Workings of the Mind

As I wrote before, for the last 3 weeks I have been on an elective in Neurosurgery.  It's been a heady (hee hee) experience being back in the OR.  Learning SO much about neuroanatomy.  Since the beginning of the month, we have been on-call for spine, so I've also been getting quite the education about spinal lesions and learning how to read MRI's.

We've been rather busy due to "trauma season," and at times have affectionately nicknamed the Trauma ICU as "Turban City" since 90% of the patients are ours and have their heads wrapped following surgery or ventriculostomies.

During the last several weeks I've come to realize a few things:

 - drunk anything is bad.  It makes you drive carelessly and hit 70 year old grandmas who then bleed into their brains.  It makes you jump on the hood of a car that then drives away, and you fall and fracture your skull and then bleed into your brain.  It makes you jump off a porch causing you to break several bones in your spine which leave you with weakened legs and needing a urine bag because your bladder no longer works properly.

 - you can be hurt by the ones you love.  The guy whose name you tattooed on your shoulder can shoot you in the head and dump you by the side of the road.  The family of your boyfriend can object to your relationship and cause broken bones in your face and head.  Your drunk husband can roll over the car causing you to have massive brain injury and leaving you as helpless as your two young toddlers.

 - walking down the street is dangerous.  You can get shot at, run over, mugged, or just trip and fall.  All of which can land you on our service.  So is riding your bicycle, driving in a car, or flying in a plane.

 - I like opening and closing surgical cases more than the actual procedure.  I know, weird.  But there's something very satisfying about gaining the exposure, identifying the lesion, then trying to cosmetically close the wound.  While drilling and plating is interesting, once I've seen the anatomy I'm satisfied.  I know, weird.

 One more week then it's back to the E.D. for my final 11 shifts.  We're on a countdown of 30 more days until I move from coast to coast... I've got to start thinking of new names for my blog...

The Brain Drain

So, I am on the Neurosurgery service this month, and one of my responsibilities is learning how to place ventriculostomies.  They look like this...

As I mentioned in my prior post, they serve to help monitor the pressure inside of the skull, and can be used as a means of releasing pressure if it starts to get too high.


You basically find your landmarks, put some anesthesia into the skin, drill a hole, hit the right spot, slide the tube in, connect it to the monitor, and then sew everything in place.  Before you get too freaked out, remember that the patients we are putting these into are the victims of head trauma.  So far I have helped put in four. 


Last night I put in one under CT guidance.  That's where we get a CAT scan, put the tube in part way, get a CAT scan, adjust, and repeat until we have it in the right position.  At one point I was leaning against the machine, standing on one foot, drilling the hole while my attending leaned against my shoulder to make sure I was heading in the right direction.


Again, while I can't talk about specifics, these are a few of the patients we are currently monitoring:


 - gun shot wound to head
 - hit while riding bicycle
 - roll-over car accident, not wearing their seatbelt
 - intoxicated and fell off moving vehicle
 - assaulted and hit on head
 - not wearing helmet and flipped over front of bicycle


It's just been a week, but it's turning out to be a great learning experience so far!

Under the Pale Moon Light...

So, this month, I am on-call with one of our neurosurgeons.  Since I am going to a place with no neurosurgery back-up, I thought I would take the initiative and find out what I would need to know to be able to manage any patient that came into the E.D. that would need to be stabilized before transporting them several hours away to a University facility.  Plus I get to spend some time in the O.R.and learn other procedures so that is a bonus as well.

Last night I was awoken from my sleep and drove to the hospital in the middle of the night under a full moon for this....

Let me explain... this is a CAT scan of someone's skull.  The shiny thing at the bottom of the screen is what is left of the bullet that struck this person's head.  In the upper left, you can see the hole the bullet made, and the small white pieces that are scattered just to the right of the hole are pieces of bone that entered the brain when the bullet came through.  We spent the first part of the surgery clearing out the clot that had formed.  We spent the next part of the surgery clearing out many of those pieces of bone.  We spent the final part of the surgery getting "the heck out of Dodge" as the patient was bleeding profusely and needed to be stabilized in the Trauma ICU.

When we arrived in the TICU, we put in an ICP monitor at the bedside.  This will measure the pressure inside of the skull (IntraCranial Pressure - ICP).  High pressure is bad because there's a certain pressure above which the brain doesn't get any blood flow.

I'll post photos as I can during the next month... hopefully there will be some happy endings as well to talk about.