One Fine Day @ Tidung Island with Neurology Fellows

This is some of my collected image from Neuro Gathering event. Good job Galz! Proud of you ;p

One look is worth a thousand listens---Merrill C. Sosman (US Psychiatrist) 1890–1959

TOP MOVIES QUOTES that Raul Remembered...so far :p

1. A Walk To Remember (2002) :

Love is always patient and kind. It is never jealous. Love is never boastful or conceited. It is never rude or selfish. It does not take offense and is not resentful.

2. With Honors (1994) :

You shall no longer take things at second or third hand, not look through the eyes of the dead, nor feed on the spectres in books. You shall not look through my eyes either, nor take things from me, you shall listen to all sides and filter them from yourself

3. The Lovely Bones (2009) :

If I had but an hour of love, If that be all that is given me, An hour of love upon this earth, I would give my love to thee.

4. Love in the Time of Cholera (2007) :

I discovered to my joy, that it is life, not death, that has no limits.

5. The Brave One (2007) :

I always believed that fear belonged to other people, weaker people, and that it never touched me. And then it did. And when it touches you, you know that it's been there all along, waiting beneath the surfaces of everything you loved.

Pause Dependent Torsade de Pointes caused by amiodarone administration complicated by thyroid heart disease

31 years old female admitted

to ER with chief complaint syncope since 4 days ago. She just had undergone P1A0L1 spontaneous parturition 2 months ago, and in breast feeding period. She feels fatigue, palpitation and over-sweating since she delivered her baby. No history of congenital heart disease, hypertension in pregnancy, and this is the first time she got detected an arrhytmia.

Early VS :

Compos mentis, BP 90/50,HR 101x/min,RR 28x/min,Temp 36,0 C.

No detectable murmur, irregular pulses, no rhonchi, no wheezing. No enlargement of spleen and liver, with normal peristaltic sounds. No lower extremity edema.

ECG : VES bigemini running to Ventricular tachyarrhytmia.

Lab : Trombocyte=145.000;Ht=41%;

Random blood sugar=101mg/dl; Calcium=8.4mg/dl;

Na=141meq/l;K=2.8meq/l;Cl=104meq/l.

patient has administered Amiodarone 150

mg pushed;

continue with maintenance Kendaron drip 600mg

(start 2.1cc/hours) and suggested to check plasma

magnesium and thyroid function.

40 mins after admission, patient had undergone monomorphic VT followed by general tonic clonic seizure and GP decided to give cardioversion.

Neurology consultation suggested to prepare diazepam intravenous 10 mg pushed slowly. Neurologist recommendation to control metabolic deterioration and manage the tachyarrhytmia.

After 200 joules shock for 2 times, ECG changed back to VES bigemini multifocal but with worsening pattern of ECG that tend to show running VT.

After 5 hours treatment, patient developed to many forms of tachyarrhytmia :monomorphic VT-polymorphic, VT(Torsade de Pointes)-T wave alternans.

Result for plasm magnesium=1.9meq/l and

thyroid function:TSH=4.5 mcg/ml;

FT4=35 mg/dl;T3=2.8 mmol/l &T4=165 mg/dl.

In this scenario, General Practitioner had misdiagnosed patient without considering thyroid involvement in patient's arrhytmia. So, as a general guidelines for Ventricular tachyarrhytmia, GP gave amiodarone as drug of choice for this patient. Au contraire, Amiodarone worsening the patient's condition.

After Amiodarone's restriction, and 2 gr intravenous magnesium drip, patient start reducing her refractory Torsade de Pointes along the fits and back to the early ECG pattern when she came to the hospital.

Next question is, what are drugs that should she has for her arrhytmia.

"SONG OF MYSELF"
By : Walt Whitman

You shall no longer take things at second or third hand,
not look through the eyes of the dead,
nor feed on the spectres in books.

You shall not look through my eyes either,
nor take things from me,
you shall listen to all sides and filter them from yourself

Sweden Tour with Frey's eyes :) PART 1 : Flower

Beautiful part of the world that I haven't seen.

Thanks for beautiful pics Uncle Jeff. I hope you won't be bored to send them to me.

:)

Folktales you've had

Uncle Jeff said :

How we can expect us to believe that the children listening to their parents………when TARZAN living half-naked, CINDERELLA coming home after midnight, PINOCCHIO lies all the time, ALADDIN is the king of the thieves, PRINCESS AURORA is lazy and SNOW WHITE living together with 7 dwarfs.

We shouldn't be surprised when the children mismanage themselves, they get it from the folktales.

IF

If you can keep your head when all about you Are losing theirs and blaming it on you; If you can trust yourself when all men doubt you, But make allowance for their doubting too: If you can wait and not be tired by waiting, Or, being lied about, don't deal in lies, Or being hated don't give way to hating, And yet don't look too good, nor talk too wise; If you can dream---and not make dreams your master;If you can think---and not make thoughts your aim, If you can meet with Triumph and Disaster And treat those two impostors just the same:. If you can bear to hear the truth you've spoken Twisted by knaves to make a trap for fools, Or watch the things you gave your life to, broken, And stoop and build'em up with worn-out tools; If you can make one heap of all your winnings And risk it on one turn of pitch-and-toss, And lose, and start again at your beginnings, And never breathe a word about your loss: If you can force your heart and nerve and sinewTo serve your turn long after they are gone, And so hold on when there is nothing in you Except the Will which says to them: "Hold on!" If you can talk with crowds and keep your virtue, Or walk with Kings---nor lose the common touch, If neither foes nor loving friends can hurt you, If all men count with you, but none too much: If you can fill the unforgiving minute With sixty seconds' worth of distance run,Yours is the Earth and everything that's in it, And---which is more---you'll be a Man, my son!