[doctor] hi miss russell .
[patient] hi-
[doctor] nice to meet you-
[patient] doctor gutierrez . how are you ?
[doctor] i'm well .
[patient] good .
[doctor] hey dragon . i'm seeing miss russell . she's a 39-year-old female here for , what are you here for ?
[patient] it's my right upper arm . it hurts really , really bad .
[doctor] so severe right upper arm pain .
[patient] yeah , uh yes .
[doctor] and how did this happen ?
[patient] i was playing volleyball yesterday , uh last night . um and i went to spike the ball , and the team we were playing , they're dirty . so um , somebody right across from me kinda kicked my legs from under me as i was going up , and i fell and landed on my arm .
[doctor] mm-hmm , like right on your shoulder .
[patient] yeah .
[doctor] ow .
[patient] yes .
[doctor] that sounds like it hurt .
[patient] it was nasty .
[doctor] um , so this happened , what ? like 12 hours ago now ?
[patient] uh , seven o'clock last night , so a little more than that .
[doctor] okay .
[patient] eighteen hours .
[doctor] so less than a day .
[patient] yeah .
[doctor] in severe pain .
[patient] yes .
[doctor] have you taken anything for the pain ?
[patient] i've been taking ibuprofen every six hours i think , but it's really not helping at all .
[doctor] okay , what would you rate your pain ?
[patient] it's like a nine .
[doctor] nine out of 10 ?
[patient] yeah .
[doctor] so like really severe ?
[patient] yes .
[doctor] have you used any ice ?
[patient] no , i have n't .
[doctor] okay . and do you have any medical problems ?
[patient] i have gallstones .
[doctor] okay . do you take any medicine for it ?
[patient] pepcid .
[doctor] okay . and any surgeries in the past ?
[patient] yes , i had a lumbar fusion about six years ago .
[doctor] okay .
[patient] um , yeah .
[doctor] all right . let's uh , let's look at your x-ray .
[doctor] hey dragon . show me the last radiograph . so this is looking at your right arm , and what i see is a proximal humerus fracture . so you kinda think of your humerus as a snow cone , and you knocked the-
[patient] the top of the snow cone ?
[doctor] the top off the snow cone . um , so i'll be gentle but i want to examine your arm .
[patient] all right .
[doctor] okay .
[patient] all right . all right .
[doctor] all right . are you able to straighten your arm ?
[patient] yeah , i can just straighten the elbow as long as i do n't move up here .
[doctor] as long as you do n't move your shoulder .
[patient] yeah .
[doctor] go ahead and bend . okay . so your exam is generally normal , meaning that the rest of your body is normal
[patient]
[doctor] but you've got some swelling and erythema-
[patient] yeah .
[doctor] . on that right shoulder . you've got uh , tenderness over your right shoulder . you've got normal pulses , and everything else is normal . any numbness or tingling in that right arm ?
[patient] no .
[doctor] okay . um , so what we're going to have to do- the good thing about um , these kinds of fractures is generally , they will heal up without surgery . um , but we have to put you in a sling that weighs your arm down and pulls it down . so we're going to put you in a long arm cast and a sling , and then we're gon na check you in two weeks to see if those bones have realigned and if they have n't , then we're gon na have to talk about doing surgery at that time .
[patient] okay .
[doctor] i'm going to prescribe you some pain medicine . we'll do lortab 500- lortab 5 milligram .

[doctor] um , you can take one to two tablets every uh , six hours as needed for pain . i'll give you 20 of those .
[patient] all right .
[doctor] and um , do you have any allergies to medicines ? i did n't ask .
[patient] no , i do n't have no allergies .
[doctor] okay . um , hey dragon , go ahead and order any medications or procedures discussed . um , do you have any questions for me ?
[patient] no , i do n't .
[doctor] okay , great . why do n't you come with me , we'll get the tech to put the cast on .
[patient] okay .
[doctor] and we'll get you checked out .
[patient] thank you .
[doctor] hey dragon , finalize the report .

Medical orders:
description: lortab 500- 5 milligram one to two tablets every uh , six hours as needed 20
order_type: medication
reason: severe right upper arm pain