Week #4 (Nerymar Ortiz Otero): Another Exciting Week with New Brain Staff

          During this week I spent more time in the OR than in the Clinic. Also, I was present in rounds of the Pediatric Critical Care Unit (PCCU). In the OR, I was observing surgeries to treat patients with brain tumor and epilepsy. In the PCCU, I was seeing children with critical conditions as bi-phenotypic leukemia, obstructive hydrocephalus, brain neoplasm, intraventricular hemorrhage, diabetic ketoacidosis, among others.

          Basing in the OR, the most interesting case is a surgical procedure to place the brain stimulator device in the tissue to control the seizures. This device deliveries electrical signals as a response to abnormal electrical activity to normalize it to prevent that the seizure occurs. The surgery to put this device consists in a craniotomy where the electrodes are placed over the brain damage tissues. The damage tissue was found using a functional MRI. This kind of MRI can to indicate the affected tissue measuring the brain activity. After put the electrodes, these are connected to the programmable device that is inside of the bone flap. At the end of the surgery, the device was switched on using the computer. This was a great experience for me because I learned about this recent device and its utility for people that the most common procedure to treat the seizure fails. This was the last shot for the patient. She had two different surgeries to remove the brain damage tissues (tissue that induce seizures).

          According with the rounds in the PCCU department, I found two interesting cases. First one, is a patient with intraventricular hemorrhage (IVH). He was a 16 years old boy transferred from another hospital with a severe IVH. The IVH is bleeding in the ventricular system of the brain. He had a surgery to control the bleeding. However, the bleeding was really significant, which the surgery was not enough to treat the IVH. Basing in the LOC/GCS scale (loss of consciousness/Glasgow coma scale), the patient did not show brain activity. The physicians were waiting for a recent MRI to can diagnose brain death. That case was very depressing for me.  See a young person that possibly can be diagnose brain death is sad. According with it, I could learn the procedure to can diagnose brain death or not. Second one, is a patient with bi-phenotypic leukemia, thrombocytopenia and pulmonary issues. He was isolate receiving bone marrow transfusion and intensive chemotherapy. The most important in the PCCU rounds were associate the condition with the treatment selected to each patient and how you can follow the healing process.