27 y.o. man presents with wrist drop, numbness on the dorsum of his hand after drinking friday night (2 days ago).

Diagnosis:  saturday night syndrome (compression of radial nerve)

I've been doing Family Medicine Rotation for about 1.5 weeks now and am absolutely loving it!

I went into the OR today thinking I would get to see an ORIF (open reduction internal fixation) of tibial plateau fracture (even spoke to the patient before the operation) but was soon whisked away to another OR (there were too many people) by the chief. 

Today, I was asked by one of the residents what the criteria were for doing an bypass of a lower extremity.  I kinda froze (was too busy holding up the heavy leg of the patient who had just had below knee amputation).  I was not sure of exact criteria although I knew it had to be signs/symptoms indicating that the tissue was still viable (like how it looked? gangrene?  any tissue loss? how it felt -- cold? like are the blood vessels still intact?).  I couldnt spit it out though!!

After doing 2 weeks of Surgery EC and then 2 weeks of Vascular Surgery at the VA, i find myself back at good old Ben Taub.  There are things that I absolutely despise about that hospital:  poor computer/info-management system, handwritten everything (can't read other people's notes, problems finding patient records), and generally more work.  However, BTGH also has some important Good points:  get to do a lot of stuff and learn more faster.

Today at Vascular surgery (VA), i got pimped on the circle of willis.  By now, i should know it backwards and forwards but I had seriously not looked at that thing for a while.  I could only recall 1/3 of what was asked of me... pretty crappy and annoying.  But the residents are really cool and teach well.

So anyhow, this is a picture of the circle of willis:

VASCULAR SURGERY CASE1:

Ben Taub was a lot different from the VA (obviously).  My first day was total chaos.  Everything in Ben Taub gets written down on paper (its like stuck in the middle ages).  People write so ugly that you can't read what it says.  I mean I write horrible but at least its ledgible.  Sometimes you can find the patient's folder.   I had to learn little things like writing lab values, reading orders, writing SOAP notes, and moving around in the hospital from one service to another to see patient. 

I keep hearing the same names again and again.  Sometimes my mentor quizes me!  Anyhow, this is the most common stuff prescribed there:

-Citalopram:  very commonly prescribed SSRI.  They like it because it has few intereactions with other drugs.  Practically every depressed patient is on it.

-Trazodone:  very commonly used SARI.  Used to help patients get some sleep (and take care of some depressive symptoms at the same time).

Last night (it was 3/10/2008) I read an article for psychiatry rotation: Cognitive abnormalities in post-traumatic stress disorder. As i usually do, i approached their claims with doubt.

To summaries, the article made the following main points.
-In PTSD patients, memories of a trauma can be represented in different ways. PTSD patients may have either have thoughs ABOUT the trauma or thoughts OF the trauma itself.
ABOUT: … why did this happen to me? [is verbally accessible]