MY INTERNSHIP JOURNEY IN GENERAL MEDICINE.
I am Ravula Sankeerthana, Intern posted in the General Medicine Department from 1/12/23 until 31/1/24.
1.SELF REFLECTIVE WRITING ON MY MEDICAL STUDENT CAREER
I started seeing cases from my 3rd semester posting which was my very first experience with the clinics, It was very overwhelming pretty much the entire year. I learned lot from my professor , some times I find myself suprised by hearing about cases and the way they approach the understanding of each case and linking the history about the case to diagnose the case and to explain how to understand a case and to diagnose a case.
My 1st case I saw in detail was Heart failure in gm posting so I studied the case in detail during my posting along with understanding where my pgs , faculty helped to take history step by step.
Here is the link of the case
http://ravulasankeerthanarollno134.blogspot.com/2022/10/a-75-old-female-with-chief-complaints.html
During my general medicine posting as an intern,it started with peripherals which are icu, amc, nephro, ward where there is monitoring of patients who are critically ill and looking into each case while understanding the condition of the patient and in nephrology I saw how dialysis works and helps the patient with CKD and observing changes in patient before and after Dialysis . During my posting in psychiatry I saw a variety of cases along with PGs who explained the importance of privacy of patient history and taking history.
2 .EVIDENCE BASED DATE WISE WORKFLOW LOGS COLLATED BY THE INTERN WITH CLICKABLE AND VERIFIABLE LINKS
1/12/23 to 15/12/23 - PERIPHERALS
16/12/23 to 31/12/23 - posted in psychiatry
1/1/24 to 31/1/24 - posted in unit
This is Ravula sankeerthana posted in medicine department from December 1st to January 31th
1/12/23 to 15/12/23 - PERIPHERALS(Icu, nephro, ward)
IN ICU POSTINGS:
During my icu, amc duties
-I monitored vitals of patients every hourly
-Took abg samples
-put ryles tube for feeding
-foleys catheterization
- Done CPR in the icu
- blood transfusion
- SDP transfusion
IN NEPHROLOGY POSTINGS :
Assisted in central line procedure and done suturing
Monitored patients undergoing dialysis
Learnt about dialysis procedure
IN WARD:
- took blood samples
-monitored vitals
- Performed ascitic tap
- Assisted in dressings
16/12/23 to 31/12/23 - posted in psychiatry
In the OP saw cases of
-schizophrenia
-Alcohol dependence syndrome
-obsessive compulsive disorder
-Anxiety disorder
-Somnambulism associated with dissociative disorder
-Psychiatry counseling
-Hypochoncdria
-Depression
Used to monitor patients in the De addiction center.
One of the admission during my posting
Diagnosis - Somnambulism associated with dissociative disorder - Overnight monitoring
1/1/24 to 31/1/24 - posted in unit
Case 1
https://ravulasankeerthanarollno134.blogspot.com/2024/01/4of-came-with-co-pain-in-upper-and.html
Case 2
https://ravulasankeerthanarollno134.blogspot.com/2024/01/this-is-a-online-e-log-book-to-discuss.html
Case 3
https://ravulasankeerthanarollno134.blogspot.com/2024/01/clo-sob-15-day-fever-pt-wan-appaeintly.html
Case 4
Case 5
Case 6
Case 7
Case 8
https://ravulasankeerthanarollno134.blogspot.com/2024/01/co-fever-since-3-days-co-cough-since.html
Case 9
https://ravulasankeerthanarollno134.blogspot.com/2024/01/70f-with-swelling-of-both-lower-limbs.html
Case 10
https://ravulasankeerthanarollno134.blogspot.com/2024/01/co-pedal-edema-since-6-days-co.html
Case 11
https://ravulasankeerthanarollno134.blogspot.com/2024/01/60y-f-came-to-casualty-with-co-burning.html
Case 12
Case13
https://ravulasankeerthanarollno134.blogspot.com/2024/01/is-a-online-e-log-book-to-discuss-our.html
PaJR:
https://chat.whatsapp.com/HSYRc1orX2CDhwIx3Yuayg
3) ANECDOTAL SELF REFLECTIONS ON THEIR INTERNSHIP LEARNING WITH SOME VIDEO EVIDENCE OF PROCEDURES PERFORMED
-Took abg samples
-put ryles tube for feeding
-foleys catheterization
- Done CPR in the icu
- blood transfusion
- SDP transfusion
- assisted intubation
- assisted central line and did suturing
Ascitic tap:
Dialysis:
ABG:
Ryles :
Upper GA endoscopy:
https://youtu.be/V9YvuOloZcs?si=IgDtxJ_NBFWTVlUP
4. Osce
-Differentiate between upper respiratory infection and lower respiratory tract infection based on symptoms??
=} lower respiratory tract infections - coughing as the primary symptom.upper respiratory tract infections - sneezing, headaches, and sore throats associated with body aches, if they have a fever.
https://www.medicalnewstoday.com/articles/324413
- most bacteria causing lung infection most common??
=} RSV ,Streptococcus, Staphylococcus aureus,fungal infections,mycplasma
https://www.medicalnewstoday.com/articles/324413
-Amount of sodium correction allowed in 24 hr in hyponatremia patient??
=} In patients with severe symptomatic hyponatremia, the rate of sodium correction should be 6 to 12 mEq per L in the first 24 hours and 18 mEq per L or less in 48 hours. A bolus of 100 to 150 mL of hypertonic 3% saline can be given to correct severe hyponatremia.
- Guidelines for asthma treatment?
The preferred reliever medication is specified as low-dose ICS-formoterol, which is an off-label use. Other reliever options include as-needed SABA. See the following stepwise approach:
- Step 1: As-needed low-dose ICS-formoterol (off-label); other options are low dose ICS taken whenever SABA is taken
- Step 2: Daily low-dose ICS, or as-needed low-dose ICS-formoterol (off-label); other options are leukotriene receptor antagonist (LTRA) or low-dose ICS taken whenever SABA is taken
- Step 3: Low-dose ICS/LABA; other options include medium-dose ICS or low-dose ICS + LTRA
- Step 4: Medium-dose ICS-LABA; other options are high-dose ICS, add-on tiotropium, or add-on LTRA
- Step 5: High-dose ICS-LABA; refer for phenotypic assessment with or without add-on therapy (eg, tiotropium, anti-IgE, anti-IL5/5R, and IL4R; other options are to add low-dose OCS, but consider adverse effects
https://emedicine.medscape.com/article/296301-guidelines
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