23rd: First day of Medicine postings, handover and briefing of the cases was done with the previous batch interns.
24th: Sunday- went for rounds with unit PG. Gave dressing for a grade 1 bedsore. Learned how to make SOAP notes.
25th: Learned how to insert a Foley's catheter in a female patient. Observed and learned how to put Ryles tube.
26th: First OP day. An interesting case of a young male with quadriparesis was admitted. Did CNS examination and studied examination of power in mucles of the limbs.
27th: Learned how to take an arterial sample for ABG and venous blood sample. Learned about metabolic acidosis and treatment.
28th: Discussion about gastroenteritis and AKI, effects of NSAIDs on kidneys.
29th: discussion of possible treatments and efficacy of treatments for AIDP. Planning next course of action for CNS patient.
30th: Learned about nerve conduction studies and nerve biopsy. Discussion about thrombocytopenia in relation to gastroenteritis.
31st: Sunday- read about GBS and its variants, and treatment.
June
1st: icu duty, discharges of patients. Learned about drugs causing thrombocytopenia.
2nd: amc night duty. Discussion of possible causes of severe hypokalemia.
3rd: Learned about ECG changes and observed them in ecgs of hypokalemia patient, learned about hypokalemic periodic paralysis. Observed ascitic tap in CKD patient.
4th: Submitted E-log. Discussed about the efficacy of steroids in inflammatory diseases of nerves.
5th: discussion about pancytopenia in HIV and necessity for bone marrow biopsy to determine cause. Monitored blood transfusion for a patient. Learned about transfusion reactions.
6th: Discussion of treatment for diabetes in a hypokalemic patient. Counseling of patient for appropriate diet in view of both conditions.
7th: First day of Nephrology duty. Monitored patients on dialysis. Learned about haemodialysis.
8th: Took patient for surgery referral due to abscess formation at site of i.v. cannula. One patient developed sudden severe SOB, and saturation was rapidly falling. Patient did not respond to Oxygen supplementation, hence he was shifted to dialysis unit and bag and mask ventilation was given until saturation was raised to a sufficient level to attempt intubation.
Observed and learned Intubation.
After intubation, CPAP machine was connected to the ET tube and saturation maintained. Constant monitoring was required until extubation was done.
9th: Follow up with patient who was intubated. Observed Lumbar Puncture procedure and ultrasound guided ascitic tap.
10th: First day of Psychiatry posting. Learned about SSRI, SNRIs, TCAs. Learned about schizophrenia.
11th: Saw a patient of General Anxiety Disorder. Learned about positive and negative symptoms.
12th: Learned about Dementia and depression.
13th: Read about psychiatric disorders caused by metabolic disorders.
14th: Learned about Dementia and Depression.
15th: Saw patients with schizophrenia, bipolar disorder, and alcohol withdrawal.
16th: Unit 2 OP duty. We had a patient presenting with severe acute chest pain since early that morning. Serial ECGs showed evolving MI. Unfortunately patient's attenders wanted to leave against medical advise. I and a co-intern had night duty. Observed procedure of establishing Central Line for a patient requiring dialysis. Learned how to obtain venous and arterial blood samples and how to give injections via IV catheter.
17th: Saw a case of domestic abuse PTSD now showing dissociative disorder.
18th: Saw a case of schizophrenia having 3rd person delusions, paranoia.
19th: Saw a case of Catatonia. Patient presented with rigidity, slow speech and decreased responsiveness. Complaints from family of hallucinations.
20th: Saw case of Generalized Anxiety Disorder. A case of Dissociative disorder presented in casuality unconscious with pseudoseizures.
21st: Read about Diuretic drugs, uses, mode of action, and side effects.
22nd: Learned about kidney function, specifically drugs which are nephrotoxic, effect of NSAIDs on kidneys.
23rd: OP duty. Admitted 2 patients; CVA and GE cases. Detailed history and examination was done after admission of patients. I had night duty as well. Inserted Ryles tube for ICU patient.
24th: admitted 2 emergency cases, a patient presenting with tachycardia and another patient with acute abdominal pain.
25th: Learned about adenosine drug. Learned BISAP scoring for necrotizing pancreatitis. GE case patient was relieved with antibiotics and discharged.
26th: Took patient for HRCT, but it appeared the patient may have an allergic reaction to the contrast material hence patient did not consent to HRCT. Normal CT was done in which enlarged head of pancress was seen. Acute pancreatitis was suspected. 1 patient was discharged.
27th: 2 patients were relieved and discharged. Read about treatment for acute pancrestitis. Examined a case of pericardial effusion.
28th: Read about Staphylococcal aureus. Read about effects of Uremia.
29th: Read about heart blocks, and the ecg findings.
30th: OP day, admitted 2 patients- hypertensive emergency, secondary cushings. Emergnecy case in casuality,
July
1st: Discussion about the secondary cushings patient, who seemingly developed features of cushings syndrome due to topical steroids.
2nd: Hypertensive patient was taken to neurology OP for opinion regarding bilateral lower limb tingling and numbness. MRI dorsal spine was done. Observed a therapeutic pleural tap.
3rd: collected reports of our patients, learned about torsades de pointes. Discussion regarding the hypertensive patient, as he had bilateral lower limb weakness and tingling sensation, which points to diagnosis other than TIA.
4th: Discharged a patient. Had technical work of preparing cases with all the relative aids (videos and pictures) for the PG exams.
5th: Studied about pulmonary hypertension.
6th: Studied pericardial effusion and its clinical findings and treatment.
7th: OP day. Saw an anemia patient, heard diastolic murmur. Saw a Patient with severe limb ischemia, so much pain that he required morphine, which is not available in our hospital. Hypoglycemia patient and a heart failure patient were admitted.
8th: Took patient for orthopedics referral due to complaints of knee pain. They requested xray, so took patient for xray. The patient had tall T-waves on ecg, and slightky elevated potassium levels, hence 2D-echo was done, but no abnormalities were found.
9th: patient was taken to cect, with bowel preparation done.
10th: Read about heart failure, and different types of pulses seen in heart failure.
11th: Took patient for chest xray and reporting of xray.
12th: read about pneumonia, how to diagnose and xray findings, treatment.
13th: collected CT report of patient. Learned about Shone complex and treatment of heart failure.
14th: OP day. Very dull as patients were few, and unwilling to get admitted.
15th: Learned about Circle of Willis.
16th: Learned the areas of brain and how to locate effected areas based on symptoms.
17th: Read about Uremic Encephalopathy in CKD patients.
18th: Discussed about Malaria, and the differences between textbook findings and in reality presentation.
19th: Read about Cholera and mechanism of action of its toxin in causing diarrhea.
20th: Read about Dengue and other causes of platelet deficiencies.
21st: OP day. Admitted 5 patients. One pancreatitis, heart failure, dengue suspect, and CVA case. One was a returning patient with CIDP.
22nd: Last day of Medicine postings. Took pancreatitis patient for CECT. Report confirmed acute pancreatitis. Briefed the next batch interns of the cases in our unit.