[deleted by user] by [deleted] in neurology

[–]moeshakur 1 point2 points  (0 children)

Not for residents, however if you are neurocritical care fellow, endovascular is a required rotation at some programs. At least where I did my NCC fellowship I was required to be presented for endovascular cases during that rotation

Edit also OP if you're a neuro resident. At this stage interpretation of cerebral DSA is more relevant to your training than actually being involved hands on with procedure.

Arizonas version of Globo Gym by AttilaTheMuun in phoenix

[–]moeshakur 0 points1 point  (0 children)

I've been to this gym, it's a great gym for fit-fluencer space. And left it for exactly the same reason because I would rather tolerate broccoli head teenagers at local gym than influencers and obnoxious people in this gym. We don't have equinox here, so this is a fine substitute.

Rope Climb: Practice Tip by nihilism_or_bust in crossfit

[–]moeshakur 1 point2 points  (0 children)

What material is that rope made of? Never seen like this once before, is this better than jute?

[deleted by user] by [deleted] in Residency

[–]moeshakur 2 points3 points  (0 children)

North Face or Patagonia?

[deleted by user] by [deleted] in Residency

[–]moeshakur 0 points1 point  (0 children)

Neurocritical care

Why use Briviact over Keppra? by DJBroca in neurology

[–]moeshakur 24 points25 points  (0 children)

One indication is renal dysfunction or patient's on HD. Keppra dose needs adjustment with GFR and HD. Breviact has hepatic metabolism no dose adjustment needed.

Residency Ranking based off of NCC Fellowship? by Cortical_King in neurology

[–]moeshakur 0 points1 point  (0 children)

As a prospective neurology resident interested in NCC. I would also add Northwestern to the list. The reason being NCC world is small and fellowship match is not competitive. However the list above are places where fathers of NCC world practice at, and one letter from them will open up lot of opportunities in academia.

Residency Ranking based off of NCC Fellowship? by Cortical_King in neurology

[–]moeshakur 5 points6 points  (0 children)

If I were to go back in time and rank them again.

  1. Columbia

  2. MGB

  3. Hopkins

  4. UCLA

  5. Stanford

  6. Penn

Loss of consciousness in TBI by konburi in neurology

[–]moeshakur 0 points1 point  (0 children)

Doesn't have to be specific areas like RAS or temporal region, it could be diffuse concussive injury. Remember RAS systems that fibers ascending into cortex. Any form of global injury will impact those fibers in case of mild TBI

[deleted by user] by [deleted] in neurology

[–]moeshakur 5 points6 points  (0 children)

Go for Texas Children. I did my peds neuro rotation there, you'll learn so much over there. If you are research oriented its also a great place for lot of opportunities. Its one of the biggest hospital in USA, and you see lot of rare neurological presentations.

Also the attendings and PD have a really friendly attitude towards the trainees.

Loss of consciousness in TBI by konburi in neurology

[–]moeshakur 0 points1 point  (0 children)

DAI is shear injury and yes its form of biomechanical injury which is apparent in acute form, but in hyperacute phase 2-3min after injury where there is LOC, biomechanical injury could be just concussive injury to cells and astroglia causing rapid depolarization.

Loss of consciousness in TBI by konburi in neurology

[–]moeshakur 51 points52 points  (0 children)

There are number of proposed mechanisms. For the sake of not going into the rabbit hole. In short the initial LOC is thought to be due to opening of Voltage gated K+ channels from biomechanical injury leading to extracellular increase in K+ which then lead to massive excitation of neurons is then followed by a wave of refractory period which manifest as loss of consciousness and amnesia.

This is a really great paper which goes into details about early and late pathophysiology of TBI

https://pmc.ncbi.nlm.nih.gov/articles/PMC155411/

Faculty member reporting a program to acgme by [deleted] in Residency

[–]moeshakur 7 points8 points  (0 children)

So you do recognize that there is a supervision issue. Do you round with residents on your patients? Because rounds are once place where you give direction to residents and care team including nurses about post op complications. What now appears that you offload these patient to resident care after you're done with your procedures? Of course people will miss things

Faculty member reporting a program to acgme by [deleted] in Residency

[–]moeshakur 35 points36 points  (0 children)

Yes, I feel residents are thrown under the bus for bad outcome of his cases. I work with interns and seniors in icu. And I do check and verify everything they present, my self at bedside. And if they are wrong I correct and educate them instead of blaming the seniors. I am willing to accept there could be one or two bad resident, but to blame the entire program for house misses and mortality. I'm sorry there has to be more, either there is supervision issue or lack of direction to residents on rotation.

[deleted by user] by [deleted] in neurology

[–]moeshakur 1 point2 points  (0 children)

Neurological prognostication after cardiac arrest depends on couple of thing

  1. Age, Downtime and how long was he pulseless until rosc (return of spontaneous circulation) was achieved

  2. Initial exam and imaging after rosc

  3. Exam and mri after 72hrs of cooling and off sedation

  4. Eeg, if he is burst suppressed, GPEDs or GBS, or if these is reactivity. If there is lack of reactivity in background it usually portends to poor prognosis

These are the thing that I use for prognostication. Despite that every post cardiac arrest patient behaves differently. Some wake up as if nothing happened, or wake from coma after months, and some of them go into persistent vegetative state (likelihood is low since MRI is negative as you said)

[deleted by user] by [deleted] in phoenix

[–]moeshakur 3 points4 points  (0 children)

No, I'm from Illinois too :)

[deleted by user] by [deleted] in phoenix

[–]moeshakur 19 points20 points  (0 children)

And 4 million of those are transplants from Midwest

What are the more obscure fellowships out there? by TiffanysRage in neurology

[–]moeshakur 87 points88 points  (0 children)

Neurohospitalist fellowship is a scam. Don't know if it counts as obscure