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Shoulder Injection
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PREOPERATIVE DIAGNOSIS
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PREOPERATIVE DX
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POSTOPERATIVE DIAGNOSIS
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POSTOPERATIVE DX
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PROCEDURE
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PROCEDURE
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MAC [Yes] / Local [No] (SPRING)
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TIVA [Yes] / Local [No]
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IV Sedation [Yes] / Local [No]
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INDICATION
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INDICATION
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OPERATIVE PROCEDURE
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Lying Prone with MAC Yes / No
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Prep
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Shoulder Location (Fluoroscopy)
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Shoulder Location (Sitting)
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Shoulder Location (Fluoroscopy) No Dye
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COMMENTS
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Sacroiliac Joint Injection
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PREOPERATIVE DIAGNOSIS
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POSTOPERATIVE DIAGNOSIS
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PROCEDURE
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TIVA [Yes] / Local [No]
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INDICATION
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OPERATIVE PROCEDURE
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Prep
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SI Joint Location
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Hip Injection
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PREOPERATIVE DIAGNOSIS
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POSTOPERATIVE DIAGNOSIS
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PROCEDURE
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TIVA [Yes] / Local [No]
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IV Sedation [Yes] / Local [No]
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INDICATION
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OPERATIVE PROCEDURE
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Lying Supine with MAC Yes / No
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Lying Lateral with MAC Yes / No
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Prep
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Hip Location (Fluoroscopy)
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Hip Location (Without Fluoroscopy)
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Recovery Room [Yes] / Direct Discharge [No]
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Knee Injection
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PREOPERATIVE DIAGNOSIS
• • •
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POSTOPERATIVE DIAGNOSIS
• • •
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PROCEDURE
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TIVA [Yes] / Local [No]
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IV Sedation [Yes] / Local [No]
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INDICATION
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Procedure
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Diagnosis
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OPERATIVE PROCEDURE
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With Sedation Yes / No
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Patient Position Yes [Supine] / No [Sitting]
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Supine Knee Position Yes [Flex] / No [Extend]
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Prep
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Approach (Without Fluoroscopy)
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Approach (Fluoroscopy)
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Tolerated well? Yes / No
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Tolerated Procedure Free Write
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Recovery / Discharge
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Recovery / Discharge Free Write
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Fluoroscopy Image #1
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Fluoroscopy Image #2
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Fluoroscopy Image #3
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