 What's up guys today? We're going to be doing another vlog style video, and I know what you're gonna say But you've already done that and the answer is yes But every day is different. So why not do another day? This is day one of six night shifts and Yeah, let's see what we see. Let's go. All right guys So the very first thing I do when I get here is log into the system and then next I go get the pager Got it. Even though I hate this thing you have to hold it for the next 12 hours I also got sign out from the interventional radiology fellow who goes home at 8 p.m.. And turns everything over to me So I transfer the IR pager over to the radiology pager So I cover radiology and interventional radiology overnight if someone needs a stat Or emergent interventional radiology console they call me and I call the fellow in that's how that works It's not a bad gate for fellows. All right, so the next thing I do is Wipe down my station. It's cold and flu season right now I have a cold right now, and I don't want the flu like I had last year So we're gonna wipe it down wipe that dig to phone down, and I use these anti cancer anti TB wipes or whatever. That's why I wear gloves because apparently they cause cancer or something like that Either way, I don't want it on my skin All right, so let's turn down the lights and start reading some studies All right, so it's now Like 8 40 and I've been here 40 minutes and I just have paged by the nuclear medicine tech that there is a high Descan that he needs me to look at to make sure the patient doesn't have acute cholecystitis So that's what we're going to do now be right back All right So that was just a false alarm the tech just had some trouble with positioning the patient to get the right image However, I will still teach you how to read a hideous scan Let's go today. We're going to be discussing a hideous scan hide That stands for a pedi biliary amino diacetic acid scan So what we do with this scan is we inject a radiolabeled substance Technesium marbrofin in and it goes in through the bloodstream Into the liver and extruded be via the biliary system So as you can see just taken up by the liver liver and Then as you see the gallbladder will eventually start showing up. It's better down here More delayed phases at the bottom So once the gallbladder shows up we know that this is a normal study as you can see This is a normal study as well You see the fade outline of the liver and as the radio tracer in the liver decreases It goes into the biliary system and then reflexes back up into the gallbladder where it is stored You have a nice opaque gallbladder, which means contrast is making it through the hepatic duct And common bile duct as well as the cystic duct and into the gallbladder Which means there is no obstruction and no cholecystitis. This is a normal study. All right So you still don't know what the heck I'm talking about So let's go into it. So here we have the liver and the biliary system Normally the radio tracer will be taken up into the liver. It'll go down the bile ducts into the common bile duct and Some of it will reflux into the gallbladder, which makes the gallbladder black on imaging because it is full of radio tracer now Say you had a whole bunch of gallstones in your gallbladder And one of them decided to come up and sit right into the cystic duct and give you a whole bunch of pain and The doctors would be worried about acute cholecystitis. What we would see on our HIDA scan is That the radio tracer would be taken up into the liver It would go down the bile ducts as it should and into the duodenum However, when the radio tracer would go down the biliary ducts it would not reflux into the Cystic duct and into the gallbladder because it is being blocked by this stone right here So we would not see the gallbladder light up on a positive scan Hopefully that made sense. So when there's a stone blocking the duct the cystic ducts Contrast or radio tracer cannot go into the gallbladder and therefore we will not see the gallbladder on our scan So just to reiterate this is a positive study for acute cholecystitis This is just gonna play on a loop here But you'll see the liver fill up first and then you'll see bowel activity But you don't see a gallbladder. So liver Go straight to the biliary ducts and down into the bowel and nothing refluxes into the gallbladder Which means it is blocked off most likely by a stone and therefore it is a acute cholecystitis So if you don't see the gallbladder Positive study for acute cholecystitis. Hopefully that makes sense now now. Let's get back to the video. Oh my gosh guys It is literally 1240 in the morning. That's four hours since I last recorded that last video And I have been literally non-stop since anything from just crazy MRs to Contrast extravasations at the MRI scanner Nuclear medicine texts needing me for the hiatus scans. I mean Non-stop I tried to help my lower level out with some traumas But she was getting destroyed by all the traumas that came in and I didn't even have time to help her Which I always feel bad about because I like to make sure their list is nice and tidy as well So now I'm going to finally get up since I've been sitting here reading studies in the last four hours I'll take a little walk and get some water and come back in and wait for some studies to come in and since I'm going to the Lounge, I might as well bring you with me. All right, so here we go We have our water cooler. This is a new addition just in our books all around male microwave coffee machine which I use all the time Drawer which is usually full which now it's just distressing Usually there's some coffee in there fridge chairs Couch that converts to a bed, which I may or may not be on later Our pack station, which is located conveniently Directly across from the bed And we have a little TV in here. Actually it's pretty big. It's like 27 inch or plus maybe 40 inch. I don't even know and some computers printer phone, they're good stuff so Hope you enjoy your stay in our lounge That is all we have here. All right guys, so it is 3 a.m And if you watch my other videos, you know what that is time for It's time for Starbucks All right guys, so it's about 3 30 ish now Got my coffee. I've been a little busy So some of the studies I've read tonight I've read a whole bunch of brain MRIs To rule out strokes, which is usually the most common thing we brain MRIs we read I haven't read any total spine MRIs yet, which is weird Because the ER loves to order those And if you've seen my Instagram, you know that I hate reading those because for one, they're usually ordered incorrectly Be they're really expensive and see they take a lot of my time to read and My list starts piling up the more time I spend on those total spines What else I've read I've had to deal with the Hyda patient today The tech needed me a few times and we've gone over that so now you know all about Hyda scans I've had to go to one of the scanners for a contrast Extravization Which is also the bane of my existence because when I'm really busy and they call me for that stuff I have to leave and go do that. I've read ct angiogram I've had to deal with the patient who is bleeding on the floor and they've I've almost had to call in the IR fellow But not yet because the patient is stable And if they do become unstable within the next three hours, I will call the fellow in to come try to embolize them And that's it so for the next few hours or so I'll sit here I have a couple more stats studies that are coming down the pipe I'll hit those and then I'll probably just work on some YouTube videos as the studies roll in for the next few hours When it gets this late, I get really tired and I really can't do much so the study starts slowing down and I'll usually start working on my YouTube videos or Whatever I have I usually just watch YouTube not too much work But it is what it is and since there's only so much I can take of wearing contacts at 4.15 in the morning It's time to take them out And switch over to glasses All right, so it's now 7 a.m. And I will go sign out to interventional radiology to let them know about the bleeding patient overnight somehow They didn't decide to bleed again, so we didn't have to intervene But they will this morning, so I have to go tell them about it and then Lucky me we have a 7 a.m. Physics lecture today, so That's pretty cool Nothing like working 11 hours then sitting through a one-hour physics session I'm sure I won't fall asleep, but we'll see how it goes Somehow we made it through another night and I need to get some sleep All right guys, so it's officially 8 15 in the morning now. I am completely dead Actually, I'm not that tired the first night is always the best because you're just not tired yet I'll probably get like two hours of sleep tonight and then wake up exhausted, so that's cool anyways do me a favor and Gently tap on that like it subscribe button Leave a comment below If I like it I'll respond to it Otherwise, I guess I'll see you guys on the next video