as above
Do neurology residents have to run codes and put in lines?
- Thread starter marsupial
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marsupial said:
My understanding is that as interns on the medicine service, yes.
As PGY-2,3,4's, at least at my school all the codes are run by the medicine code team. As far as lines go, usually not on the general neurology ward, but certainly on ICU roations.
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depends on your institution. In reality, all docs are obligated to go to a code if nearby, but in reality, 95% of the codes are in the ICU and there is always somebody from the ICU team there 24/7.
There is such a things at a neuro ICU too at some larger institutions, here, yes, you will be running codes and putting in lines.
If putting in lines the mainstay of a neurology resident? No, but it doesn't mean that it can't happen from time to time. You have to show your interest.
There is such a things at a neuro ICU too at some larger institutions, here, yes, you will be running codes and putting in lines.
If putting in lines the mainstay of a neurology resident? No, but it doesn't mean that it can't happen from time to time. You have to show your interest.
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At my institution it is, at most, very rare for a neuro resident to do a line. So far, none of my R2 cohort has been called upon to place one. It may happen in the future, but it seems unlikely. We will stick to LPs and those oh-so-painful overnight EEGs to rule out status...
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At our institution, neurologists primarily run codes in the neuro ICU, but typically help out with the medicine team when a code occurs on the floor. That said, I typically run to any code at night if I am not otherwise too busy.
Neurology also has its own set of codes. The residents at Washington University run to all acute strokes (onset within 3 hours that is) and manage these patients like codes, make the decision for tPA or not over the phone with a chief resident and then administer the tPA. For all intents and purposes, this feels and runs much like any other code, requires accurate head CT reading skills, administration of the NIHSS, etc. It ends up being pretty fun also...
Status epilepticus is our other big "code" where again "time is brain". PGY-2 residents are also allowed to read an EEG to rule out non-convulsive status epilepticus in the middle of the night which can be difficult to diagnose for more experienced neurologists anyway. However, I suppose NCSE doesn't carry such a bad prognosis if not treated right away, unlike generalized convulsive status epilepticus.
In terms of lines and procedures, we typically only put in lines in the neuro ICU. I hear that at a few institutions, a resident with the fellow's assistance may be allowed to place a bedside ICP monitor or EVD also. Another "code" that neuro deals with in the ICU is acute hemorrhage and herniation requiring immediate intubation, mannitol delivery, and potentially other rapid measures.
Overall, neurology is a lot like medicine in terms of thrills and procedures. With neurocritical care and interventional neurology these days, (as well as the advances in movement disorders) neurology is rapidly becoming as interventional and exciting as medicine is, which will hopefully help potential medical students realize the light...
B
Neurology also has its own set of codes. The residents at Washington University run to all acute strokes (onset within 3 hours that is) and manage these patients like codes, make the decision for tPA or not over the phone with a chief resident and then administer the tPA. For all intents and purposes, this feels and runs much like any other code, requires accurate head CT reading skills, administration of the NIHSS, etc. It ends up being pretty fun also...
Status epilepticus is our other big "code" where again "time is brain". PGY-2 residents are also allowed to read an EEG to rule out non-convulsive status epilepticus in the middle of the night which can be difficult to diagnose for more experienced neurologists anyway. However, I suppose NCSE doesn't carry such a bad prognosis if not treated right away, unlike generalized convulsive status epilepticus.
In terms of lines and procedures, we typically only put in lines in the neuro ICU. I hear that at a few institutions, a resident with the fellow's assistance may be allowed to place a bedside ICP monitor or EVD also. Another "code" that neuro deals with in the ICU is acute hemorrhage and herniation requiring immediate intubation, mannitol delivery, and potentially other rapid measures.
Overall, neurology is a lot like medicine in terms of thrills and procedures. With neurocritical care and interventional neurology these days, (as well as the advances in movement disorders) neurology is rapidly becoming as interventional and exciting as medicine is, which will hopefully help potential medical students realize the light...
B
Good post, Bonobo! As you wrote, there is plenty of action for us Neurons in the ED, especially in dealing with strokes. Thrombolysis has made it possible for us to actually save stroke patients, just as our colleagues have been able to do for patients with AMI.
Besides reading CT's (to rule out hemorrhage or massive infarct), Neurons can offer their diagnostic skills to prevent unnecessary (and always risky) thrombolysis. I've saved a few patients from unecessary thrombolysis by accurately dianosing such things as Bell's Palsy, Meniere's Disease, radiculopathy, and even Carpal Tunnel Syndrome...
Other serious problems that may present in the ED are Guillain-Barre Syndrome and Myasthenia Gravis, and the astute Neuron can identify these cases and really assist in saving a life.
Nick
I was a resident there (in the East-Bay Program) from 1991-1995. It was a good program then. I chose the EB program because it ran neuro at Highland Hospital and I wanted to work there and live in the East Bay.
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I wasn't aware that they had an East Bay program. I live in Walnut Creek and would love to stay here. Are you practicing in the East Bay now? Were you able to do the majority of your residency throughout the East Bay or did you do a great deal in Davis?
Bialik
Bialik
I don't know if the EB program still exists. EB residents had to go to Sacramento to do 3 months of Peds Neuro and 3 months of UCDMC Neuro wards...The Peds was excellent. The general Neuro there was disappointing, compared to the EB sites, in my opinion and the opinion of most of my EB colleagues.
