Bedpan Banter
Welcome to Bedpan Banter | The Human Side of Healthcare -- the podcast that feels like sitting at the nurses’ station swapping stories with your favorite coworkers. Hosted by the one and only Nurse Mike, this show goes beyond the textbooks and into the real, raw, and hilarious moments that make up nurse life.
Whether it’s unfiltered stories from the floor, emotional patient moments, or those laugh-until-you-cry shifts you’ll never forget... we’re talking about it all. Oh, and don’t worry, we’ll be sneaking in a few knowledge bombs you can actually use on the job.
If you're a nursing student, new grad, or seasoned pro who just needs to feel seen (and maybe laugh a little), you’re in the right place.
Bedpan Banter
Nurse’s Guide to Neuro & Stroke Patients with Dr. Uddin, Neurologist
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You can feel the stakes the moment a patient starts to change. With inpatient neurologist Dr. Uddin at the table, we go straight to the front lines of neurocare—where strokes dominate, seizures confuse, and nursing judgment buys back brain. This conversation is a field guide for bedside pros who want to move faster, document sharper, and advocate louder when seconds matter.
We break down the reality of inpatient neurology and why nurses often make the decisive difference. You’ll hear exactly how last known normal unlocks TNK or TPA, plus the small habits that add up: distance visual field checks that catch big deficits, short smartphone videos to separate seizures from look‑alikes, and the clean handoff language of GCS and NIHSS that pulls ER, neurology, and ICU into alignment. Dr. Uddin opens the toolbox—when reflexes reveal spinal cord trouble, what clonus really means, and why the neurologic exam can still beat a battery of tests when the clock is relentless.
The human side runs through it all. Confidence grows when leaders praise the right calls and correct clearly. Veteran neuro nurses compress the story into three seconds that matter. Younger clinicians learn faster by asking, “What should I be watching for in this anatomy?” And everyone wins when we drop the jargon and say exactly what we see. If you’ve ever felt that tug to hit the button early and call the team, this talk hands you the why and the how.
Listen for practical tips you can use on your next shift, from stroke scale nuance to reflex clues and documentation that saves lives. Then pass it on. Subscribe for more bedside-ready episodes, share this with a colleague who runs toward the rapid response, and leave a review with your best neuro tip—we might feature it next time.
To submit your stories & comments, visit: https://simplenursing.com/podcast/
Meet Dr. Udin And The Mission
SPEAKER_01We got a coat brown. Welcome to Bedpan Banter with me, Nurse Mike, the Nursing. Can I get a Bedpan over here? Welcome to Bedpan Banter, the official podcast of Simple Nursing, where we talk all about the human side of healthcare. I'm your host, Nurse Mike, and today we're with Dr. Udin, a board-certified neurologist based here in Miami. So your social media platforms are all about educating and advocating around neurocare. Is that correct?
SPEAKER_00Absolutely. I think um I intermix a lot of jokes, obviously, to keep the audience entertained, but a lot of it is about my experience as a doctor, my my experience working in healthcare, and um just talking openly and honestly about a lot of things.
SPEAKER_01So obviously, you're on the uh the provider side of things and our channel, we talk more to nursing students as well as nurses. So today we're gonna be talking about neurocare basics that really every nurse should know, and how you as a nurse can level up your advocacy for neuropatients and some practical tips that you can bring to your nursing care. So, neurology. Are you an inpatient or outpatient?
SPEAKER_00I'm an inpatient doctor. Um, when you do neurology, you kind of have to decide that's the big decision point, right? If you're going inpatient or outpatient. Um, for me, I was I was trained very heavily in inpatient medicine. I'd say like four years of neurology residency, nine, nine of the 12 months every year I was working inpatient.
SPEAKER_01So can you describe to the audience who are unfamiliar, like what is inpatient versus outpatient the roles?
Inpatient Neurology Explained
SPEAKER_00Yeah, yeah. So uh outpatient is probably more of what most of you expect when you think of a doctor. You go to a clinic, you set up an appointment, you show up for 30 minutes to a half hour, um, you get um some lab tests that you have to get done, you go home and you go about your day. Uh inpatient medicine is whenever you are admitted to the hospital, you went to the ER or something like that because you weren't feeling feeling well, and then you have to stay in the hospital for a certain number of days because the staff is worried about you. As a neurologist, I'm on call 24-7 the week that I'm on. 24-7 days. So there's a there's nothing I physically have to go in for, but there's always a resident or a PA or a nurse practitioner um in the hospital available to directly examine the patient. And they call me with their findings and I help guide them.
SPEAKER_01Now we all know residency is long, but now how long have you been practicing? Yeah.
SPEAKER_00So this is uh this is gonna be year two for me out of residency. Um I've been fortunate enough to practice in a bunch of different settings. Um, right now I'm currently working uh inpatient at a private practice, and they rotate us throughout the hospitals in Miami.
SPEAKER_01So let's talk about the top two, three conditions that nurses most commonly see in neurology.
Stroke And Seizures: The Big Two
SPEAKER_00Yeah, I would say I would say 80% of neurology is uh stroke. Um that's the way a lot of hospital medicine is going these way these days. Um the other 20 to 30 percent I would say would be uh seizures or epilepsy. Um so those are the two big things that nurses would be seeing in a hospital setting um and that I see on a day-to-day basis.
SPEAKER_01What's something that you think like the medical staff or the care team, even nurses, like what do we miss?
SPEAKER_00The nature of neurologic care is that a lot of people don't have as strong of a background in neurology. Um, and that's not just from nurses, that's from other doctors too. That's from pretty much every other specialty. Neurology is one of those fields that's often punted. In fact, some of the time, uh, some medical students who go who complete medical school don't have to do a neurology rotation to finish medical school. Wow. Um, so a lot of them get like this peripheral understanding of neurology, and then they show up in clinical practice and then they get concerned about a neurologic change and uh they make a lot of calls, and that's when the neurology team has to show up and make a decision about what they want to do.
SPEAKER_01So you're saying 80% of the cases you see is is strokes, CVAs? Um the majority of inpatient medicine is is stroke. And then obviously nurses are with the patient for 12 hours. Uh, what should nurses know about how to treat patients with that?
Nurses As Baseline Keepers
TPA Timing And Last Known Normal
SPEAKER_00Yeah, so it depends on which one we're talking about. Well, we can we can start with stroke. Yeah. Um, I think um when it comes to stroke care, um, neurology has gotten very far in terms of treatment. So if um I had the opportunity to talk to nurses who are working around neurologic patients, um, I would say in terms of stroke, one of the most important things that you are doing is keeping eyes on the patient. Um, so as long as we have eyes on the patient and you have a good understanding of how they look at a certain point in time, that's very important because over the next few hours or days, they might not look the same. And you are the advocate for that patient by um basically telling the rest of the team what you saw and what their baseline is. Um, one thing I would tell nurses that would be good for uh neurologic patients would be to document. Um, when it comes to stroke care, if someone is having an acute stroke, um, there's two big interventions you can have in terms of treatment. And the first one being uh TNK or TPA, and I'm sure all of you have heard of it. Um basically, if you catch someone's stroke symptoms uh at the point of onset within four and a half hours, they are a candidate for medicine called TPA or TNK. Um, and that is a clot buster medicine that can potentially break up that clot. Um, so the reason I mentioned that documentation is so important is because if you have a written-down last known normal, that's kind of indisputable and it could actually save a patient's life if you if we have a documented last known normal. I've seen patients where half of their body stops working in their right arm, the right leg, um, and they can't move, and then we give them the medicine the next day they walk out of the hospital.
SPEAKER_01Wow.
SPEAKER_00It's a pretty rewarding career, and I think I think nurses actually play a very big part in it because you guys are with the patient a lot longer than I am, right?
SPEAKER_01Yeah, it's like we always say this like nurses are with the patient for literally half the day, 12 hours. And it's we always talk about nurses like have to assess, you know, you're sometimes the only um person between life and death or absolutely um being paralyzed forever uh as a stroke patient.
SPEAKER_00Yeah. Nursing's nursing's a very hard job. Yeah. Um when you're in residency and you're working like 80 hour weeks. Um, I leaned on a lot of the nurses in my residency program and I got to know them on a first name basis. We'd hang out after hours if I ever got a day off, which is not very often. Um, but they've actually saved my uh my butt a few times during residency by seeing things I didn't or telling me to come examine a patient. Um, so I understand that it's a it's a very hard job and you guys spend a lot more time with patients than we do.
SPEAKER_01Yeah, thank you so much for acknowledging that too. I know it's it's it's funny because uh a lot of my friends they ask if you know, Gray's Anatomy is uh is just like nursing. But there was something in Gray's Anatomy that was like, you know, uh, I forgot who, I think it was Meredith or one of the main roles. She was like, listen to the nurses. She was talking to the residents. Yeah, yeah. Nurses, like especially the veteran nurses, they've been there forever.
SPEAKER_00Yeah, yeah. If um that's that could not be more true. Um, some of us learned that the hard way, but I unfortunately was very lucky to take those words uh seriously early on.
SPEAKER_01That's amazing. I mean, a lot of us forget that you know healthcare is a team approach and we're all working toward the same goal. And I know like a lot of um, a lot of ego and a lot of pride comes in. Absolutely, yeah. But I think that's one of the one of the lessons that any new nurse or even veteran nurse is that it's called a practice for a reason. We're all learning together, and nurses are you know eyes on the field and they're closest to the patient.
SPEAKER_00So yeah, I wouldn't say I wouldn't say Gray's anatomy is accurate. I would say Scrubs is a little bit more accurate. Scrubs is a little bit more accurate, where like the nurses say things that are very important, you should probably pay attention. Yeah. Um, especially in the ICU.
SPEAKER_01But also med surge, do you think there's anything that nurses miss from neurological signs or even changes? And we try to educate as as much as we can that uh a changing patient is a critical patient. Absolutely.
SPEAKER_00Yeah, I think that's a great way to describe it. A changing patient is a critical patient. I like that. I'm stealing that.
SPEAKER_01Yeah, yeah, yeah. You know, big changes are are not always good. Uh so is there anything that nurses might miss that could be meaningful?
Teamwork, Ego, And Trust
SPEAKER_00Yeah, I think um, I think in my experience, especially in residency, um, nurses would, because I was friends with a lot of them, they had a pretty quick trigger to call me. Um, so I don't I don't think there's anything that they they miss really, because anytime there's a neuro neurochange, most nurses react appropriately and call somebody. Um, I think some one of the things I would say is that um what's useful for neurologists is having our own eyes on the patient. Truthfully, I think neurology is going to be the last specialty that gets overtaken by AI. Um there's there's a lot of things that we're trained in to just look at for certain signs for certain physical exam findings that will point us one direction or another. Um, for I think a good example would be um seizures. So if someone has a seizure, usually they get loaded with Atavan right away to try to get them to stop seizing. But what happens a lot of the time in the hospital, and this is not just nurses, this is other healthcare providers, this is everyone in the hospital who's not a neurologist, um, they'll see something that looks similar to a seizure, any kind of shaking, any kind of strange movement, and they'll call it a seizure. So I think what would be useful for me as a neurologist for nurses, and I've told a few nurses this actually a few times, is if we have a patient who's doing, you know, something strange and we're not sure it's a seizure or not, what they can do is videotape it and then bring it to a neural neurology resident or a neurologist and have them look over look over the video. Um, that's very helpful for not only the patient and for us because it it helps us allocate resources appropriately and then prevents unnecessary medication administration and gives us a better idea of what's going on with the patient's brain.
SPEAKER_01Units that I've worked on have had like, you know, cameras to take pictures, like really old ones.
SPEAKER_00Yeah, yeah. Obviously with like the patient's permission of the phone. Oh yeah, the HIPAA and stuff and all.
SPEAKER_01But I mean, that's super helpful.
SPEAKER_00Yeah. On the on like uh your worker company phone, if you get a quick video and then call in the resident or the neurologist, or even the the primary team managing the patient, um, and you show them the video, that is so valuable for all of us. Really?
SPEAKER_01All right. So when a nurse does see a subtle change uh in a patient's neurostatus, obviously it's typically critical. Um, what's the best way to act or escalate? And you talk a lot about patient advocacy on your TikTok. Absolutely, yeah.
Video The Event, Not Every Tremor
Escalate Early, Never Hesitate
SPEAKER_00Um so when it comes to neurologic care, um, like you said, a changing patient is a critical patient, right? Um, and when I was in residency, I think I think nurses had a pretty quick trigger on calling me or because I was I was in residency. Um, and now that I'm the attending, I have, you know, uh physician associates, nurse practitioners, and residents working alongside me. And those are the providers that are getting called pretty frequently now. And then once they review the situation, they usually call me. Um, what happens a lot of the time is uh nurses feel like a change is um not that severe, so they they don't call the staff or they're worried about how they're going to look in a situation, if they're too worried about something that's not that serious. Uh my general advice is to just go ahead and call. Um, if you have a uh a staff member, one of the positions I mentioned, the resident, the physician associate, the nurse practitioner who gets upset at you for raising a concern, that's a problem with them, not a problem with you. Um so it takes if you make a hundred calls about something you're concerned about, and only one of those was something that was interventionable and that we could have made a big change on the patient's life, then the other 99 times were worth it, in my opinion. Um, when I was in residency, that happened quite a bit, right? I would I would be on night shift. I was on night shift a lot. I was on I was on night shift and um I'd get called fairly often because I was friends with a lot of the staff. Go examine a patient. I was like, is this a seizure? Is this not a seizure? Never really got mad about it. But you know, after like the 80th time, you start to get skeptical. Yeah. But around like the 80th or like towards the higher numbers, um, we had a patient who um whose arm stopped working. Um, and this was actually towards the end of my night shift, around like 5 a.m. or something like that. And um, one of the nurses I know called me. I was like, okay, I'm coming. And I went to go look at it. And I had just seen this, I just admitted this patient a few hours ago. So we had just gone over imaging. I I was the only one who had a good understanding of her because the attending was, you know, transitioning to coming in in the hospital and the patient's arm wasn't working. I had just seen her a few hours ago. So um, she was actually had severe carotid stenosis um on both sides, meaning that she was high risk for flicking off a clot and having a stroke downstream.
SPEAKER_01So carotid stenosis is like the um Yeah, yeah, sorry. The clogging of the carotid arteries.
SPEAKER_00Exactly. So atherosclerotic disease from high cholesterol diabetes, basically your arteries narrowing because there's junk in there.
SPEAKER_01And so the uh so there's no oxygen going to the brain.
SPEAKER_00The the it narrows the blood flow, but while the blood flow is very strong, what it can do, it's like a river, right? It's flowing at a very high velocity. It can break off a piece, and that piece that breaks off can block a smaller artery. That's where a stroke comes from.
SPEAKER_01Correct, correct. Got it. And so that's you think what happened?
SPEAKER_00That's exactly what happened. So um she called me. We her blood pressure um was kind of low at the time. So I told her to press the bag. Um, and then we had the patient already in motion by the time my boss showed up. And we were in the scanner, we got the imaging, we saw the clot, we gave her the medicine, and then she actually went for uh thrombectomy as well, which were they go in with a wire through the groin and fish the clot out. That's insane. Um, the next day, or actually a few hours later, her arm was working. Wow. So um, me and that nurse during residency. Um, every time I see her, she's always very excited to see me because she knows because after while all of that was happening, I talked to her and gave her a high five and said, good job. I knew that that meant a lot to her, but it made all the other times where you know it maybe not have maybe was not as serious more more worth it, you know.
SPEAKER_01So and that's that's really what builds confidence, it builds trust uh between staff. But it's yeah, it's also for anyone taking their NCLEX or or you know becoming a new grad. I think that's where a lot of students lack or new new nurses. Yeah, their confidence level. And it's all about just like you said, assessment and then raising your hand when you don't see something. Sure.
SPEAKER_00Right, that's right. Sure. That that's the way so I'm I'm a new attending. Um, I'm really still in my education process and I'm learning how to be a leader myself. Um, and I think um I thank my residents fairly often for letting me teach them and for letting people ask like lead them. I think it's a big responsibility. Um, what I've learned in my short time being a leader um is it's really important to tell people good job because those things will stick in their head. Not it's also important to tell people when they're not thinking correctly, but there's a right and wrong way to do it.
SPEAKER_01Right.
SPEAKER_00Certainly.
Carotid Story: Rapid Save
SPEAKER_01Do you feel like a lot of providers uh or leaders in healthcare do it a wrong way? Absolutely I was gonna say that that was a gimme putt, right there.
SPEAKER_00Absolutely. Yeah. Um anyone who's been in medical education, you know, has stories about uh someone who was teaching them or somewhere along their medical journey who didn't handle things correctly or said something to them, and those things stick in their head for their entire life, and they they look back on those. Um, so you know, I'm trying to be the change that I want to see in the world. That's beautiful. But but a lot of uh a lot of medical education is that way. I just don't want any of those problems be coming from me.
SPEAKER_01Yeah. And and you mentioned the the TV show scrubs. Yeah, and a lot of doctors are like that old grumpy guy that's uh he's always snarky.
SPEAKER_00Absolutely, yeah. So funny. Try and be more of a JD or a Turk.
SPEAKER_01Yeah, yeah, there you go. So is is that what you wish nurses knew more about? Is just building that confidence and knowing that maybe their leaders don't know.
SPEAKER_00I think another piece of advice would be if there's a diagnosis or something you've never seen before and it's like a neural a neurology case and you see the neurologist rounding, it's completely okay to go ask them questions and ask them what they directly ask them. What should I be looking for? That could change somebody's life and that could save somebody's life. When I'm in the ICU, that actually happens quite a bit. Okay. Um, where they'll tell me everything that that's happening and they're super concerned. And that's why a lot of nurses go into ICU work. Um, and if I sit down and explain things to them and how I'm seeing it from my eyes, it helps save them a lot of anxiety. It helps um, it just helps the team all together.
SPEAKER_01All right. So let's switch gears to talk about neuroassessment questions here. A very important tool that we use is Glasgow Coma Scale. Can you explain uh why we use that for those who don't know?
SPEAKER_00Yeah. So I think uh a lot of pretty much every scale that you learn in medicine is designed for you to effectively and quickly communicate with other healthcare providers. Um the GCS is kind of a quick way for a provider to tell another provider um how a patient looks at any given time. So the scale is the lowest is three, the highest is 15. Um, basically, you're looking at uh how well their eyes are responding to communication, if they're producing speech, or if their limbs are moving. Um, 15 being normal with three being this patient probably needs to be intubated.
SPEAKER_01Oh, yeah. So I know something we learn and we teach in nursing schools, like less than eight, you got to intubate. Absolutely. Yeah and then yeah, the lower you go, um, the more comatose your patient is. And that's a scary part.
Learning Culture And Kind Leadership
SPEAKER_00In the neurology world, GCS is cool, but our exam is a lot more in-depth, obviously. Um, and this is goes back to what we were talking about earlier. That's why I think that that conversation with the neurology team about what I should be looking for can be super helpful because based on the location of the patient's pathology, like let's say they had stenosis in one spot or carotid stenosis in one spot versus another, or stenosis of one artery versus another, um, you can directly ask the neurologic team, you know, what deficits is this person going to have, or would you expect them to have it if things got worse? Because we know that. Usually the the the crux of neurology residency is that you get um you get so good at the exam and looking at patients, looking at seizures, looking at strokes, that you can kind of tell where the where the pathology is without getting any imaging. Wow. So I think um you can get that good at it.
SPEAKER_01Yeah, yeah.
SPEAKER_00That's amazing. We live in a completely different world. Um, so all hands on deck is actually preferred for from my point of view.
SPEAKER_01So are there any tips about monitoring cranial nerves quickly for nurses?
SPEAKER_00So a lot of the times um I've done a little bit of a telestroke um and I've seen uh a lot of nurses assist me with the exam when they're checking uh stroke patients at the stroke launch pad. Um and I think a lot of the a lot of the cranial nerves are self-explanatory, but I think one of the biggest things that does often get missed is visual fields. Um I see um I see a lot of nurses and pretty frankly other providers, not just nurses, all other providers, um make mistakes when it comes to checking visual fields. Um so a lot of them will cover up one eye and try and check the visual fields there. But when you're in an emergency situation like a stroke or something like that, if you let the patient lay flat in their bed and take a step back, so you're just facing them, and then just hold your fingers up, as if you imagine four big quadrants, that can that can be a lot more revealing than taking the time to cover one eye and getting point blank in the face.
SPEAKER_01And going, yeah, really close. Yeah.
SPEAKER_00So if you if they have a big visual field deficit, you have a much bigger problem on your hands, right? Than if they're having trouble if you point blank in their face. Right. Um, usually when patients show up to the hospital, um, they're petrified, right? They're like, they probably don't think they're having a stroke. People around them are carrying them everywhere, shoving I know, IVs inside them. It happens so quick. Exactly. So whenever you're you get close to their face and you start covering up their eyes and stuff, it usually doesn't provide accurate information. But if you just give them some space, step back and hold fingers up from a distance. And do a little okay. Exactly like that, yeah.
SPEAKER_01So, what about some other testing for cranial nerve assessments that you think is missed?
GCS, NIHSS, And Why They Matter
SPEAKER_00I think eye movements are something that's often missed. And truthfully, unless you're a neurologist or have done neurology training, um, eye movements are pretty hard. Um, there's three big cranial nerves that have to do with your eye movements. There's three, four, and six. Um, six being your lateral eye movements, four being your superior orbital, and three being pretty much everything else. Um, and when one of those goes out of whack, the other becomes stronger, right? So what you see won't really be like a one-to-one thing, like, oh, if it's if this one's out, it'll look like this. If this one's out, it'll look like this. Very rarely does it ever look like the textbook. Um, so it depends on where the patient's pathology is or what part of the brain is affected. Um, but when it comes to eye movements, um, being careful and asking questions and honestly calling neurology is probably your best bet.
SPEAKER_01We have all the gear for nurses, but we rarely use a reflex hammer. I think it's honestly for us, it's like a prop. Um and it's it's just fun to use. But do you actually use it? Do you think it's essential? For neurology. Absolutely. Yes.
SPEAKER_00I think the reflex hammers like the Tomahawk one, the little try.
SPEAKER_01Yeah, that's like a Halloween costume.
SPEAKER_00That one kind of is a prop. Okay.
SPEAKER_01But there's another hammer, like a blood chip? No.
SPEAKER_00There's better reflex hammers. Um, you just want one that's heavy on the end. Neurologists are snobs about the reflex hammers. Yeah. I uh I actually have like four or five. No, you do. Um there's there's some that are different colors. There's one that's a queen square. There's what's a queen square? So it's like the one that's round, and like it extends and then you turn it. Really? Yeah. And it's like a basically hit, it's like a small tire.
SPEAKER_01It's like a selfie stick.
SPEAKER_00Pretty much. It extends like that. But it's an essential part of our exam. Um, there's certain diagnosis where you need ref you need reflexes or you can't make a diagnosis.
SPEAKER_01What are some common diagnoses that uh are revealed when you do check reflex?
SPEAKER_00Yeah, so pretty much any problem with the spinal cord reflexes or reflexes are probably the most important thing I ask my residents, uh PAs and nurse practitioners about. Basically, if you have a lesion in your spinal cord or damage to your spinal cord at a certain area, below that lesion, you should be hyperreflexic. So if I have a thoracic spinal cord myelopathy or something like that, or stenosis in my spinal canal in the thoracic region, my patellar reflexes will fire off me. Yeah. Really? And then um the reflex scale is also something that neurologists are snobs about. Um, but checking for reflexes is important, but also checking for clonus.
SPEAKER_01Wlonus, can you explain what clonus is?
Cranial Nerves: Visual Fields First
SPEAKER_00Yeah. So basically, um, if someone has an upper motor neuron lesion, um, like in that same example I mentioned where you have a thoracic lesion and your patellars are high. Sometimes on the reflex scale, you have uh threes and fours. So those that would mean you're hyper-reflexic. Uh, in some cases, threes can be normal. Some people are just jumpy people when you give them uh a tap with your hammer. But if they have clonus, that's never normal. Okay. So clonus is whenever you you kind of shock the nerve and then it bounces like this. So for example, I would Oh, yeah, when you get the twision.
SPEAKER_01Exactly.
SPEAKER_00So basically you you kind of relax the foot like this and then you press it up, and then it'll bounce like this on its own. And that'll be a good example of what it is. And what does that indicate? Is that a huge risk? Or um it tells me that I need to get an MRI of their spinal cord or try and figure out where the lesion is. That would be one piece of the entire neurologic exam, and I'd keep going farther up until I had a good idea of where I think it is in their spinal cord, and then I MRI that part.
SPEAKER_01That's intense. Like it's it's funny, like just a simple bouncing of a foot can indicate.
SPEAKER_00I think uh I think neurology is probably the only specialty left where we like truly examine the patient. Everybody else is ordering tests. Right. Like give me a hammer and a room, and I'm good to go.
SPEAKER_01Give me a hammer and a room, let's do it. For neurological assessments. What should we pay attention to?
Eye Movements And When To Call
SPEAKER_00Is it motor strength or I think I think motor strength is actually one of those things that's usually not missed very much. I think um most people can tell when an arm is weak or um there's subtle weakness sometimes. Um, like when I'm checking deltoids or biceps and triceps, um, neurologists have done the exam so many times that when somebody else checks it, it's just it's never gonna feel accurate. Um I think um in terms of motor strength, what happens a lot, um, especially whenever you're on tele as a neurologist and the nurses are doing the majority of the exam, um you're not going by GCS at that point, you're going by the NIHSS or the NIH stroke scale. Um so the NIH stroke scale is an objective way to evaluate patients uh when you think that they're having a stroke. They they were found at like a park, you bring them into the hospital, and NIH has to be done quickly. Um, similar to the GCS, which allows you to communicate between providers quickly, an NIH helps you uh communicate between providers who are involved in the stroke process. So that'd be me, the neurologist, the neurointerventionist, the ER doctor, and maybe the ICU. If everyone has an NIH, it basically tells you how bad the patient looks. Um and then after you give them a number of the NIH, you tell them you can further specify as like he was weak on the right, and but his score is this or something like that.
SPEAKER_01So that there's obviously advantages for you being a younger provider, younger doctor. You're only 30 years old, and most people don't even graduate nursing or a med school until like mid-30s, I think I would say.
SPEAKER_00I think like the average age when I started was like 24 and I was 20. Wow.
SPEAKER_01So now there's there's something to be said about the older generations that are stuck in their ways, especially nurses as well as providers, um, that want to do things a certain way and they want everyone to conform to the certain way that they do it. Um, do you find that there's advantages of actually being a younger provider and setting a tone and teaching the youngers?
Reflex Hammers, Clonus, And Spinal Clues
SPEAKER_00One of the biggest parts of my education was learning how to be an adult learner. Um, and I think there's a place for both. I think there's a place for you know the people who are stuck in their ways, the older guys. Um, because I wouldn't be the doctor I am today without, you know, the old heads taking me under their wing and showing me a lot of things. Yeah, I think the the biggest takeaway is always just being open to learning. Um, if I had any advice for for someone, a nurse who is interested in getting into neurology, um, is to get involved early. Um, neurology isn't one of those fields where like there's a set pathway you go down and this is how you learn it, even for doctors. Like there's no set pathway. It's kind of a bumpy road. You have to show that you're interested in it, you have to kind of seek it out. Um, right now I actually have a physician associate who I work with. And as you know, physician associates, they they finish their school and then there's no like residency. They just kind of go into practice and they they pick a field. Oh wow. Um, so a lot of the physician associates that I've met, um, there's some that are a lot more tenured and know exactly what they're doing in neurology, and they're they're amazing. Um, but there's newer physician associates who who don't know as much and need need education. Um, and that education can come very quickly when you're in practice. But I think um what's working well for the ones that work with me is asking questions. So, like when you're in a situation, I say something weird or I'm doing something weird, it's always like, why are you doing that? What does this mean? And I think all the boxes connect very quickly when you're an eager learner or you have, you know, the wants to be there and learn more about neurology.
SPEAKER_01The big takeaway there is just to always ask questions, always be eager to learn, like a sponge.
SPEAKER_00How I found out I was going to be a neurologist. Um, I was in medical school um doing our required neurology rotation. And I was in the ICU um and I had a neurology attending who trained at Mayo, who's from Nepal. Um, and he was uh examining a patient who was had just been extubated um and was kind of sleepy, um, wasn't really responding. He pulled her eyes open and was like going like this with his fingers in her eyes. In her eye, oh my gosh. And I was like, what are you doing? And I was like a med student with my little short white coat sitting in the back, being like, What's the sky? That's weird. And he was like, I was like, What are you doing? I was like, I'm checking if she can see. So what he's doing is he's he was putting fingers in their eyes as a blink to threat. So you if you're not blinking to threat when a finger is coming at you, you probably can't see out of the world. It's not something you can really fake. And and from your perspective, you're like, whoa. Yeah, I was like, you're able to get this very valuable piece of information without talking to anyone. You just walk in, grab their eyes, and point at is that common practice or is that uh that's that's what I do now. Wow, no way.
SPEAKER_01Look at you now.
Exam Mastery Over Tests
SPEAKER_00Yeah, yeah. You um I fell in love with the neural the neurologic exam very quickly. Um I think it's just so interesting how you don't need tests, you just use your hands and you just talk to the patient about their history, you do your exam, and the majority of the time you know what's going on. It's it's pretty it's pretty incredible to be honest.
SPEAKER_01All right. So, in your experience, um, how crucial is the nurse's role in neurocare? And we kind of touched on it before.
What Great Neuro Nurses Do
SPEAKER_00Yeah, yeah. Um, I mentioned that story about catching uh the woman's arm who stopped working. Um, there's many other cases. Um, if you are if you have a good neuro ICU nurse looking after the patient that you're most worried about, your life is so much easier. I can't even explain it. Um, there's a couple of the neuroisu nurses at the hospital I work at now, and they're incredible. And I always like will talk to the staff and be like, hey, could we have her watch him or something like that? So, what makes an incredible nurse? Uh communication and experience. Um, so I think um the two nurses I'm mentioning have really good experience, have seen a lot of cardiac arrest, a lot of brain hemorrhages, a lot of status epilepticus, which is like a really long seizure. Um, and they kind of know what you're supposed to look for and what's what um I would be concerned about. Um, a lot of them are when I walk into a room and I'm on my doing my daily rounds, a lot of them would just tell me everything I need to know within three seconds. It's it's very helpful, it saves a lot of time. And that's what you mean by coming with experience? Coming with experience and asking questions. Um, I think uh the things I had mentioned earlier in this podcast about knowing what I'm worried about is questions they ask me. So they're kind of taught me that this is how you're supposed to teach nurses. Um, so um it really depends on what's going on in each different patient about what you should be looking for. There's no like standard for every neuropatient because um one stroke or one high-risk stroke patient will look very different than another high-risk stroke patient just based off of anatomy in the brain.
SPEAKER_01So communication and experience. Would you say with experience? Um, obviously they've they've seen a lot of patients with does that come with a territory of knowing when something's wrong in terms of an assessment and when to raise their hand, calling it.
SPEAKER_00Well, I think I don't I don't think they need to know what's wrong, but knowing when something's wrong is important. Got it. Um, and I I'm not I'm not gonna lie, a lot of a lot of medicine, not just medicine and nursing as well, um, is is making mistakes. You know, you the nurses have a lot of experience and are good nurses probably because they've been around long enough to have made those mistakes. I've made mistakes in my education and those things have only made me better. Um, but that's that's just how medicine works, and that's what things like residency and nursing school are for.
SPEAKER_01Learning from your mistakes. Absolutely and learning from others' mistakes as well. So to wrap this up for nurses that are interested in going into neurology, um, what is some advice that maybe nurses miss or that that you see um nurses should focus on more often?
Documentation, Words, And Precision
Final Takeaways And Thanks
SPEAKER_00Like I mentioned before, a lot of a lot of neurology is stroke care. Um, and uh we mentioned documenting before, like this patient looked like this at this time. Um I think um when a patient's in a hospital and they have an ischemic event, I think it it's never really acceptable to not know the last known normal. And that's actually happened a few times at a few different places um where a patient's in the hospital, they're being watched by our team or our staff in the hospital, um, and no one knows the last time they were completely normal for with certainty. Um and that's not that's not acceptable for any hospital, to be completely honest. Um, so I think I think documenting is very important and very helpful. Um and a lot of the times when you're when you're communicating with uh with staff or neurologists or people in the neurology field, um, I would avoid using a lot of the big words if you're not certain what they mean. And this is true for for doctors. Yeah, for anyone, yeah. Um so I think one I see fairly commonly is something called aphasia, where someone has a speech problem and not all speech problems are considered aphasia. So um there's dysarthria and there's different kinds of aphasia. So when when people say aphasia, that means something very different to a neurologist than it does to any other doctor because the aphasia localizes to a specific part of the brain. Interesting. And if that doesn't make sense based off what's going on with the patient, then it's an emergency because you're like, oh, what's going on? Right. Um, so I think I think just saying exactly what you see and having good documentation is very important. Um, so we don't we're all a team. It doesn't, you don't have to try and impress anyone with big words, just tell me what you saw. You can act it out if you want what they're doing. That's amazing. But we'll get to the bottom of this. Yeah.
SPEAKER_01So okay, so the big takeaways, you know, communication is critical. Absolutely. Um, you know, being a sponge and learning, making mistakes and learning from those. Um, and then just being a team player and you know learning as you go along.
SPEAKER_00Absolutely. Yeah. I think um I was really excited to do this podcast. I like I like helping us, I like teaching as you can tell. Um, and uh they've saved my butt plenty of time. So I'm happy to give back as much as I can. I love that.
SPEAKER_01Thanks so much for watching. Please be sure to subscribe, share, and follow. And as always, don't let the bedpans bite.