Internship in Medicine department
I, Vaibhav Sai, worked as an intern in the department of General Medicine from 01/12/2023 to 31/01/24.
1) Self Reflective Writing on their medical student career -
My role as in intern involved looking after the patients in ICU, AMC, medical wards and the dialysis unit in various phases of my posting under the guidance of my PGs.
Initially, I faced the challenges of having to deal with multiple patients in my unit, long shifts and the bureaucracy of work flow in our hospital. But, this initial discomfort helped me grow and face any further hurdles efficiently.
I learnt the importance of taking a detailed history of the patient's complaints and the impact it had on their daily lives. I also improved my clinical examination skills during the posting. I was given the opportunity to perform and assist in various procedures.
One of the key takeaways from this journey has been the realization that medicine extends beyond diagnosis and treatment but involves understanding the holistic needs of the patient and the impact of illness on their lives.
As I reflect on my internship in the general medicine department, I realize it has been more than a professional experience. The lessons learned, skills acquired, and the empathy cultivated will serve as a stepping stone for my future endeavors in the field of medicine.
2) Evidence based date wise workflow logs collated by the intern with clickable and verifiable links -
01/12/23 - 31/12/23 ----> UNITS
01/01/24 - 15/01/23 ----> PSYCHIATRY DEPARTMENT
16/01/24 - 31/01/24 ----> PERIPHERALS
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.
CASE 1 -
BLOG -
https://vaibhavrollno143.blogspot.com/2023/12/60f-with-cad-ccf-since-august-2023-with.html?m=1
Chief Complaints -
60 year old female presented with complaints of ulcer over the left since 1 month.
History of Present Illness -
Patient was apparently alright 1.5 month ago when she developed blisters over left leg and foot which progressed to form a necrotic ulcer over the left leg.
She has associated loss of appetite and generalized weakness since 1 month.
It is associated with pain and intermittent fever. It is also associate with discharge.
No history of trauma.
No history of similar complaints in the past.
Past History -
K/C/O HTN since 3 years, on Telma 20mg OD.
N/K/C/O DM, Asthma, TB, Epilepsy.
Sequence of Events -
- History of backache since 15 years for which she did nnot use any medication.
- History of knee pain since 5 years for which she used to get injections from an RMP (4-5 injections/ month for the past 3-4 years)
- On September 18th, She developed cough with sputum and facial edema for which she had to be hospitalized. She was discharged the same day and recovered in about 1 week.
- On November 4th, She developed blisters over the ankle and lower leg. She was prescribed medication in a private hospital and was discharged.
- By November 8th, she developed generalized weakness, loss of appetite. She was hospitalized again and was diagnosed with necrotizing fascitis. She underwent debridement and excision and was discharged on november 12th.
- She continued to have a poor appetite, generalized weakness over the past month.
- On December 15th, She had to hospitalized again on worsening of her symptoms. She underwent further debridement and excision of the remaining necrotic tissue.
- On December 18th, she was admitted here with C/O chronic ulcer, loss of appetite and generalized weakness.
- She was transferred to the department of general medicine on the evening of 20th December over persistent hypoglycemia.
On NOVEMBER 6th -
Personal history -
Addictions - None
Diet: non-vegetarian
Apetite: decreased
Bowel and bladder: regular
Sleep: disturbed
6 pm -161. 8 pm -235. 9 pm- 187. 11pm - 242
21/12/23
12 Am -224. 6 AM -132.
1Am - 172. 8 AM -141
2 Am -212 . 10 AM - 141
4 am - 178.
Stopped infusion @12 pm, continued ryles feeding-ragi java ,protein powder in milk given
12 PM - 136.
2 pm -75
8pm -118
10 pm -124
22/12/23-morning-ragi malt
Afternoon-milk with protein powder
Eve-musk melon juice
12Am-40 6Am-90
2Am-70 8Am-62
4Am-100. 10Am-168
12pm-161. 2pm-75
23/12/2023-morning-milk with protein powder
Pt is not cooperative for ryles she removed it
Afternoon-raagi malt
Again started on ryles
Eve-raagi malt
2 AM - 112. 10AM -147. 8PM - 147
4 AM - 118. 2PM -117. 10 PM -136
8 AM -163. 4 PM -168.
24/12/2023-morning-milk
Afternoon-grape juice,water
Eve-raagi malt
Again she took off ryles and non cooperative for ryles feeding
2 AM -146. 2 PM -103 8 PM -110
8 AM -126. 4 PM -106.
10 AM - 98. 6PM -108
25/12/2023
2 AM - 126
6 AM - 110
8 AM -130
23/12/23 -
S -
Low grade fever
Generalized weakness
Left Leg pain
O -
On Examination
Patient is C/C/C
Temperature - 99F
BP - 120/80 mmHg
PR - 108 bpm
RR - 16 cpm
SpO2 - 97 on RA
CVS - S1S2 heard, no murmurs
RS - BAE+, Crepts in left axillary and infraaxillary region
P/A - Soft, NT
CNS - NFND
A -
1. CHRONIC NON HEALING ULCER OVER LEFT LEG
2. HYPOGLYCEMIA SECONDARY TO ?SEPSIS
P -
- IVF 3 NS AT 100ML/HR
- Inj. PAN 40 mg IV OD
- DVT Stockings of Right lower limb
- Left lower limb elevation
24/12/23 -
S -
Left Leg pain
O -
On Examination
Patient is C/C/C
Temperature - 99F
BP - 110/70 mmHg
PR - 104 bpm
RR - 14 cpm
SpO2 - 98 on RA
CVS - S1S2 heard, no murmurs
RS - BAE+
P/A - Soft, NT
CNS - NFND
A -
1. CHRONIC NON HEALING ULCER OVER LEFT LEG
2. HYPOGLYCEMIA SECONDARY TO ?SEPSIS
P -
- IVF 3 NS AT 100ML/HR
- Inj. PAN 40 mg IV OD
- DVT Stockings of Right lower limb
- Left lower limb elevation
Some of my other Case Reports -
CASE 2 -
https://vaibhavrollno143.blogspot.com/2023/12/47-year-old-male-with-altered-sensorium.html?m=1
CASE 3 -
https://vaibhavrollno143.blogspot.com/2023/12/60-y-old-male-patient-with-shortness-of.html?m=1
CASE 4 -
https://vaibhavrollno143.blogspot.com/2023/03/1801006155-long-case.html?m=1
CASE 5 -
https://vaibhavrollno143.blogspot.com/2023/03/a-29-yo-female-with-sobedema-facial-p.html?m=1
CASE 6 -
https://vaibhavrollno143.blogspot.com/2022/12/49-year-old-with-headache.html?m=1
CASE 7 -
https://vaibhavrollno143.blogspot.com/2023/01/71-year-old-male-with-hypervolemia.html?m=1
3) Anecdotal self reflections on their internship learning with some video evidence of procedures performed
- Ryles tube insertion
- Took abg samples
- Assisted in Central Line insertion
- Learnt how to do 2D Echo
https://youtu.be/yXUGq6hISLw?feature=shared
Anterior wall hypokinesia and Moderate LV dysfunction
- Monitored patients on Dialysis
- Assisted in intubation
- Performed Ascitic tap
- Performed Foley's Catherization
- Performed CPR
- Took venous blood samples
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