My Patient is Confused! (Hepatic Encephalopathy)

Testing for asterixis (a flapping tremor) is a great way to help assess for hepatic encephalopathy, but it's not always easy.
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[@1901180108]

She really is confused. Otherwise she would know that Jonathan never speaks. :p

[@stephaniehowe0973]

😂

[@Ghostchickie]

He just nods politely and does the ophthalmologist’s work.

[@WhiteHazee]

@@GhostchickieHe do way more than that...

[@Ghostchickie]

@@WhiteHazee True, during Covid when even ophthalmologists worked in the ICU, Jonathan did all of ICU work too.

[@khalilahd.]

😭😭

[@dukeofanchor]

Jonathan, the omnipresent scribe.

[@TheRealityfades]

A Dr Glaucomflecken reference! But also, seriously appreciate the education. Never will need it, but I love learning.

[@leshommesdupilly]

Jonathan is everywhere, even in your brain

[@maryaigler7651]

Ah, did I detect a nod to fellow medical youtuber Dr. G.? I love both of you!

[@grantmegan91]

The Glock flock ❤️❤️

[@2Bad4YOUuu]

@@grantmegan91 The Schmidty committee ❤❤❤🤣

[@omiai]

i just needed to see jonathan appear and nod at the end there. like come out a cupboard or something.

[@TheCamiclo]

Is she talking about Jonathan from Dr Glaucomflecken???????? Please yes!

[@khalilahd.]

The wigs always crack me up the most 😭😭

[@MZSOhio]

And so the Jonathan lore continues 🙌

[@spicy4868]

Jonathan? Do I smell a collab?

[@savagejeans]

I remember my first HE patient, I was really confused as to why they were getting SO MUCH lactulose 🤣 I was like "how constipated is this person??" Never knew until then that lactulose had other uses than treating constipation

[@EmilyGloeggler7984]

Wait till you see the HE patient that has suffered adverse reactions including anaphylaxis to the drug but it was not reported by the doctor, even though it was thoroughly documented. Not easy getting doctors to acknowledge those of us who get sick off of pharma poison.

[@ninakaiser2930]

Loved the Jonathan twist!

[@JaneDoe-ip5yl]

haha excellant. I like how patient put arms like a bus was really coming. keep 'em coming

[@JaneDoe-ip5yl]

there MUST be a collab. borrow Jonathan

[@CallieMasters5000]

HE was a 2 year nightmare before my family member died. It was awful. Truly awful.

[@geriroush8004]

I'm so sorry, I feel for you. My mom had fatty liver disease and lived less than a year after she was diagnosed. The lactulose is no fun.

[@CallieMasters5000]

The doctors could never really clear up the HE for my family member, regardless of meds or lactulose. Total loss of career, needed 24/7 care, it was so sad.

[@ggclipsunlimited8637]

Every one needs them a Jonathan lol love the reference

[@corneliaeleanore3215]

It was so funny! And so accurate ! And even Jonathan is here ! 🤣🤣🤣 It killed me!

[@pennyfitzgerald595]

I DO LOVE ALL YOUR INSANE SKITS, KEEP EM COMING DOC

[@bettyframe8044]

My experience with HE was unpleasant. I worked the TICU for a few months (I would float when I did renal) I swear all of the men with HE resorted to public masterbation. At least they weren’t combative or angry but I wonder if that would have been better!! The TICU was an experience, I can say that much!!! 🤦🏽‍♀️

[@lolitaalmostgrown]

It happens to old men after open heart surgery too. Maybe oxygen deprivation brings their inner perverts out.

[@classicambo9781]

Add that to the Dementia ward along with a penchant for strangling people...

[@khalilahd.]

Woah that’s crazy 😳

[@PRDreams]

@@lolitaalmostgrown don't do that. Please. Stigmatizing mental illness is wrong. They are old and have dementia, or other serious conditions that destroy their brains in horrible ways that we still cannot understand. They are not in control of themselves in any way. Most even defecate themselves and do not recognize themselves in a mirror. Saying "Maybe oxygen depravation brings their inner perverts out" is such a horrible thing to say of men who were always respectful to others... when in fact they are at their most vulnerable. I really hope my dad dies before anything like this presents itself. Would absolutely hate if someone accuses the most outstanding man I know of such a horrible thing.

[@steveyboyy1]

Some of the liver reg's I know test for the asterixis by just pushing the patients hand back into dorsiflexion and feeling the tremor. Then the patient doesn't need to be able to follow commands 😛

[@julieromley]

Ahhh lactulose. The bane of my existence. Glad I switched to labor and delivery 😂😂

[@Doc_Schmidt]

I can imagine 😬

[@Noblebird02]

how do doctors switch?

[@MrMedmechanic]

Yea, bring on the collab!

[@Titannurse]

As a nurse the BM outcomes of lactulose can definitely add to workload but I have stay on newer nurses about patients refusing it. Yes, it would be nice if refusing had no consequences and all the not diarrhea benefits but it's not worth it. I didn't know about this assessment though, thanks for the education!

[@emilyscloset2648]

The armies of Jonathan will rise up!

[@isabellac5228]

HAHAHA The Johnathan reference got me so good there.

[@Emily-hd9sm]

Oh my goodness is there a crossover in the works 👀👀👀

[@nicolaorman4900]

I love how so many other people commented on Jonathan making it into another medical persons videos!! ❤😂

[@Steampunkkids]

Who’s Jonathan? Why he is that sweet boy flying outside my window! (That’s what I get for working in the Psych ward)

[@omargow]

I love these subtle crossovers!

[@SFROutdoors]

Enter Dr Glaucomflecken

[@mbsaxman600]

😂😂😂 oh man that bit at the end!

[@fxnepilogue]

I have had 2 patients with hepatic encephalopathy, the worse of the two couldn’t follow any directions at times and was sent out (I work in snf setting) for paracentesis regularly. Unfortunately they didn’t last long.

[@leslierae6416]

Glad to hear this hospital has a Jonathon!

[@khushis8759]

Ohhj myyyy god.... Jonathan in doc schimdt hospital 😍🤣🤣🤣

[@makell2702]

Might be the most helpful video I have seen yet

[@AzzaRudd]

I remember a patient who recurrently would come in with HE because she just wouldn't adhere to a bowel regime. She was quite constipated, had all the classic Sx; it's a quite unique form of confusion typically in my experience. We gave her boatloads of laxatives, supps etc and after a day....nothing> The next day the dam broke and the flow began...it was....impressive. D/C 2/7 later, happy patient and tired nursing staff :P Also, love Johnathon.

[@donahunt832]

LUV you, you're so funny in a medical way, not sure everyone can appreciate it 😂

[@breebrat56]

Nice GlockFlock Jonathan reference! 😁

[@ghostguy9162]

HE patients go one of two ways, either they're lovely patients or they'll make them 13+ hours LOOOOOOOONG 😆😆

[@amberlance3221]

Weird, coz its not exactly easy for the family - at least you can switch off at the end of the day 😆😆

[@aqualife88]

Jonathan, Dr. Glaucomfleckens scribe haha

[@liahk1000]

Haha so relatable! But for me in geriatric patients! Always difficult with grasset and how to hold the hands, and also finger nose!

[@patrick815]

Haven't thought of Amonia in ages, still thinking of sodium !

[@BornToBeRhino]

Reminds me of my medical er days

[@beccakirk4367]

Would love for y’all to check out my new silly nursing KZbin playlist! Just graduated nursing school and now uploading all of the silly ways I remembered things! Here’s the link! kzbin.info/aero/PL7djyCAqCH4cqb7zqd9gsB_Xw3BIEc0gN

[@Mak_Vintage]

WHO IS JONATHAN???? I feel a crossover coming.

[@fariesz6786]

somehow i heard an ophthalmologist scribe nod silently in the off (yes, i can hear silent nods iff performed by ophthalmologist scribes)

[@edwardcornell1263]

Johnathon is the scribe.

[@JonathanLittlemore]

I'm Jonathan! (I know not quite the same spelling)

[@razakhan23465]

What if you tell her to push away from her?

[@Idontwantachann]

If you prescribe Lactulose or Rifaximin PLEASE WARN YOUR ELDERLY PATIENTS ABOUT THE RISK OF DEHYDRATION! My mom had hepatic encephalopathy after being prescribed a medication that hurt her liver and no one told us she could become dehydrated (she also had an ileostomy). The same hospitalist that diagnosed the hepatic encephalopathy didn’t see she was dehydrated when we rolled into the ER with her having mental confusion and a problem with talking the following week. He told us her organs were shutting down and insisted we put her on comfort care. They didn’t give her any fluids in the ER. The next day I saw her labs reflected dehydration and had to fight to get her an IV of fluid and she was back to her normal self!

[@SasankaDurov]

Teach ?

[@ArunRamaDS]

Not funny. I jus lost my mother to acute liver failure. I cried watching her episodes of hepatic encephalopathy.. mom was in so much suffering and pain 💔

[@josepharrington8391]

i'm watching this happen to mine in real time

[@amberlance3221]

Reading through these comments, I'm really disgusted by the number of 'medical professionals' who enjoy mocking their patients. Shame on you. Good thing your patients don't need their liver 🙄

[@veronicamarrs]

Oh my gosh lactulose 🤮 my stomach is bubbling from my nightly dose as I type this

[@RileyJane2022]

Ohh those are the best patients and oh how I love cleaning up lactuloSe poop! Notttt I rather smell Cdiff than that! Lol

[@jedikaren8112]

Sqqqqquuuueeeee!

[@dougadoo1976]

Boy oooooh bOY this is what my wife went thru totally confused incoherent and could not follow instructions for got how to do the simple things and electronics were the worst. She carbonized a sweet potato with a wet paper towel around it foe 12 to14 minutes until it caught fire and house filled with smoke and sweet tater was black and hot orange. This is no joke I wish the doc would have informed us of the and much more. It's like an information gap

[@douglaspedersen3355]

LOL. So true. Gotta love my HE patients.