Internship assessment

 This blog is made based on my experience that showcases my competency and pitfalls

UNIT duties—-First 15 days (12/12/22-26/12/22)

                        Last 16 days (27/1/23-11/2/23)

>I would check the vitals of my patients and update SOAP notes Daily morning   

>Have taken samples and took the patients for required investigations (CECT,USG ABDOMEN,XRAYS AND RECENTLY GOT IVP DONE FOR A URETHRAL STRICTURE CASE)          

>have done ascitic tap on a patient 

On OP DAY

>I have checked vitals of every patient 

>Examined for reflexes, postural hypotension, Romberg’s sign

>Have learnt basic management protocol for sob, chest pain and headaches 

Here are the blogs I made during my unit duties 

1)

https://166sasirakasinadhuni.blogspot.com/2022/12/80year-old-with-fever-burning.html

2)

https://166sasirakasinadhuni.blogspot.com/2022/12/13-year-old-with-gross-haematuria-and.html

3)

https://166sasirakasinadhuni.blogspot.com/2023/01/27year-old-with-bl-pedal-edema-facial.html

4)

https://166sasirakasinadhuni.blogspot.com/2022/12/60year-old-female-brought-to-casuality.html

5)

https://166sasirakasinadhuni.blogspot.com/2023/02/68yf-with-sob.html

ICU AND AMC DUTIES (27/12/22-31/12/22 and on 6/1/23,7/1/23)

                           

>My first and foremost important work in ICU AND AMC was to monitor the vitals of patients timely ( varying from hourly basis to 2nd hourly)

>Have Taken about 5 ABGs and many samples for lab investigations.

>Have Learnt how to manage in critical situations 

>I have Assisted in intubation for 1 patient

> Ryles have been put for 4 patients  

> Foleys have been put for 7patients

>Have given RT feeds 

> have helped the patient for ambulation

NEPHRO DUTY (1/1/23-5/1/23)

>monitored patients who came for dialysis 

>Handled Day care patients who came for dialysis. 

> Learnt about dialysis machine , central line care and fistula importance

>Have given NTG to 1 patient and have monitored the patient meticulously 

> Have learnt how to maintain patients BP and GRBS while dialysis is going on

> Have Learnt about drugs used in hypo and hypertension

> here is the link to the blog of an icu patient who underwent dialysis :

 

https://166sasirakasinadhuni.blogspot.com/2023/01/24ym-with-sob.html

WARD DUTIES (8/1/23-11/1/23)

> Have updated soap notes of patients

>Helped my co interns in updating soap notes 

>Have taken samples

>was present for rounds and presented the cases 

>with the help of my Co intern , i have completed all the works assigned 

PSYCHIATRY DUTY (12/1/23-26/1/23)

>Learned about importance of history taking 

>vitals monitoring done for OP patients

Examples like :

1. Schizophrenia 

2.OCD

3.ALCOHOL DEPENDENCE SYNDROME 

4. TOBBACO DEPENDENCE SYNDROME 

>  learnt about the medications given to the patients and their side effects

> have seen and learnt from pgs regarding how they handle patients in DAC

>Have had a catatonic schizophrenic patient admitted, for whom I have monitored and learned how BENZODIAZEPINES worked in this patient. 

68Y/F WITH SOB

 This is an a online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.

This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan 

COMPLAINTS AND DURATION:

Pt c/o cough: 6 months

Shortness of breath= 4-5 months 

HOPI:

-Patient was apparently normal untill 6months back.

 then developed productive cough, insidious in onset gradually progressive  with white colored mucoid sputum , relieved on taking medication and aggrevated later I.e., cough Increased mostly at night time around 3-4AM

• Shortness of breath: 4-5 monthly, insidious in onset and gradually progressed to grade-IV now. Increases on walking for few steps.
  Orthopnoea present.
• feels better on lying to lateral side.
• Pt also gives h/o PND

PAST HISTORY:

H/o decreased appetite: 4 months.

no h/o fever/ burning micturition/ pain abdomen / chest pain/ palpitations

No Decreased urine output/ pedal edema.

Not a k/c/o DM/HTN/TB/ Epilepsy / CVA / CAD/ thyroid diseases

- H/o fall 2 years back -> Right antle # - POP applied.

PERSONAL HISTORY:

Normal appetite, mixed diet with regular bowel and bladder habits and addiction of smoking 

2-3beedis/day started 8years back ,stopped 2 years back

GENERAL EXAMINATION:

PT IS C/C/C

PALLOR: PRESENT

NO PEDAL EDEMA,ICTERUS,CYANOSIS,CLUBBING,

LYMPHADENOPATHY 

VITALS ON ADMISSION:

PR-98 BPM

BP- 130/80MM HG

RR- 40 CPM

SPO2- 92% AT RA

GRBS - 133mg/dl

SYSTEMIC EXAMINATION:

1) PER ABDOMEN:

INSPECTION:UMBILICUS IS CENTRAL AND INVERTED, ALL QUADRANTS MOVING EQUALLY WITH RESPIRATION,NO SCARS,SINUSES, ENGORGED VEINS, PULSATIONS.

PALPATION: SOFT,NON TENDER.NO ORGANOMEGALY.

ASCULTATION: BOWEL SOUNDS - HEARD

2)RESPIRATORY SYSTEM:

INSPECTION: SHAPE OF THE CHEST IS ELLIPTICAL. B/L SYMMETRICAL. BOTH SIDES MOVING EQUALLY WITH RESPIRATION..NO SCARS,SINUSES, ENGORGED VEINS,PULSATIONS.

PALPATION:NO LOCAL RISE OF TEMPERATURE AND TENDERNESS.TRACHEA IS CENTRAL IN POSITION.EXPANSION OF CHEST IS SYMMETRICAL VOCAL FREMITUS IS NORMAL

PERCUSSION: RESONANT BIL

ASCULTATION: BAE + , NVBS HEARD

3) CVS:

INSPECTION: B/L SYMMETRICAL, BOTH SIDES MOVING EQUALLY WITH RESPIRATION,NO SCARS,SINUSES, ENGORGED VEINS,PULSATIONS.

PALPATION: APEX BEAT FELT IN LEFT 5TH ICS. NO THRILLS AND PARASTERNAL HEAVES.

ASCULTATION: S1S2 +,NO MURMURS

4) CNS:

PATIENT WAS C/C/C.

HIGHER MENTAL FUNCTIONS- INTACT

GCS - E4V5M6

B/L PUPILS - NORMAL SIZE AND REACTIVE TO LIGHT

NO SIGNS OF MENINGEAL IRRITATION,CRANIAL NERVES- INTACT, SENSORY SYSTEM-NORMAL,

MOTOR SYSTEM:

 TONE- NORMAL, 

POWER- 5/5 IN ALL LIMBS REFLEXES: 

B/L REFLEXES: BICEPS - 2+, TRICEPS-2+, SUPINATOR + , KNEE - 2+, ANKLE - 2+

INVESTIGATIONS :

ECG 

CXR 

Sputum culture

DIAGNOSIS:

SOB UNDER EVALUATION

?PULMONARY KOCHS

TREATMENT:

1.Nebulisation with DUOLIN 4th hrly 

                                  BUDECORT 8th hrly

2.Syp: ARCORYL-LS

        2TBSP TID.

3.T LEVOCETRIZINE PO BD

      8AM —————-8Pm

4.T. PAN 40mg PO OD

7am —x——x

5.SYRUP CREMAFFIN PO HS 10ml

60year old female brought to casuality in unresponsive state

This is an a online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.

This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan 

PATIENT WAS BROUGHT TO CASUALITY IN UNRESPONSIVE STATE.

PATIEN WAS APPARENTLY ASYMPTOMATIC 3 YEARS BACK THEN SHE DEVELOPED GENERALISED WEAKNESS FOR WHICH SHE VISITED LOCAL HOSPITAL AND WAS DIAGNOSED WITH TYPE 2 DM. SINCE THEN PATIENT WAS ON IRREGULAR MEDICATION. TODAY MORNING PATIENT ATTENDERS NOTICED THAT PATIENT WAS IN UNRESPONSIVE STATE AND WAS UNABLE TO WAKEUP FROM SLEEP AND WAS TAKEN TO LOCAL RMP (HIGH SUGARS 600 MG/DL WAS OBSERVED) AND WAS REFERRED TO OUR HOSPITAL IN UNRESPONSIVE STATE, HER GCS - E1V1M6.

NO H/O ABNORMAL MOVEMENTS, HEADACHE,VOMITING. K/C/O DM2 SINCE 3 YRS AND ON IRREGULAR MEDICATION.

NOT K/C/O HTN,ASTHMA, CAD, EPILEPSY. PERSONAL HISTORY :

APPETITE - NORMAL

DIET - MIXED

BOWEL AND BLADDER - REGULAR

SLEEP - ADEQUATE

ADDICTIONS : OCCASIONAL TODDY-ONCE A WEEK

TOBACCO(BEEDI) FROM 20 YEARS, STOPPED 3 YEARS AGO

GENERAL EXAMINATION :

NO PALLOR, ICTERUS,CYANOSIS,CLUBBING,LYMPHEDENOPATHY,PEDAL EDEMA

VITALS ON ADMISSION:

TEMP- 101 F

PR-90 BPM

BP- 100/70MM HG

RR- 20 CPM

SPO2- 97% AT RA

GRBS - 226 MG/DL

SYSTEMIC EXAMINATION:

1) PER ABDOMEN:

INSPECTION:UMBILICUS IS CENTRAL AND INVERTED, ALL QUADRANTS MOVING EQUALLY WITH RESPIRATION,NO SCARS,SINUSES,ENGORGED VEINS,PULSATIONS.

PALPATION: SOFT,NON TENDER.NO ORGANOMEGALY.

ASCULTATION: BOWEL SOUNDS - HEARD

2)RESPIRATORY SYSTEM:

INSPECTION:SHAPE OF THE CHEST IS ELLIPTICAL,B/L SYMMETRICAL.BOTH SIDES MOVING EQUALLY WITH RESPIRATION..NO SCARS,SINUSES,ENGORGED VEINS,PULSATIONS.

PALPATION:NO LOCAL RISE OF TEMPERATURE AND TENDERNESS.TRACHEA IS CENTRAL IN POSITION.EXPANSION OF CHEST IS SYMMETRICAL .VOCAL FREMITUS IS NORMAL

PERCUSSION: RESONANT B/L

ASCULTATION: BAE + , NVBS HEARD

3) CVS:

INSPECTION: B/L SYMMETRICAL, BOTH SIDES MOVING EQUALLY WITH RESPIRATION,NO SCARS,SINUSES,ENGORGED VEINS,PULSATIONS.

PALPATION: APEX BEAT FELT IN LEFT 5TH ICS.NO THRILLS AND PARASTERNAL HEAVES.

ASCULTATION: S1S2 +,NO MURMURS

4) CNS:

GCS - E1V1M6

B/L PUPILS - NORMAL SIZE AND REACTIVE TO LIGHT

NO SIGNS OF MENINGEAL IRRITATION,CRANIAL NERVES- INTACT, SENSORY SYSTEM- NORMAL,

MOTOR SYSTEM: TONE- NORMAL, POWER- 0/5 IN RIGHT UL AND LL , 2/5 IN LEFT UL AND LL REFLEXES : BICEPS - 1+ , TRICEPS-1+ , SUPINATOR - 1+ ,KNEE - 1+ , ANKLE - 1+

Investigations:

1)HEMOGRAM:

29/01/23

HB : 13.0 mg/dl

PCV : 24.8%

TLC : 13500 CELLS/CUMM PLAT: 1.8 LAKH/CUMM 30/01/23

HB : 11.1 mg/dl

PCV : 34.5%

TLC : 13400 CELLS/CUMM PLT : 1.7 LAKH/CUMM 31/01/23

HB : 10.6 mg/dl

PCV: 33.1 %

TLC : 6900 CELLS/CUMM PLT : 1.7 LAKH/CUMM 

01/012/23

HB : 10.8 mg/dl

PCV : 33.3%

TLC : 6700 CELLS/CUMM

PLT : 2.1 LAKH/CUMM

ABG ON 28-01-2023 (04:15:PM)

PH   4.50 

PCO2  30.4 

PO2  76.6

HCO3  24.0

St.HCO3 : 26.3 

BEB : 2.2 

BEecf : 1.2 

TCO2 : 46.0 

O2 Sat : 95.7 

O2 Count : 19.5

Serum creatinine :1.2mg/dl

PHOSPHOROUS 28-01-2023:-2.0 mg/dl 

HBsAg-RAPID: Negative

HIV : Negative

ANTI HCV : Negative 

BLOOD UREA : 28- 56 mg/dl

SERUM ELECTROLYTES —

SODIUM  ; POTASSIUM ; CHLORIDE ; CALCIUM 

143 mEq/L ;   3.0 mEq/L      ; 105 mEq/L   ;1.05 mmol/L

LFT:

Total Bilurubin :1.07 mg/dl 

DB: 0.20 mg/dl 

AST:24 IU/L

ALT: 13 IU/L 

ALP: 143 IU/L

TP:6.2 gm/dl 

ALB:3.0 gm/dl 

A/G: 0.89

2)USG ABDOMEN: NO SONOLOGICAL ABNORMALITY DETECTED 3)USG NECK: TRIRADS 3 LESION IN RIGHT LOBE OF THYROID

TRIRADS 2 LESION IN LEFT LOBE OF THYROID 4)BLOOD C/S : NO GROWTH SEEN

5)URINE C/S : E.COLI ISOLATED.

6)2D ECHO : NO RWMA , CONCENTRIC LVH+

TRIVIAL TR+/MR+/AR+

NO AS, MS

EF=62%

GOOD LV SYSTOLIC FUNCTION, DIASTOLIC DYSFUNCTION +, NO PE,PAH.

Diagnosis:

? SEPTIC ENCEPHALOPATHY (SECONDARY TO UROSEPSIS) WITH HYPERGLYCEMIA (RESOLVED) WITH TYPE 2 DM

Treatment :

1.IVF - NS@ 75ML/HR

2.INJ.PIPTAZ 4.5 GM IV/TID

3.T NITROFURONTOIN 100 MG PO/BD

4.INJ PAN 40 MG IV OD

5.INJ KCL 20 MEQ IN 100 ML NS

6.INJ MAGNESIUM 1 AMP IN 100 ML NS

7.T DOLO 650 MG PO/TID

8.SYP POTCHLOR 10 ML PO/TID

9.INJ HAI S/C ACCORDING TO GRBS