 What is going on everybody as you can tell it is a chilly day in New York City right now I just currently like 30 degrees or so so I do have to dress a little warmer now on these colder wash Blocking to work right now. It's early in the morning. That's really actually came in about 8 a.m. Today So not a big deal, but the reason I'm filming this video because I haven't done a Straight-up day in the life of a doctor video or a day in my life as a doctor video in a very long time I usually do these vlogs while I'm on call, but I haven't just done a Straight-up day in my life where I take you around on my entire day at work So first of foremost as usual walk into work. It's a chilly day And I have some pretty big cases to do today, which I'm pretty excited about I'm also really out of breath right now for some reason, but I'm going to bring you along for the ride as usual and we'll see you what we can get into if the cases are good I'll try to make some educational Content about it or whatnot. So we'll see you where it goes All right, so this video is sponsored by board vitals now you may have heard my prior video on Passing the core and what my thoughts were on the core examination last year when I did this video and I discussed how the Hands-down best resource for this exam is the board vitals question bank The questions are almost identical to that on the actual core exam The explanations of the questions are second to none. I learned so much from this Q bank I can't even recommend it enough even if this video wasn't sponsored I would still tell you all that this is the best Q bank far and away That's how much I loved it all of my colleagues who also passed the core exam felt the exact same way about this Q bank So do yourself a favor and use my code Dr. Chalini to get 20% off the entire board vitals website with the exception of the CME gift card products So use my code dr. Chalini now get 20% off your board vitals radiology question bank and pass the core exam now Let's get back to the video I guess people are still taking city bikes to work every day As you know, I'm a huge fan of city bikes, but I haven't used them Quite a bit of time because it's too cold to and like whenever it gets a little warm out I feel like and still use a city bike, but I get on it and the wind starts blowing all over my face Yeah, I'm come freezing so I just stick to walking right now Now I will say when it's this cold outside for some reason my nose always runs I don't know how many of you all your nose runs when it's freezing outside But mine runs like crazy. Maybe it's because I have a big nose. I don't know But I do like wearing masks in the winter I will say way better in the summer because it actually keeps you warm and keeps the wind off of your face The only downside of that is my nose just runs all in my mask the whole like 20-minute walk So that's kind of annoying, but the benefit of working at a hospital is that I can just get a new mask When I get to work, it's not half bad. Also, I haven't told you what I'm actually doing this week I'm not on call as you can probably tell since I'm not filming a week in my life on call video But I'll tell you what I'm doing as soon as I get in the hospital because my hand is frozen from holding this phone in the cold weather All right, so my case is officially delayed Currently, well the bad news is I look terribly tired right now But the good news is we have a really cool case coming up right now that nobody is covering Which means I am the fellow that gets to cover it and that is a tips procedure Which I think I mentioned it on my last week on call video It is a transgenular Intra-hypotheic Porto-systemic shunt and it is done for portal hypertension in the setting of cirrhosis So people with bad liver disease have portal hypertension which can cause a host of issues such as hepatic encephalopathy predisposition to hepatic cellular carcinoma can also cause refractory ascites and Bleeding varices as well So we do the tips procedure to essentially relieve some pressure and create a bypass Essentially which allows the pressure in the portal system to kind of decrease a little bit and prevent some of those Complications I just mentioned if I can find a good diagram online or something So you know exactly what I'm talking about But is it pretty complex procedure that has become not so complex over the years It used to be like the it thing to do an interventional radiology But now it's kind of like not bread and butter, but it's not as challenging as it used to be So all right, let me go check on this patient and get this room ready and we'll do a procedure and hopefully check in afterwards All right, so that was a complete change of plans, which has happened there So instead of what my hair looks good today, right? So instead of a tips ended up doing a Semi-urgent pulmonary artery Embolectomy or thrombectomy whatever you want to call it So that was completely different than the tips that I thought I was going to do so. Yeah, it was actually a pretty fun case We don't get too many of those but during the daytime I should say usually we get called in for those in the middle of night So it's kind of nice to do that in the daytime with you know a lot of personnel around so basically this patient came Into the ER did a CAT scan showed a large pulmonary embolism taking up almost the entire Main and bilateral pulmonary arteries So we call that a saddle pulmonary embolist because it kind of rests on the main pulmonary artery trunk like a saddle wood I think I did a video on pulmonary embolism, which I will link up here So you can go check that out and I talked about where pulmonary embolism come from or pulmonary embolize come from and usually DVT's in the Lord's chimney, but if you need a refresher I did it with imaging link up here So I'm actually it is 5 p.m. By the way at the moment and I'm actually starving So hold on a second. Let me get a snack Otherwise, I won't be able to continue this what happens now after I finish your procedure We just brought the patient up to their room and right now I have to do all the like post-op stuff Like I have to do the brief op note Which is like you know a brief little note telling everybody what I did so that they know what happened during the procedure And then after that I will have to actually dictate a summary of the entire Operation or the entire procedure in which I go into detail about like what vessel I was in what catheter I used all that kind of stuff We do have templates for that But it does take a little time and you want to be pretty accurate because if you say something that's not accurate That could be medical fraud much like surgeons who do op notes our dictations are everything op note orders Tell the team everything that happened do my dictation then I can get out of here Okay, so just finished dictations I'm about to put my jacket on because it's freezing and head home And wait for angina to get off work So we're gonna eat dinner together because I know it's as every time but even I'm not on call this week My mother-in-law brought us a roasted chicken dinner. I don't know why she does this so much But I'm down for it and I'm here for it. So we're gonna have a nice dinner again tonight So I forgot to mention though I did take a video of the pulmonary embolectomy that we did and I'll show you the results of it But you may have already seen it on my tiktok I don't know I'm making a tiktok video in this video at the same time And I don't know which one's going to be out first So if you follow me on tiktok, you may have seen this footage already Otherwise, I'm going to put it in this video and it's kind of shot in portrait mode because it was for tiktok originally But you'll see some pretty cool Stuff here and you can see me playing with the clot that I actually pulled out of the pulmonary artery through a big catheter Which is crazy. So I am headed home right now All right, so we just finished the pulmonary artery embolectomy or thrombectomy and we do this for patients with large PEs or pulmonary emboli in the main pulmonary arteries of the heart What we do is we take a large bore catheter The size of this little if you look on the ruler right here, you can see that little circle that says 24 That's actually the size of the catheter It looks like a very large straw that we insert into the right common femoral vein And using our x-ray machine We use live x-rays to advance that giant catheter all the way up from the common femoral vein and the groin To the heart and we get into each branch of the pulmonary artery and suck out this clot And this is actually what the clot looks like. It's this slippery Bloody tissue that kind of forms together and blocks off the pulmonary arteries And we have to get this out because the heart cannot pump blood against this blockage in the pulmonary arteries And if you don't get proper blood flow to the lungs, you won't get oxygenated blood Which means you won't get oxygenated blood sent to the rest of your body And this is the importance of getting this clot out And this is just me playing with it all over the place because I don't know it's kind of fun to play with So I hope you all enjoyed it Okay, so everything's all wrapped up now and my least favorite part about leaving Even though it's only like 5 20 right now is you'll see why It's literally pitch black outside Which is not fun at all It's definitely cold enough to wear a nice beanie out So that's what I have to do now so my face doesn't freeze off on the way home today That about wraps up this video You all enjoyed coming along with me for a day in the life like the good old fashioned times that we used to do If you have any questions leave them in the comments below Make sure you follow me on instagram and also tiktok because I've been posting some good stuff over there Otherwise as always I'll see you all on the next video