. So we have what we call [a?] transition clinic that you can go to for follow up. And they'll help you get into a physician, but they'll follow you up initially. So [scribe,?] if you could make follow up for three days from now at the transition clinic, that would be awesome. And I think that pretty much covers anything that you have. Any questions?
SPEAKER S2: Can I drive on those medications?
SPEAKER S1: You can drive on the naprosyn, the anti-inflammatory, [-inflammatory.?] the other one. Some people find makes them drowsy, so I don't advise it.
SPEAKER S2: Okay.
SPEAKER S1: Okay then. Good luck to you.
SPEAKER S3: Thank you. [You're?] [welcome.?]