Hi Dr. Strong… I was a patient of yours at Stanford last spring. I had HLH and a major autoimmune storm. I was there for a month, and you were my hospitalist the last week I was there. I really appreciated how you would take time to sit in my room and chat! One day you brought a bunch of students in to review my case. It’s been a long recovery, but I’m really doing great considering I almost lost my life! I often think about all the wonderful Dr.’s and nurses that took such great care of me. You all are amazing! Keep up the good work!❤
this series cannot be more timely. i just started a month of nights and am getting hammered with new admits and RRTs nonstop. they don’t teach this in med school and attendings are universally unhelpful. THANK YOU SIR
Fantastic video! Just wanna add that if the patient also presents with nausea and vomiting, we should also be looking out for elevated ICP and confirm it via imaging. Papilloedema is usually a late exam finding which is not that useful for ruling out elevated ICP in a rapid response call setting.
Hypotension is a big topic. I don't have a rapid response call video for it yet, but do have a 5 video playlist on it; ~80 min in total: ru-vid.com/group/PLYojB5NEEakXi2wW00LkbkcaESav1Quk9
How common is ischemic stroke as a cause of somnolence?? I thought that it was only if it affects the brain stem or the thalamus, which was quite rare.
That's generally correct - somnolence is not common except in brainstem strokes or in massive strokes with subsequent cerebral edema, but I've occasionally seen this in already-hospitalized patients who have a smaller stroke on top of an active infection/sepsis or other major metabolic derangement. But stroke would rarely if ever be my leading diagnosis during an RRT for somnolence.
