You examine Mr. Martino’s oropharynx, and postoperative changes prevent you from completely opening the mouth, but you see no obstruction.
Neck exam shows firm midline neck mass, approx 3cm x 2cm. Lung exam is significant for transmitted upper airway sounds, and decreased breath sounds throughout. Cardiac exam is tachycardic, without murmur. No peripheral edema.
He appears to have a slightly altered mental status, but the wife says he has been taking more of his medications than usual which include oxycodone and ambien.
His wife adds that the patient has a ”Living Will” and would not want to be resuscitated or intubated for an irreversible cause, but would want treatment for a reversible cause to maintain his current level of functioning. The electronic chart from his last admission and from his clinic visits document these wishes.