Any medfags here? I just gave my patient having an ischemic CVA

>>721230487
forgot to say, pic related, it's the repeat CT

>>721230487
Did you try banging the side? That sometimes works.

>>721230487
It's AIDS, look it up

Ask Hugh Laurie.

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>>721230487
he's got hot dogs on the brain xD

....ischemic CVA with all that ? nigga u just went full retarded...that's an hemorragic CVA

may the fucker RIP

>>721230487
THIS IS A FUCKING WEBSITE NOT HOSPITAL AND WHAT THE FUCK DOCTOR WOULD DO HERE ANYWAY?

>>721230487
I think it's Lupus.

That's a bran tumor not a stroke u lying asshole

>>721230487

Fuck her before she dies, that way she won't die a virgin. Virgins in heaven don't fit in

>>721230487
Stop tpa, push amicar, call neurosurgery, give 250ml hypertonic saline, and start a nicardipine drip to keep the SBP <140.

>>721230487
It's lupus

>>721230487
Give him 40mg of chlorexadrine and a spinal fibula.

Yeah you've done fucked up. That's a hemorrhagic CVA now. Looks like you didn't quite thoroughly do your inclusion checklist but yet again this is the chan

>>721230753
right, because a solid brain tumor would totally fill the space of the lateral ventricle as if it were a fluid, right?

>>721230487
Wait for the neurologist you fucking dumb ass and stop posting people's private shit online

>>721230487

>TOP KEK If Dubs patient lives

>>721230740
it always is

>>721230932
Checklists for hemorrhagic CVA risk aren't black and white. Even in someone who meets all TPA inclusion criteria, reperfusion hemorrhage still occurs. Call me when you finish undergrad, we can talk about it more.

It's either autoimmune or fungal, environment rules out poisoning and no tests showed signs of viral or bacterial infection. Try doing an extremely dangerous test that could possibly kill him but ends up giving you a clue to the diagnosis. Then fill every inch of his body with every antibiotic you can think of.

Also the patient is probably not gonna be cooperative so you have to go in there and be mean to either them or the family until they give in.

>>721230767
This. Secondary bleed

>>721230487
Nice picture you found on google, reverse image search newfags

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>>721230614
>Obviously it is Hydrocephalus
>Maybe a tumor
>Blood cloth?
I have no clue. The problem is however: I have no audience to manipulate so obviously I can not do the diagnosis

>>721230487
Do what all doctors do. Tell the patient you have to take a call, go back to your desk, and check uptodate.

>>721231168
reverse google image search yields no results you fucking jewfag

MD here.
This is blood, not ischaemia...
Wait for for the neurologist, you're going full retard here.
hemorraghe is not that huge thoug, your patients may still survive.

>>721231206
This.


This is how you know this person is a doctor.

As a psychiatrist currently on his neurology rotation, I highly suspect conversion disorder

>>721231180
Someone is going to have to monologue to me about all of my flaws and then I notice something weird about something they said or something that happens to me, then I can properly diagnose the patient.

"Listen, I know you think that you can just do this and this to avoid seeing that, but in actuality you're just this and that, and you keep trying to that because you can't admit this to itself."

dat midline shift though

>>721231291
And stop the tpa...

>>721230767
>>721231132
i'm always honestly STUNNED genuine medfags are on /b/

>>721231412
Don't worry, they only operate on anime characters.

>>721231291
You're an MD that's recommending that you sit around and wait for neurology in someone with a secondary ICH after getting tpa that's already got a GCS of 3?

You're a pretty shitty doctor, eh? Must have gone to one of those caribbean schools.

OP, do this:
>>721230767

Since there are real medfags here, always wondered . When you have a hot patient that goes under, do you ever snap photos of their tits, etc? Just for your own use?

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>>721231477
Aren't all doctors 'shitty' by design? Isn't that exactly what the Jews, who run the entire industry, want?

>>721230767
RSI that bitch, there's no way a worsening secondary bleed with midline shift and likely herniation is able to maintain their own airway or maintain a physiologic respiratory drive.

>>721231527
>snap pictures
Oh boy. We do much, much worse than that, newfriend.

>>721230487
it looks like a penis is on his mind

>>721231527
I think about it everytime, but there's always nurses and techs and shit around. I just take a mental snapshot of it and get to the locker room ASAP for a wank

>>721231115
Oh, I love Scrubs!

>>721231640
in retrospect, allahu akbar is open

>>721231527
Not a medfag but I'm pretty sure both an anesthesiologist and a doctor have to be in the room to put a patient under. Unless he's cool with it I don't think you'd get the chance with all the people around.

>>721231673
Do you really love them, or was 'love' the quickest excuse you could come up with to form a phrase in which you could imply the guy is a scrub?

this, and try to look casual and not stare

You in Colorado? At Aurora South?

>>721230767
>>721230487
>>721231477

By god, one must be really screwed to resort to doctors like you

>>721231622
So tell me stories. Please. What happens

>>721231687
> anesthesiologist
> and a doctor

Fucking burn!

>>721230487
test.

>>721231649
No way to pretend to look at phone or hidden can shit?

I just got done watching the 2nd season of Gay's Anatomy. I think you should try to impress your nigger boss and have sex with him, and then he'll let you scrub in for your first ever surgery, even though you should have been scrubbing in and getting plenty of experience for 2 years in med school, but ignore that fact.

Also when you get done, go run every test in the book to find out why this person with epilepsy is having seizures. Sure, I know you're a general surgery intern and epilepsy is a medicine/neurology illness, and the appropriate treatment would be to increase their keppra dose and get them the fuck out of the hospital, but just do it or I won't have sex with you in the on-call room.

>>721231687
Two could work together.... just saying

>>721231576
the Indians obviously run that bit now, the jews just keep it as an "ideal", but nobody wants to be a fucking doctor really, they're all in real estate

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>>721230487
Did you try turning it off then back on again?

>>721230487
Why would you choose here over reddit?

>>721231831
It's not like they actually treat anyone. They're just there to knock the patient out and make sure shit doesn't go bad.

>>721231940
Hence why I said if he's cool with it.

>>721231757
Actually, realtalk, scrubs was just the first non-House medical show that came to mind to imply that I "Understood" the reference.

But the inferring he was a scrub thing, that's better. So you win I guess.

>>721231477
Pal I don't know how you do this kind of things in the US, but here we usually put patients with CVA in neurology ward... so assuming OP is a paramedic, yeah, he should wait for his resident or the equivalent you have there, after stoping the tpa infusion.

As for "shitty doctor", Let's just say I'm not that afraid of comparison.

Seeing as I have too much time on my hands would any of you guys be interested in a q&a with a factitious disorder patient currently locked up on the closed ward? I know the pic isnt of much proof but if you check exif you'll see the location checks out.

>>721230487
suck him off

Nursefag here. If you have access to a Hyperbaric Chamber, get them in to it, pronto. The pressure will diffuse oxygen across, and around, the obstruction, giving time for the tpa to do it's job. It isn't a cure, but it can mitigate the damage.

>>721232078
>I don't know how medicine is practiced in the US
>here in Shitfuck, India, we treat patients inappropriately and let hemorrhagic CVA's die while they wait for a neurologist, because even though we're all doctors, we're very incompetent

>>721230487

I would suggest generic blood thinners first and considering getting ready to lower brain pressure from the haemorrhage through minimally invasive, either nasal access or waiting to consult with neurologist.

patient should be sitting upright. keep asking simple math questions to ensure function of cerebrum

>>721232109
What "symptoms" is this nigga suffering from?

What is CVA?
What is tpa?
What is midline shift?
What is obtunded?
What is bolus?

t. aspiring medfag

>>721230767
Op, you do this she dies. Not like anything else you do will save her, if you're smart, dissapear, you killed him

>>721232184
This is exactly why nurses should keep their dumb mouths shut and follow the MD's orders.

https://www.youtube.com/watch?v=LQCU36pkH7c

>>721232031
Lol, yeah, it's super simple. They just bring a person to the closest thing to being dead so others can cut into them. And if the surgeon fucks up it's their job to keep the person alive. Anybody can do it.

that's a penis

>>721232230
Callous Variable Autism
Tranny Penis Atheism
A shift at the midline
An ob that becomes tunded
A pair of heavy balls attached to rope or string that can be thrown at a target's legs to trip them.

>>721232225
Blood thinners for a secondary bleed that's causing midline shift and likely herniation. You're a fucking idiot, please don't ever go near a hospital.

>keep asking simple math questions
HE ALREADY SAID THE PATIENT IS OBTUNDED YOU FUCKING RETARD

>>721230487
What the fuck, did you suck cock to pass med school just resign and save yourself from malpractice suits

>>721232230
Cerebral Vascular Accident
TPA is a potent blood thinner designed to lessen clots.
Midline shift is just like what it sounds like.
Obtunded means to lessen or dull.
Bolus is a large dose of medicine delivered intravascularly.

>>721232307
Salty anesthesiologist detected.

>>721232230
aspire harder lmfao

>>721232279

I've been a hyperbaric nurse for a dozen years, and can attest to it's efficacy in treating CVA's.

>>721232426
I'm only 2nd year undergrad. None of these things are going to be on the MCAT.

>>721232197
Lol I like the way the troll, my friend.
Not India, France btw.
And here, we usually have neurologists on duty within the building... meaning less than 5 minutes away.

>>721232397

surprised you took my generic jibjab for real and even replied.

bait success

>>721232230
CVA refers to either a stroke or a hemorrhage in the brain that kills brain tissue. Neurologists hate the term because it describes two very different events.
TPA is a substance that dissolves clots, but can make you bleed like a stuck pig.
Midline shift is when you have enough extra stuff in your head it ends up shifting everything toward the empty side. Very bad sign.
Obtunded is the state of the girls you have sex with.
Bolus is when you give a lot of something at once, like fluids, or meds, or my spluge

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>>721230767
I watched that episode of "Emergency" too.

>>721232228

"Faking" was the early stuff, now I'm more into self-healing in order to cause legit crap. They just sent me to the hospital earlier today for injecting toilet water into my abdomen, sometimes it does nothing but a lot of times it causes abcessess that are usually nice enough to need surgery, I've had nine stomach ones so far. That being said the dumb resident who checked me out didn't order an ultrasound despite my stomach being stiff as a rock and hurting like hell, he sufficed with a normal WBC count on the CBC. So fuck knows what's going on in their. That being said I've faked and/or caused just about everything so the full list would be too long to get into.

Also sorry but I can't upload the pic, my phone apparently takes photos over 2mb.

>>721232625

It is actually quite amusing when self harming gets autocorrected into self healing. I don't see that every day.

>>721232456
> in my experience
> doesn't cite a single journal article

Nurse confirmed
MD kek

>>721232411
Psych resident. Was going to do anesthesia but did shit on Step 1

>>721232625
Just crop it until it's less than two mb? Do you have insurance and how do they feel about your nine stomach abscesses?

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>>721232456
Please please please please PLEASE get out of the medical field. Go work at a restaurant or something.

Your absolute retardation in regards to medicine is making me want to cry. How the fuck do nurses get licensed these days?? Are there any standards left???

>>721232671
But we can dream

>>721232562
Thanks. Where is the midline shift in the OP image? It doesn't look like anything is shifted. Just a big mass of what I guess is blood after knowing what those terms mean.

>>721232800
Doctor's orders, bye RN (Retardo Nurse).

>>721232840
Take a ruler and draw a line down the longitudinal fissure. You will see a bulge to the left, which toward the patients right

>>721232800

Doctor, why does my pooper develope bubbles under the skin near the cornhole that i can push around and that start to itch?

>>721233027
external hemorrhoids, stop taking it up the ass so much

>>721233027
1. They aren't bubbles
2. Those are hemmorhoids
3. Quit playing with your butt so goddamn much

>>721233073
Ah, fucking beat me to it

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>>721230487
I'ts a boy!

>>721233014
Oh I see it now. Wouldn't have seen it unless I knew what to look for though. Thanks again.

>>721232800
I can tell be the pixels

>>721232755

It's a phone, I dunno how to crop. There's universal health care here so insurance generally isn't an issue, the only problem is getting them to cover ER visits that don't result in hospitalization (not covered) and ambulance bills (not covered). Currently have around 42 open ones for +- $250 each. No idea how I'm gonna cover them, but the ambulance service here does have a comitee that can waive fees, I just need to hope I can get on their goodside.

>>721233127
No prob, we have all been there in our education. Study hard and good luck

>>721233120
When I think about it, I made a typo in that picture.

>>721233131
What's the worst thing you've ever done to yourself in order to get hospitalized?

>>721233073
>>721232800
>>721233093


but doctor, why do i get slurred speech sometimes and black out during conversation? I wake up with people standing around me in a circle asking me if I'm ok, and I'm like "sure, why?" I don't remember. happens like every month

>>721230487
Thanks, Obama!

>>721232800
Is emergency medicine where you planned on ending up when you decided to go to medical school? Did you want to do another speciality?

>>721233222
> happens every month

That's your period, bro. Don't worry about it

>>721232027
REEEEEEEEEEEEEEE

>>721232411
And if the patient dies within 24 hours of the procedure...it is considered the anesthesiologist's fault! Next time try being operated on while wide awake..you will come to appreciate this profession.

>>721231331
How did you come up with this amazing reply? Truly marvelous >.<

>>721231331
the entire show in a nutshell.

>>721233120
Zozzle! (And congrats!)

>>721232800
What kind of legal issues come into play when a patient dies under your care? What's the most bullshit reason a person's come to see you?

>>721231622
look more rekt threads and you'll get an imagination what it means to be a doctor

>>721232456
>>721232184
>Hyperbaric Chamber, get them in to it, pronto

This is a secondary bleed with a rapidly detrimental course, as evidenced by the quickly dropping mental status. The last thing they need is to be in a hyperbaric chamber at a great depth so that no doctors or nurses can get to the patient when they finally start to vagal down or go into agonal respirations, you fucking retard


>The pressure will diffuse oxygen across, and around, the obstruction,

This is absolute nonsense, just technobabble. There is no obstruction, and even if it was still a clot causing an obstruction, no amount of pressure will force oxygen to magically diffuse across a clot, you fucking retard

>giving time for the tpa to do it's job

The tpa already did its job you god damn retard, the problem is that now the coagulation cascade can't do its job and the patient is bleeding out into their brain, you fucking retard

>It isn't a cure

The only thing you said that's correct, it isn't a cure, and it sure as fuck isn't medically indicated either, you fucking retard

>but it can mitigate the damage

It won't do anything to help, just keep the patient further away from life-saving therapy, you fucking retard


This is why everyone is calling you an idiot, because you're a fucking retard, and you would kill countless patients if you were actually making any of the decisions. Just sit down, shut your dumb mouth, and obey the orders of the MD who actually knows what they're doing.

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>>721233222
Not right now you don't!

>>721233222
Autism

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>>721233633
>>721232800

>>721233220

A. Taught myself phlebotomy, bled two liters at a time several times a day into a plastic container for several days, constantly rehydrating myself to keep the fluid up but not doing anything that couldn't the hemoglobin up from critically low levels. At the end dehydrated myself, swallowed some blood then took the bag to the ER and said I was puking it up. Blood work came back critically low HGB, nasogastric positive for fresh blood, got put on fluids which actually made the HGB lower on repeat blood work making it look like I was actively losing blood. Got sent to the ICU, straight into imaging. CT and angiogram obviously negative, in a last ditch effort they embolized my left gastric artery even though there was nothing going on there. Got my first court ordered hospitalization after that one.

>>721233685
>>721233697
>>721233307
>>721233073
>>721233093
>>721232800

but Doctors, I ate an old chicken wrap lately. I knew it was olf and smelly, but I couldn't let it go to waste.
A few hours later, I shit my guts out.
Get real bad stomache cramps and pain in the intestine, just above left hip-bone, frontal. what do? feels hard and bloated

>>721234022
And it's shit like this that made me go into psychiatry

>>721230487
Did you try setting it to Wumbo?

>>721234022
What do you get out of this?

>>721230487
"i'm a doctor, i'll handle it"
>gets the neurologist
>and has the ingenius idea to ask 4chan for help
>instead of /sci/ or something, goes to /b/

Neurosurgeon here. Consult a mortician.

>>721234336
Proof or gtfo

>>721234336
What did OP do that killed this guy? Could he have been saved?

>>721234012
Another flaw of nurses, they don't have the ability to critically analyze research, and I'm guessing you don't even bother reading articles to determine if it's even appropriate to the situation you're referring to.

This study is done in rats. We're not about to start changing medical practice guidelines for secondary hemorrhage based on a rat study.

This study looks at giving tpa for ischemic stroke, giving the rats HBO therapy BEFORE a secondary hemorrhage, and then seeing how many of them get a secondary hemorrhage and comparing the sizes and functional damage.

We're talking about someone who is already having a secondary hemorrhage, and who now has a GCS of 3 and requires ICU care with careful hemodynamic and respiratory support.

HBO chambers are NOT for critically ill patients, that's one of the first things you learn about HBO chambers. The patient has to be stable enough to be without any nursing or doctor support for however long you're diving them.

Again, you're a complete fucking retard. You even try to google random articles to support your point, but you're too retarded to realize that those articles are only proving that you're wrong and that you have no idea what you're talking about.

Please find a new career. You're doing your patients a huge disservice.

>>721230487
Brainstamp please op

>>721234500
https://www.youtube.com/watch?v=zOuIxd1_es8

>>721234500
Lol, you just got trolled by another MD.

I didn't even read that article. Lulz

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>>721234805

>>721232588
Amicar came out within the last few years. Tpa came out long after Emergency stopped airing.

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>>721234223

>>721230487
so what's happening here? You gave a stroke patient blood thinners which led to a brain hemorrhage? Is this a rare complication?

>>721235479
> blood thinners

lol

>>721235529
DAWG ENLIGHTEN ME THEN
>lol

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Why is my patient's stroke smiling?

>>721235529
> tissue plasminogen activator
gotcha

>>721235658
It knows you're there. Get out as fast as you can!

Okey bro, so here is what you have to do. This patient is bleeding and shit, so you need to stop that because it will probably die of dehidratation or some low levels of potassium/sodium (blood carries all that shit).

You need to give him a high dose of glucocorticoids (500 mg in bolus) to increase his stress levels and with this, the veins will close themselves in that area and the bleeding will stop.

Next, you must give some glucose (500 gr bolus) so the reverse osmosis in the hemorragic zone kicks in and the entire blood oes back into the vains.

I'm in my third year of medicine, so take it with a grain of salt but I'm sure that''s what you have to do (I saw a friend who is at his last year do it to a patient)

>>721235698
It's not a blood thinner. It's more like a clot remover.

>>721235826
I am back in the safety of the resident work room. He can't get past the badge access. Hell, he can't even get off the vent.

>>721235595
>Ischemic stroke from thrombus
>give "clot-buster" tpa
>thrombus breaks up
> blood flow returns downstream of the clot
> ischemia damaged the blood vessel walls
>oops.png
> blood vessels rupture, patient now has hemorrhagic stroke
> total 180° in terms of care

You wanna keep BP up in ischemic stroke patients to avoid loss of collateral circulation or hypoperfusion or something I don't fully understand, the key to treatment is to anticoagulate to prevent another thrombus, and then PM&R for rehab and recovery of any lost functionfunction.

You keep the BP relatively low in hemorrhagic strokes to prevent further bleeding, you don't want to anticoagulate them so they can stop bleeding, they need the ICU for close monitoring and neurosurgery if indicated to drain blood or coil the blood vessels.

>>721235835
Obvious bait

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Isn't there something homeopathic you can use?

>>721236619
Good thinking. Call your nearest naturopathic doctor and ask them what tincture of tree bark and animal shit to mix up and smear on the patients nipples with a crystal from the realm of Gamalon.

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So is the patient dead yet. It surprises me not at all that certain people in the profession hang out in /b/. I'm guessing more than a few of you work in Florida.

>>721236764
Not to forget Reiki. You need to channel your energy and rub his belly to start the natural healing process. It helps if you have an "Anti-oxidant healing card", you can buy one for only 59.99$

>>721230487
fucking run, if the neurologist is even semi competent he will get you for that

>>721230487
It is time to embrace your destiny as an Angel of Death .. mercy killing.

>>721230487
Is he dead yet?

>>721235658
Why does no one care about my cool stroke patient? :(

>>721238536
I'd rather have you answer questions instead of posting some poor guy who's gonna be pissing himself soon.

>>721238677
I'm not OP bro. I'm just another neuro fag

>>721234396
OP didn't kill the guy, the stroke did. Probably couldn't have done anything better, as this is a standard emergency response. The scan says only surgery with a bolus of miracle would save the patient, with likely irreparable brain damage as a result anyways.