This is M swathi of 2k18 batch posted in General medicine department as an intern.
My internship is from October 1 to November 30
This is an online E log book 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 series of inputs from global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.
This E log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box is welcome."I've 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 a diagnosis and treatment plan.
Procedures performed during internship
Taken abg samples
Procedures done 2 ryles tube
4 Foleys catheterization
Done 2 cpr
Assisted in 1 intubation
Inj lasix 40mg given during dialysis
Assisted in ascitic tap
In icu and amcu duty;
Monitored vitals of all pts hourly
Maintenance of ventilator settings as guided by the respective PG.
Taken ABGs and have taken samples for lab investigations.
Learnt how to manage in critical situations.
Learnt stabilisation of pt in critical situations
Nephrology :
65 yr old male came with complaints of
Fever, dry cough , decreased urinary output since 4 days and patient developed sudden onset of chest pain,sob,and hypotension on 3/10/23
Provisionally diagnosed as pyrexia with thrombocytopenia aki on ckd
Learning points
Indication of dialysis
- Acute kidney injury.
- Uremic encephalopathy.
- Pericarditis.
- Life-threatening hyperkalemia.
- Refractory acidosis.
- Hypervolemia causing end-organ complications (e.g., pulmonary edema)
- Failure to thrive and malnutrition.
- Peripheral neuropath
- Complications of dialysisis:
- Hypotension
- *Cardiac arrthymias
- *Hemorrhage due to anticoagulants
- *Air embolism
- *Anaphyalctic reactions
- *Infections
- *Pulmonary edema
- *Dialysis disequilibrium syndrome-Characterized by nausea, vomiting, headache,hypertension, seizures and coma. This is because of rapid changes in plasma osmolality leading to cerebral edema
Cases scenario 1
Case
Focal Seizures with impaired awareness with CVA with k/c/o Hypertension.
Patient came to casualty with H/O 2-3 episodes of involuntary movements of right upper and lower limb and face since evening(28/10/23)
Another intern who went for peripherals handed over the case to me I updated everything about this case
History Of Presenting Illness:
Patinet was apparently asymptomatic till today afternoon after she which she started having involuntary movements of right right upper and lower limbs associated with up rolling of eye balls and frothing not associated with involuntary micturation and defecation associated with postictal confusion for 15-20min.
H/o seizure activity on and off from past 3years and is on medication.
No h/0 fever and head trauma.
K/c/o Hypertension,CVA
Past History:
N/k/c/o DiabetesTuberculosis,bronchial asthma,epilepsy,CAD.
https://moteswathi94.blogspot.com/2023/11/75-yr-female-with-convoluntary.html
Case scenario 2:
C/o abdominal distension, Abdominal bloating sensation since 20days Bilateral Pedal edema since 6months
History of presenting illness:
Patient was apparently alright 6 months back then developed bilateral pedal edema, which was insidious in onset gradually progressive pitting type extending upto knee
Abdominal distension which was insidious in onset gradually associated with sob and loss of appetite No chest pain,
No h/o chest pain, sweating, palpitations ,orthopnea,PND
No H/O burning micturition
No H/O fever,cold,cough
No H/O nausea, vomiting, loose stools
Past history
k/c/o diabetes 2 since 10 years
K/c/o CAD s/p PTCA done on 17/8/22
K/C/O CKD , CLD
H/O jaw surgery was done secondary to cancer 3 year's ago
Provisional diagnosis:
Ascites with spontaneous bacterial peritonitis.chronic liver disease, chronic kidney disease stage
Blog link:
https://moteswathi94.blogspot.com/2023/11/65-yr-old-male-with-co-abdominal.html
Pajr link
https://chat.whatsapp.com/GUumpKOWhPzE7Trm2b2mpn
Case scenario 3:
Case seen in ward 70 yr old male with complaints of
H/o fever since 20days
H/o cough since 10 days
H/o cold since 10 days
Patient was apparently asymptomatic 20 days backlater developed fever, which was intermittent,more at night, associated with chills and rigor not relieved on medication . Fever low grade to high grade
Cough insidious onset associated with sputum, mucoid, non foul smelling,non blood stained, more at night relieved with medication
Cold since 10 days
Patient had h/o palpitations, burning micturition weekstream of urine
No H/o chest pain, vomiting, loose stools,
No H/o PND, orthopnea
No H/o headache
Past history:
HTN since 1 year on tab amlong 5 Mg PO/OD
Provisional diagnosis: lower respiratory tract Infection
Blog link
https://moteswathi94.blogspot.com/2023/11/70-yr-old-male-with-co-fever-since.html
Case scenario 4
Case came to casuality with
CHIEF COMPLAINTS:
C/o vomiting since 1 day.( 10-15 episodes)
- non bilious
- non projectile
- immediately after drinking water or eating food
C/o pain abdomen since 1 day
- epigastric region
- non radiating
I took the abg sample and patient had a severe nausea so zofer injection given to patient and patient was hypoglycemic at the time of presentation 25 %dextrose given
PROVISIONAL DIAGNOSIS:
Alcoholic liver disease with Acute Pancreatitis with hypoglycemia
https://moteswathi94.blogspot.com/2023/11/32m-pain-abdomen-and-vomiting-since-1.html
Psychiatry posting:
Learnt how to take History in Psychiatry
2. Seen a case of Obsessive Compulsive Disorder
3. Seen a case of Moderate depression
4. Seen a case of Cannabis induced psychosis
5. Seen case of Alcohol dependent syndrome and Tobacco dependent syndrome
6. Participated in the activity of awareness of suicide prevention and starting of a helpline number on the occasion of World Suicide Prevention
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