Internship assessment
My learning experience in medicine posting
Posted in medicine from 12th December.
I was in first unit for four weeks(12/12/22 to 27/12/22 and from 27/1/23 to 12/2/23) And i learnt alot during this period. On OP days we used to see nearly 70 patients from morning to night . I learned to take proper history in OP and got to see some really interesting cases in casualty.
Here are the blogs that i have done during my unit duty
https://vignatha45.blogspot.com/2022/12/chief-complaints-bl-knee-pains-since-30.html
This is a case of 57 year old male with bilateral pedal edema and was diagnosed as acute on chronic hyponatremia .
Learning points:
Learned to examine reflexes.
Learned a practical approach to hyponatremia
https://vignatha45.blogspot.com/2022/12/20-year-old-male-with-massive.html
This is a very interesting case of 20 year male with splenomegaly.
Learning points:
Learned palpation of spleen
Learned an approach to anemia
Didn’t get to do a bone marrow biopsy for this patient but instead got a chance to prepare a slide for it.
https://vignatha45.blogspot.com/2023/01/this-is-online-e-log-book-to-discuss.html
This is a case of 55 year old female who is diagnosed as septic shock with MODS
learning points:
Learned ABG sampling and also learned to interpret an ABG
learned about types of respiratory failure and the mechanism of BIPAP and CPAP during rounds
Learned grading of bedsore
Learned placement of ryles tube and foleys catheter
Monitored this patient carefully during the dialysis sessions for every 30 minutes.
Learned to identify the septic focus and finding out cause for it and it’s treatment.
https://vignatha45.blogspot.com/2023/02/40-year-female-with-hypokalemia.html
This is a case of 40 year old female with recurrent hypokalemic paralysis with distal RTA and (probale sjogrens)
Learning points
Learned correction of hypokalemia
Learned about distal RTA during rounds
Understood the importance of 24 hour urinary electrolyte values which helps in the diagnosis of renal loss of potassium.
Got a chance to see lip biopsy for this patient. Spent a whole day with her waiting for the biopsy and she’s mentally one of the strongest patients that I’ve ever seen. During the biopsy even though she was in pain, she called me and asked to click a picture of her while getting the biopsy done!
Felt really happy when i saw a smile on her face and gratitude in her eyes while leaving the hospital.
https://vignatha45.blogspot.com/2023/02/29-year-old-female-who-is-customer.html
This is a case of 29 year old female with AKI on CKD.
She is a known case of SLE .
Learning points:
Monitored her blood transfusion carefully for any transfusion reactions
https://vignatha45.blogspot.com/2023/02/60yr-old-male-labourer-by-occupation.html
This is a case of 60 year male with COPD and heart failure with reduced ejection fraction
Learning points:
Learned about the importance of postural hypotension
Learned about the 2D echo changes in heart failure
Placement of foleys
Psychiatry posting:
In psychiatry postings I’ve seen many cases like schizophrenia
Anxiety disorder
Substance abuse
Alcohol dependence syndrome
Mood disorders
Depression
Obsessesive compulsive disorder
Bipolar disorder
Monitored a case of 20 year old female with catatonic schizophrenia which was very challenging as it is not very easy to deal with a person who is in depression for 4 long years without even uttering a single word with her family members, which is very disheartening.
I’m glad that their family decided to seek for psychiatric help. And i also wonder how all the people from rural areas are well aware of their mental illness and they are also seeking psychiatric help without any stigmas.
Icu duty from 12/1/23 to 16/1/23
Learned so many things in 5 days
Drew more than 20 ABG samples
Learned drawing blood samples
Assisted during active management of cardiac arrest patient
He was a 55 year old male with CKD on MHD. On 14/1/23 patient was shifted to AMC from nephro ward as his blood pressure was around 70/50 mmhg . Norad was connected and dose was being increased as his blood pressure was falling. I checked his BP and it was not recordable.. and pulse was feeble. And immediately the patient was shifted to ICU and was intubated by Dr. Vinay sir and Dr. Deepika mam. After 20 minutes pulse was not recordable and CPR was done for 30 minutes.
Learned when to taper the dose of NORAD
Learned insertion of ryles tube
Insertion of foleys catheter and removal
Monitored patients during blood transfusion and learned about transfusion reactions.
Nephrology duty from(17/1/23 to 21/1/23)
CKD is one of the interesting topics for me.
I’ve been taking history of chronic kidney disease patients since 2 nd year..but unfortunately there’s no evidence of my work in past as we didn’t know about blogs. So, here are my previous blogs which i have done in my 3rd and 4th year
https://vignatha45.blogspot.com/2021/09/this-is-online-e-log-book-to-discuss.html
https://vignatha45.blogspot.com/2021/09/a-45-year-old-male-with-bilateral-pedal.html
https://vignatha45.blogspot.com/2022/01/38-years-old-female-with-ckd-on-mhd.html
Assisted for central line (under Dr. Deepika mam) two times
First central line was for a 50 year old male
And second central line was for 58 year old female with CKD.
Insertion of IV cannulas
Monitored vitals during dialysis and tranfused blood during dialysis.
Ward duties :
Updated SOAP notes of every patient
Took history of a patient with neck pain
A 40 year old female ,tailor by occupation presented with Chief complaints of neck pain since 2 weeks
Head ache since 2 weeks
Tingling sensation of both hands since 10 days
Hopi:
Pt was apparently asymptomatic 2 years back then developed neck pain diffuse on both sides radiating along both arms associated with tingling sensation of both hands c/o neck pain increased from past 2 weeks H/o headache ,diffuse type ,not associated with any aggravating factors ,relieved on taking medication
Pt is a k/c/O of hypothyroid since 1and half year and stopped medication since 3 months and she is on thyroxine 25 mcg For 15 months
H/O loss of appetite since 10 days
H/o decreased sleep since 3weeks
H/o decreased concentration
No H/O weight gain
No H/O constipation
No H/O palpitations, sweating, tremors
No H /o cold intolerance
No H/o menustral irregularities
Rounds were the interesting part during ward duties
Saw a case of 60 year old male who is a trumpet player by occupation with bronchitis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497376/
This is an article about lung function in wind blowing instrument players
Discussed and examined a case of limited systemic sclerosis patient who was admitted under DVL
Attended CME on 25/1/23
I would like to thank Dr. Rakesh biswas sir , Dr. Zain sir, Dr. Raveen sir , Dr. Vinay sir, Dr. Deepika mam and all my seniors.
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