Wednesday, 3 May 2023

Internship assessment

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

UNIT duties— 1st one month ie
                          (4/3/23-4/4/23)

>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 ONCE 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 

ICU AND AMC DUTIES
>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 learnt how to take ABGs and many other samples for lab investigations.

>Have Learnt how to manage in critical situations 

>I have Assisted in intubation for 1 patient

>Assisted Ryles insertion for patients  

>Assisted in Foleys been put for patients

>Have given RT feeds 
  


NEPHRO DUTIES:-
>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.

WARD DUTIES:-
> 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 DUTIES:-
>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.







75F recent ALTERED SENSORIUM right hemiparesis

This is an 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.

75/F presented to casuality in drowsy state at 7:45pm.



History of presenting illness  

Patient was apparently asymptomatic till afternoon after which patient had sudden loss of consciousness followed by fall after which patient became altered and was not coherent and confused. BP after the fall was around 170/110. No history of seizure activity.

No H/o frothing, up rolling of eye balls, involuntary micturition and defecation. No H/o ENT bleed, projectile vomitings. 

Past history 

N/k/c/o DM, HTN, asthma, epilepsy, TB, thyroid disorders.



On examination 

Patient is drowsy but arousal.

GCS:E3V4M6

BP:110/80mmhg.

PR:92/min

RR:18CPM

SPO2:98%ON ROOM AIR 

TEMP: 98°F

CVS:S1,S2 HEARD,NO MURMURS. 

RS:BAE+,NVBS.

PA:SOFT AND NONTENDER 

CNS:PUPILS :NORMAL SIZE AND NON REACTIVE. 

TONE: RT. LT

        UL HYPOTONIA NORMAL

    

  LL HYPOTONIA NORMAL

POWER:

        UL 0/5. 4/5   

        LL 0/5. 4/5

REFLEXES:

        B: 2+ 2+

        T: 2+ 2+

        S: 2+ 2+

        K: 3+ 2+

        A: 1+ 2+

        P: EXT. FLEXOR


PROVISIONAL DIAGNOSIS 

ALTERED SENSORIUM (RESOLVED) 2°TO ?ACUTE HEMORRHAGIC STROKE (SUBACUTE HEMATOMA IN LEFT PARIED OCCIPITAL REGEION).



On 02/05/2023

S:

4 FEVER SPIKES SINCE YESTERDAY MORNING

STOOLS PASSED 



O:

ON EXAMINATION:

Patient is conscious but not oriented. 

Gcs:E4V5M6

BP:140/90mmhg.

PR:98BPM

RR:18CPM

TEMP:96.7°F

CVS:S1,S2 HEARD ,NO MURMURS. 

RS:BAE+,NVBS.

CNS:PUPILS:B/L NORMAL SIZE REACTING TO LIGHT.

TONE: RT. LT

   UL: HYPOTONIA NORMAL

    

  LL:. HYPOTONIA NORMAL

POWER:

   UL. 0/5. 3/5   

    LL. 0/5. 3/5

REFLEXES:

        B: 2+ 2+

        T: 2+ 2+

        S: 2+ 2+

        K: 3+ 2+

        A: 1+ 1+

        P: EXT. FLEXOR



A:

ALTERED SENSORIUM (RESOLVED) 2°TO ?ACUTE HEMORRHAGIC STROKE (SUBACUTE HEMATOMA IN LEFT PARIED OCCIPITAL REGEION).





P:

RYLES FEED :100ML WATER EVERY 2ND HOURLY 

200ML MILK EVERY 4TH HOURLY. 



INJ. MANNITOL 100ML IV/ TID 



MONITORING VITALS HOURLY