MEDICINE INTERNSHIP

This is Sindhusha, a medical student from India. As an intern who worked in the general medicine department, I embarked on a transformative journey, witnessing challenges and complexities of patient care. In this platform, I will share the glimpse into my journey in the department and recount my experiences and  lessons I gained during my time in the department.

 

CBBLE PAJR PARTICIPATORY LEARNING ACTION RESEARCH DISCLAIMER

NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS/HER GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.

 

 

My general medicine posting is from december 1 to january 31

 

 From 1st Dec to 15th Dec 

PSYCHIATRY- 

 

In psychiatry posting I have seen cases like schizophrenia , alcohol withdrawal , OCD , Dissociative disorders , ADHD

CASE :

According to OD mother and brother C/O decreased social interaction ,occasional self smiling and irritability since 6 months 

Decreased sleep and appetite , decreased selfcare and hygiene since 3 months 

HOPI :

Patient was apparently asymptomatic 6 months ago then OD observed decreased social interaction with family members and isolating herself from family members and self smiling , these symptoms increased since 3 months. 

Since 3 months Patient is not sleeping at nights and not taking food regularly and decreased selfcare and hygiene ( Patient passing stools and urinating in the bed and not taking bath for days ) 

Not doing any household work 

H/O head injury head injury at the age of 8 years , no scan taken

Family history: 

No psychiatric illness in the family 

Past history :

N/k/c/o DM , HTN , TB , asthma , epilepsy , CVA , CAD 

Treatment :

1. OD psychoeducated 

2. T. Olanzapine 5mg po/od 

I also visited deaddiction centre where patients are taught the consequences of taking alcohol and also given medication 

This is a case of 60 yr old female with CAD with heart failure with reduced ejection fraction

Patient presented to casualty with chief complaints of pedal edema since 5 days and shortness of breath since 3 days (approx. 3rd dec)

Patient was apparently asymptomatic 1 month back the she developed vomitings insidious in onset, daily 4 to 5 times watery in consistency, non projectile, non bilious, non blood stained, this continued for 4 to 5 days no known aggravating factors relieved on medication

Then the patient developed fever insidious in onset, continuous, low grade associated with chills and rigors with no associated aggravating and relieving factors.

The patient also developed blackish discolouration of the 3rd toe of left foot, (approx. 6th dec) the patient observed it 2 to 3 days after the symptoms started for which the patient was patient was taken to NIMS (approx. 8th dec) for all the above conditions where they treated the fever, chills, rigors and vomitings conservatively and were advised on removal of the third great toe for which the patient got admitted in our hospital on 13th December for the procedure and underwent disarticulation and debridement of 3rd toe of left foot. Later she was admitted in the hospital for 9 days and discharged on 21st December

Later the patient presented to casualty on 25th December with complaints of pedal edema for both legs since 5 days and shortness of breath since 3 days

Pedal edema was gradually progressive, not relieving, pitting type.

The patient had complaints of SOB which gradually progressed to MMRC grade 4 while presented to casualty, aggravated on sleeping position and relieved on sitting position.

The patient also had an ulcer of size 16x4x1 cm present over the plantar aspect of the left foot extending from the base of 3rd metatarsal to dorsum of the left foot

No H/o seasonal variations or episodes

No h/o giddiness or diarrhea

No h/o seizure episodes

PAST HISTORY

History of diabetes since 12 years using metformin 500mg and glimiperide Per oral once in the morning

Not a known case of hypertension, epilepsy, CAD, CVA, thyroid disorders, epilepsy

H/o disarticulation and debridement of 3rd toe of left foot 20 days back

PERSONAL HISTORY

Apetite decreased

Bowel and bladder movements normal

Mixed diet

Drinks toddy occasionally once a month

FAMILY HISTORY

No known cases of diabetes in family

GENERAL EXAMINATION

Patient is conscious, coherent, and cooperative

Moderately built

No pallor, icterus, lymphadenopathy, clubbing, cyanosis

VITALS

PR: - 140 beats per minute

Temperature: - 98 F

Respiration: - 32cpm

Blood pressure: - 90/70 mmHg

GRBS: - 419mg/dl

PROGRESSION

On the night of 25th the patient developed tachycardia upon ecg it was identified as ventricular tachycardia to which she was administered amiodarone and she was bought to normal sinus rhythm. Later on the patient developed bradycardia and her stats started to drop suddenly for which CPR was done and she was intubated and kept on a mechanical ventilator for 10 days from 25th of December to 2nd January. 

She was shifted from mechanical ventilator to oxygen through t piece on 2nd and extubated on 3rd January 

During CPR she suffered from a fracture of 2nd rib on the right side.

She developed bed sores in the sacral region on 31st December initially of grade 1 which now progressed to grade 2 bed sores

Prior to getting admitted here she was diagnosed to having a fungal ball in the left upper left lobe which is thought to be aspergilloma

DIAGNOSIS

Diabetic ketoacidosis

Acute pulmonary edema secondary to acute coronary syndrome

Herat failure with reduced ejection fraction

Severe LV dysfunction

Left upper lobe fungal ball (aspergilloma)

 

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LEARNING POINTS:

•  This case made me look into the physiology behind the development of heart failure and the various clinical scenarios in its presentation.
• I got very clear insights in relation between heart failure and pulmonary edema.
  

SERIAL ECGS:

 

 

 

CASE-3

This is one of the cases,I came across during my rotation in the nephrology ward.
 

https://patasindhusha117.blogspot.com/2024/01/a-70-year-old-female-with-ckd.html 

 

LEARNING POINTS:

• assisted in the central line.
• 
  
  
  
  
• I gained insights into the renal physiology and understood how hemodialysis plays a crucial role in supporting these functions.

• I learnt the importance of patient monitoring during the dialysis sessions including vitals,fluid status and the risk of potential complications.
  
• I got the opportunity to learn how to acquire the vascular access for hemodialysis.

 

 

 

CASE-4

This is a case of  27 year old male with generalised weakness since 20 days and yellowish discoloration of eyes since 2 years 

 

I came across this patient recently during my OPD duty , this is a case of 27 yr old male  who came to OPD with yellowish discoloration of eyes since 2 years, generalized weakness and loss of appetite since 20 days. 

https://patasindhusha117.blogspot.com/2024/01/a-27-year-old-male-with-generalised.html

 

 

LEARNING POINTS:

• Did ascitic tap with help of my post graduates
• Understood the pathophysiology behind the development of alocohol induced liver diseases.
   

 

IN ICU:

 

- taken ABG sample

 

- done ascitic tap of a patient  

-done CPR 

- Assisted in 1 intubation 

- learnt how to use BIPAP 

Procedures done-  4 ryles,  7 foleys  

 

CASE-5:

 

This is a case of 32 Year old male with C/O aphasia and generalised weakness

 

https://patasindhusha117.blogspot.com/2024/01/32-year-old-male-with-co-aphasia-and.html 

 

 

CONCLUSION:

 

• Working the general medicine department gave me opportunity to forge relationship with my patients, these interactions taught me the significance of communication between in a doctor and patient.
• The valuable time in the department also made me realise the vital role of research in advancing medical knowledge and improving patient outcomes.

 

 THANKYOU