Neuro: HA protocol and eyes

SO we always seem to get these consults about patients with headaches. Its not that nobody else can handle it, its that this neurologist get great rates of fixing them and he can figure out who is faking and who isn't.  But his method isn't exactly kosher. He simply judges their 'crediblity' with a series of rapid fire questions that have right and wrong answers but you don't realize them.

The best combo he recommends: Doxepin (an alzheimer drug), Pentobarbitol(anti epilepsy), Fluids, and sometimes involving ambien to help sleep.  And these patients always always wake up refreshed with at least a severely diminished headache and a better outlook.


On other notes, many of these intubated, severely brain dead patients present with an odd physical finding that I found worth  mentioning-- chimosis. Its swelling of the whites of your eyes (the mucus membrane part).  Some patients have more of this than others and of course its possible to be reverable, but you know when you see it: this patient is really really sick.

In this picture, it looks more yellowed than usual and it does not extend into the white part of the eye toward the nose. This is because this patient is in a medically induced coma, which means he's unresponsive for a reason, in this case because he had a heart attack. The patients that exhibit less chimosis have a better prognosis.  This is not a medical definition just something i have noticed and when brought to the neurologist's attention, he agreed.  NEAT!