Dear Neurology Residents Starting in the ED Next Month,
You will frequently encounter “?GBS” or “GBS rule out” consults. Please remember to carry your reflex hammer, save this post for future reference, and read the open-access review that I share ⬇️. 🤓
Since you won’t have much time for history taking, make sure to ask about important details such as falls, the use of gait aids, the ability to climb stairs, difficulty walking, using zippers, and washing their hair. These activities can help you gather an accurate timeline. I also suggest asking when they last felt like their usual selves, as this can help pinpoint when the symptoms began, along with their prior level of disability, which is crucial. Don't forget to ask about potential triggers, including recent vaccinations, infections, surgery, and trauma.
The following physical examination features make GBS very unlikely and may assist you in “ruling it out”:
- A sensory level
- Unilateral weakness
- Markedly asymmetric weakness (excluding cranial nerves)
- Weakness confined to either the upper or lower limbs
- Normal (or preserved) ankle reflexes
- Fever or skin rash
- Normal gait
GBS is the most common cause of ascending weakness and paresthesias. So, if history suggests it, the patient is unable to walk, the weakness is symmetric, and the reflexes are reduced/absent, please admit the patient and start IVIg overnight. Time is nerve! 😅
We pursue medicine for moments. Several years ago, I had a moment— worked with my team to revascularize a young woman with cardiogenic shock/AMI due to LM/LAD/LCx SCAD who remained on the brink of transplant for a week. Today, I witnessed a REAL moment— her wedding.
Modi is the twin devil of Netanyahu.
India under a fascist regime clearly wants to take advantage of a world that can’t stop even the most obvious genocide ever.
May Allah protect Pakistan, and the innocent people of the world at the mercy of small tyrants with big weapons.
If you’re in a hard season of studying, may these words encourage you:
1. You do not study in a vacuum. Your time and effort are not wasted. Push through self-doubt & keep working hard, because your future patients will benefit from what you learn today.
I didn't know my heart was capable of breaking this much, or that humans were capable of being as unbreakable as you.
I'm so sorry oh people of Gaza. Wallahi I love you with my whole heart. And I am so ashamed of not being able to do more while watching you scream on my screen.
I cried alot last night, just thinking of all the beautiful people we lost in the past 5 months.
Do you imagine how many families that won’t gather because they were killed or separated?
Ramadan is a holy month and I hope it wakes up the Muslim world to stop this genocide.
How was your superbowl last night? Fun?
Last night israeli forces launched several strikes on Rafah city in southen #Gaza Strip: The 150 km2 city sheltering almost 1.5 million Gazans who were asked to head there because it’s a “safe zone”.
So who won the superbowl?
I want to congratulate my party, our leadership, all of our candidates, our workers and the people of Pakistan for a resounding @ptiofficial victory.
This sweeping victory is owing to the sacrifice and example of our Kaptan, Vice Kaptaan and all of our jailed workers and supporters, who galvanised the entire country to stand up for rule of law and for justice.
A special acknowledgement to the PTI social media, Election Analysis and Management teams - it is their hard work, innovation and perseverance that propelled the party forward.
For those of us robbed of our seats and the people of their mandate, we protest peacefully across Pakistan today and we call on the judiciary for justice!
Pakistan Zindabad!
Chairman Imran Khan's victory speech (AI version) after an unprecedented fightback from the nation that resulted in PTI’s landslide victory in General Elections 2024.
PTI won the Elections 2024 by an absolute landslide.
The world witnessed it.
Manipulation of results now will not achieve anything other than absolute chaos & instability.
The people have decided!
Honor their decision.
#Elections2024
Another big loss for me
Like a father, Mohammed Omari
He got killed by Israeli snipers while doing his humanitarian work to evacuate injured people from Gaza city to the south as the PRCS coordinated with ICRC and they got permission to do their job.
They shot him in the chest.