I officially reached the half way mark of third year. I can't believe it; third year is flying by way too quickly and at this rate, I'll still be clueless by the end of the year. I took the neuro shelf and am pretty exhausted. There were lots of questions about peds neuro and what the heck do I know about that, given that I'd never seen a kid the entire time while on neuro? I hope that I passed the shelf!
This weekend, I definitely need to think, recharge, and prepare mentally for medicine. I really want to get the most out of this medicine rotation and do well in it.
Cool (or perhaps not so cool but certainly memorable) things in neurology:
1. Watching everyone's response to an acute stroke. It's no joke and has been the closest thing to ER (meaning the TV show, with all the doctors/nurses running alongside a patient's gurney, mowing down everything and everyone in the way) that I've witnessed so. The urgency of the situation is palpable. Time is of the essence since there's a 3 hour window from symptom onset to give IV TPA and 6 hours to give IA (intra-arterial) TPA. Sometimes we get transfers from outside hospitals and can only shake our heads: they scanned the patient, saw an ischemic bleed, yet didn't give TPA - are you kidding? Now the patient is out of the time window!
2. TB meningitis. So very rare in the U.S yet we had a patient in the Neuro ICU with what we are almost entirely sure had this. The patient had the classic pattern of cerebral damage. Unfortunately, she declined rapidly and passed away.
3. Serotonin syndrome. Also no joke! The patient's temp rose to 105, hypertension, tremor, and some serious clonus. He was taking linezolid and demerol, the combination of which we think triggered the serotonin syndrome. Did you know that linezolid, in addition to being an antibiotic, is an MAO inhibitor?
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