Carotid Sheath Puns

Hey there, sorry, this may be a little long. I have been a CPC for a Neurology department for about two years. We recently hired a new doctor who is a Neurointerventional radiologist and is doing procedures at one of our hospitals. I am brand new to coding the surgeries for him and I have gotten down the thrombectomy's, stents, and DSA's that he does with the help of the sweetest lady from our facilities general surgery department, but we can't figure out or understand how to code his MMA Embolization's and aneurysm procedures. We tried to code one and it keeps giving me the same edit and we can't figure out what to do. This is one of the notes...if someone smarter than me could please help me out that would be fantastic!!!

INJECTIONS:

LEFT common carotid artery

LEFT external carotid artery

LEFT middle meningeal artery

Post embolization LEFT external carotid artery

LEFT internal carotid artery angio through existing catheter for procedure

confirmation

RIGHT external iliac artery

INTERVENTION:

Coil and particulate embolization of LEFT middle meningeal artery

Angio-Seal arteriotomy closure

ADDITIONAL SPECIAL RADIOGRAPHIC TECHNIQUES: None

COMPARISON: CT and MR studies performed on the previous day.

TECHNIQUE: Prior to the procedure, consent was obtained. Maximal sterile

technique with mask, sterile gown, sterile gloves, large sterile sheet, hand

hygiene, and patient prep with 2% chlorhexidine for cutaneous antisepsis were

all followed as Covenant Health guidelines. Physiological monitors were placed.

Right common femoral arterial access was achieved with a micropuncture system.

A 6 French sheath was introduced.

Benchmark I catheter introduced over a Berenstein catheter and Glidewire and

advanced into LEFT common carotid artery. Angiographic assessment performed. The

guide catheter then advanced into the LEFT external carotid artery and repeat

angiographic assessment performed. Intravenous heparin was administered and

heparin drip initiated through the sheath. Direxion catheter introduced over

Fathom wire and used to selectively catheterize the LEFT middle meningeal

artery. Angiographic assessment performed. Embolization performed with 300-500

um polyvinyl alcohol particles followed by platinum microcoils. Postprocedural

assessment of the LEFT common carotid artery demonstrated near stasis in the

LEFT middle meningeal artery distribution with NO additional m

I don't want to step on anybody's toes here, but the amount of non-dad jokes here in this subreddit really annoys me. First of all, dad jokes CAN be NSFW, it clearly says so in the sub rules. Secondly, it doesn't automatically make it a dad joke if it's from a conversation between you and your child. Most importantly, the jokes that your CHILDREN tell YOU are not dad jokes. The point of a dad joke is that it's so cheesy only a dad who's trying to be funny would make such a joke. That's it. They are stupid plays on words, lame puns and so on. There has to be a clever pun or wordplay for it to be considered a dad joke.

Again, to all the fellow dads, I apologise if I'm sounding too harsh. But I just needed to get it off my chest.

I guess the concept didn't work

FINDINGS:

• No significant change in size of elongated transfacial right lower neck cystic mass lesion which measures 4.8 x 1.3 x 4.9 cm (trans-, AP, CC).

• Mass insinuates along the posterior aspect of the right sternocleidomastoid, internal jugular, and common carotid, and lies just anterior to the anterior scalene musculature.

• Medially, mass appears to insinuate along the posterior inferior aspect of the right thyroid.

• Inferiorly, mass extends towards the thoracic inlet along the carotid sheath.

• There is very slight effacement of the internal jugular vein as it transits anteriorly to the mass.

• Signal characteristics of the mass are heterogeneously T2 hyperintense, T1 hypointense, and with only minimal peripheral enhancement.

• No significant solid enhancing component is evident.

• There is a small enhancing nodule underlying the right sternocleidomastoid just superior to the cystic mass lesion which measures 1.0 x 0.6 cm (axial post contrast series 8, image 92), probably a mildly prominent lymph node.

• Otherwise normal-appearing small bilateral cervical chain lymph nodes which do not appear pathologically enlarged.

• Otherwise normal appearance of the neck structures. IMPRESSION:

1. Elongated and somewhat bilobed right lower neck cystic mass lesion extending inferiorly towards the thoracic inlet along the carotid sheath. Favor a congenital cystic lesion most likely cervical thymic cyst. An atypical second branchial cleft cyst or lymphatic malformation would be less likely differential considerations. A cystic neoplasm is considered much less likely.
2. Small enhancing nodule underlying the right sternocleidomastoid just superior to the cystic mass lesion, probably a mildly prominent lymph node.

Alot of great jokes get posted here! However just because you have a joke, doesn't mean it's a dad joke.

THIS IS NOT ABOUT NSFW, THIS IS ABOUT LONG JOKES, BLONDE JOKES, SEXUAL JOKES, KNOCK KNOCK JOKES, POLITICAL JOKES, ETC BEING POSTED IN A DAD JOKE SUB

Try telling these sexual jokes that get posted here, to your kid and see how your spouse likes it.. if that goes well, Try telling one of your friends kid about your sex life being like Coca cola, first it was normal, than light and now zero , and see if the parents are OK with you telling their kid the "dad joke"

I'm not even referencing the NSFW, I'm saying Dad jokes are corny, and sometimes painful, not sexual

So check out r/jokes for all types of jokes

r/unclejokes for dirty jokes

r/3amjokes for real weird and alot of OC

r/cleandadjokes If your really sick of seeing not dad jokes in r/dadjokes

Punchline !

Edit: this is not a post about NSFW , This is about jokes, knock knock jokes, blonde jokes, political jokes etc being posted in a dad joke sub

Edit 2: don't touch the thermostat

Do your worst!

How the hell am I suppose to know when it’s raining in Sweden?

Mathematical puns makes me number

Ants don’t even have the concept fathers, let alone a good dad joke. Keep r/ants out of my r/dadjokes.

But no, seriously. I understand rule 7 is great to have intelligent discussion, but sometimes it feels like 1 in 10 posts here is someone getting upset about the jokes on this sub. Let the mods deal with it, they regulate the sub.

They were cooked in Greece.

I'm surprised it hasn't decade.

He lost May

Now that I listen to albums, I hardly ever leave the house.

Don't you know a good pun is its own reword?

Two muffins are in an oven, one muffin looks at the other and says "is it just me, or is it hot in here?"

Then the other muffin says "AHH, TALKING MUFFIN!!!"

For context I'm a Refuse Driver (Garbage man) & today I was on food waste. After I'd tipped I was checking the wagon for any defects when I spotted a lone pea balanced on the lifts.

I said "hey look, an escaPEA"

No one near me but it didn't half make me laugh for a good hour or so!

Edit: I can't believe how much this has blown up. Thank you everyone I've had a blast reading through the replies 😂

It really does, I swear!

And now I’m cannelloni

Because she wanted to see the task manager.

But that’s comparing apples to oranges

And boy are my arms legs.

Put it on my bill

Heard they've been doing some shady business.

but then I remembered it was ground this morning.

Edit: Thank you guys for the awards, they're much nicer than the cardboard sleeve I've been using and reassures me that my jokes aren't stale

Edit 2: I have already been made aware that Men In Black 3 has told a version of this joke before. If the joke is not new to you, please enjoy any of the single origin puns in the comments

BamBOO!

They’re on standbi

A play on words.

Calcium, nickel, neon

My daughter, Chewbecca, not so much.

[removed]

Pilot on me!!

Christopher Walken

Nothing, he was gladiator.

The bartender says, "Sorry, no minors”

Dad jokes are supposed to be jokes you can tell a kid and they will understand it and find it funny.

This sub is mostly just NSFW puns now.

If it needs a NSFW tag it's not a dad joke. There should just be a NSFW puns subreddit for that.

Edit* I'm not replying any longer and turning off notifications but to all those that say "no one cares", there sure are a lot of you arguing about it. Maybe I'm wrong but you people don't need to be rude about it. If you really don't care, don't comment.

Or would that be too forward thinking?