TravoltasBodyDouble (MD!)

PGY-1 in neurology, musician, and writer with a love of various nerdy pursuits. McGill U alumni x2. American who relocated to Canada ~16 years ago. He/him.

[TravoltasBodyDouble (MD!) @alexsilver44]

@LisaVegasLMT @timeforjaya @Raymax_10 Uh, disagree.

[TravoltasBodyDouble (MD!) @alexsilver44]

@homesteader1000 @SkepticalMutant @DrCasteelEM We do not get paid based on the treatments we prescribe.

[TravoltasBodyDouble (MD!) @alexsilver44]

@roryisconfused I’ve always just said “history of excessive alcohol consumption” or “longstanding IV drug use” or whatever in medical circumstances. Or just writing “IVDU” in the medical history. IMHO, not demeaning, but not a kind of overly laboured phrase.

[TravoltasBodyDouble (MD!) @alexsilver44]

@EM_RESUS Even if somebody had the one type of medical emergency I have reasonable experience with—stroke—my ability to actually do anything would be limited to saying “…yup, that looks bad.”

[TravoltasBodyDouble (MD!) @alexsilver44]

@shaqfan1937 @lukeisamazing There’s a great bit in the book where Gandalf gets super grumpy and scattered when they get into Moria and then realizes it’s because he hasn’t had a smoke since they got in there.

[TravoltasBodyDouble (MD!) @alexsilver44]

@JamesDowell2 @LucreSnooker I don’t know a ton about how the amygdala hooks into that circuit (not sure if anyone does) but if you lose that breathing reflex you are essentially dead—probably makes sense that it wouldn’t need a lot of other structures to work well.

[TravoltasBodyDouble (MD!) @alexsilver44]

@JamesDowell2 @LucreSnooker The sensation of “air hunger” is a very, very ancient response (deep in the brainstem) triggered by increased CO2 or more acidic blood (which is often caused by too much CO2. It directly triggers faster breathing, and probably hooks directly into the emotional areas of the brain.

[TravoltasBodyDouble (MD!) @alexsilver44]

@AshleyGWinter This is incredibly still how it is in most hospitals I’ve worked at in Canada.

[TravoltasBodyDouble (MD!) @alexsilver44]

@gretchemaben Man, trauma surgery is such a wild world. I will defer to my surgical colleagues and will happily reassess when my favourite organ is no longer visible from outside thankyou.

[TravoltasBodyDouble (MD!) @alexsilver44]

@gretchemaben Wow, this sent me down a rabbit hole. Short answer; yes its possible!

This paper (https://t.co/bv92QtYbfN ,warning very graphic!!) estimates about 250N of force to penetrate the temporal bone.

This paper (https://t.co/CmFiPvHtPY) has forces of 400-500N generated by stabs.

[TravoltasBodyDouble (MD!) @alexsilver44]

@RNSuperHero Also just altered mental status is not usually enough. should have *some* kind of focal neuro sx! Currently working on a QI project looking at false positive code strokes, most of whom don’t get lysed—many are things like migraines seizures etc where we know risk of tpa is v low.

[TravoltasBodyDouble (MD!) @alexsilver44]

@RNSuperHero @skoolnerse Also, agreed that there are a lot of AMS NYD folks that get lysed. At least where I am, its a neuro team (including staff neuro/neurorads) leading the code strokes so we’re pretty decent at sussing out the mimics (I’d like to think).

[TravoltasBodyDouble (MD!) @alexsilver44]

@RNSuperHero @skoolnerse Most stroke caught early enough where thrombolytics will have significant benefit wont be obvious on a plain CT, since the CT changes can take a while to show up.

Also, risk of causing hemorrhage is much much lower when giving TPA/TNK to someone with stroke mimic vs real stroke.

[TravoltasBodyDouble (MD!) @alexsilver44]

@CartoonsHateHer I assume you’ve talked to your therapist about it but have you tried doing not the cold-turkey approach? For some compulsions I found even just forcing myself to set a 5 min timer before I engaged in it made a huge difference.

[TravoltasBodyDouble (MD!) @alexsilver44]

@DrDogmum @DrDiGiorgio Being woken up every 30-60 minutes throughout the night with pages. This happens maybe one in every 2-3 call shifts I have. Sometimes for very important/useful stuff. Sometimes not.

[TravoltasBodyDouble (MD!) @alexsilver44]

@emilyjsavary @HealthNS Its bad!

[TravoltasBodyDouble (MD!) @alexsilver44]

@ncccalto2 @RNSuperHero Counterpoint: why? If they’re asymptomatic and no end-organ damage. Dropping their BP below an arbitrary number is more likely to cause harm than leaving it at 180.

[TravoltasBodyDouble (MD!) @alexsilver44]

@SophiasHotTakes @CartoonsHateHer Heyo, neurology resident doc here. There is some interesting pre-clinical (ie, not in humans) data about the role of HSV-1 in Alzheimer's, but there’s no good evidence that asymptomatic folks getting tested for HSV and taking acyclovir is going to be helpful.

[TravoltasBodyDouble (MD!) @alexsilver44]

@rbarbosa91 @DerbyPBunit @Innov_Medicine @SAGES_Updates @MISIRG1 @BehindTheKnife @BrownJHM @MedicalAdv @altaf_awan12 @ib9994 @javlatif Im a neurology resident and even I had a visceral “nope” reaction to seeing that.

[TravoltasBodyDouble (MD!) @alexsilver44]

@CartoonsHateHer @Co08621038Cox Also, from my brief time working in the community a lot of the women were REALLY put together and very stylish (obviously with a different template)—the men often kinda looked unkempt and like they hadn’t changed in a few days.