applications are amongst us. resistance is futile.
doing ERAS while working on NRMP which needs USMLE. hunh? yeah, basically
ccm at the neurovascular ICU. I’m a bit nervous about CCM. There’s a lot to know in the Wiser center
and I can’t seem to get onto the actual outlines notes…hmmm.
today i rounded on at least 20 patients with the team. team
consists of one Ecuadorian CCM Fellow, one Indian Surgical Fellow and
an American CCM attending who also trained in both general and
neurosurgery. Pretty laid back team. Though we did have one
bit of excitement. A patient was being sent to MRI to assess an
intracranial hemorrhage and placement of an EVD but about half an hour
before being sent down she became hypotensive with her BP dropping to
90s/40s. They started her NSS drip and her BP started going up,
but not until they d/c’d her Propofol. So my CCM fellow was
uncomfortable sending her down b/c she became hypotensive and was
therefore unstable. I mean she’s morbidly obese, out of it and
dropping…who wants to send that kind of patient anywhere?
“Pretty Please Mr MRI lab tech, can we call a code now???”
Anyway, the nurse wanted to send the patient down b/c neurosurg had
tried so hard to get the MRI in place for today (and we all know how
ornery and persnickety tech people are) but the CCM fellow didn’t so he
told them to wait a half an hour. Well there was some
disagreement and it was decided that it would take just that long to
get her ready to go so might as well let it be. Well about 10
minutes later, the nurse comes by to tell us that she may be having
seizures b/c she’s posturing and has wild eye movements. Soooo,
yeah, she’s NOT going then to MRI. Not like that! But,
well, just b/c you’re CCM doesn’t mean you get to have any say.
Even with her unstable self (she had been hypotensive once before this
episode) and her possible seizure activity they took her down anyway.
Wow. Well, tomorrow I’ll find out what happened. And then
there’s the other patient getting at least 11 L in the past week and
since we all know that fluid goes to the dependent areas of the body
with the least resistance…whose scrotum is bloated now?
I’m only taking one patient. I refuse to take more. Dude, it’s my fourth year! No means no!