Intern online assessment

Duration of posting - 12-08-22 - 11-10-22

During wards duty (12-08-22 - 16-08-22) :

Collected venous blood samples for routine investigations.

During Nephrology duty (17-08-22 - 21-08-22) :

1. Assisted in a central line procedure

2. Monitored Blood Pressures of the patients during dialysis, in the CKD ward

3. Attended to the complaints post-dialysis of the day care patients

4. Shifted a patient from ward to ICU (k/c/o CKD patient came to the casualty with complaints of SOB. Secretions blocking the airway were cleared and patient was shifted to dialysis. After dialysis I shifted the patient to ward (he was stable and was having his breakfast. When I came from lunch, he complained of SOB. So, I shifted him to dialysis and checked his SpO2 which was 74%. Therefore, immediately shifted him to ICU)

During ICU duty (22-08-22 - 26-08-22) :

1. Monitored vitals of the patients

2. Watched 1 central line procedure

3. Inserted a cannula for a female patient in ICU Bed 5

4. Took venous blood samples of patients

5. Took ABG

During Psychiatry (27-08-22 - 11-09-22) :

1. 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 Day - 10th September)

During units duty : 

1. Inserted Foley's catheter twice and tried inserting twice

2. Tried ascitic tapping in a obese patient with ascitis present in AMC

3. Took ABGs (once femoral, once when the patient was in casualty)

Case 1 :

http://caseopinionsbyrollno05.blogspot.com/2022/09/21-year-old-female-patient-with-fever.html



Case 2 :

http://caseopinionsbyrollno05.blogspot.com/2022/09/33-year-old-male-patient-who-is-chronic.html

1. The patient presented to the casualty with a SpO2 of 15%. The patient was intubated in the casualty i/v/o falling saturations even on 15 lit of O2. What could be the causative organism for his rapidly falling saturations? 

The ET tube culture showed Acinetobacter species. But would Acinetobacter species cause such extensive damage to lungs? Could there be some viral cause (RT-PCR Negative)?

2. After 2 days of intubation, on the 3rd day, the patient was conscious, coherent and cooperative and was signalling us if he can go home. On the same day we have planned the extubation of 2 patient. ICU BED 1 and ICU BED 3. While ICU BED 1 was being extubated, I found that this patient became unresponsive and called my seniors who were extubating the 1st bed. Then 3 cycles of CPR was done. The pulse of the patient was back. What was the cause of sudden loss of consciousness in this patient?

3. Dialysis was planned for this patient. I assisted in shifting the patient from ICU to Dialysis and monitored the vitals of this patient during dialysis, after 45 minutes of start of dialysis, the BP of the patient started to drop and then O2 saturations also dropped. Dialysis was stopped, patient was stabilized and brought to ICU. Proning was tried but we couldn't prone the patient due to the risk of disconnection of cannulas, due to ET tube etc. 

4. Patient attenders left against medical advice thinking that the patient can't be saved even though the central pulses were present.

5. The repeat 2D Echo of this patient revealed a VSD. Is there are chance of the patient having infective endocarditis which could have spread to lungs through VSD?

6. In the process of discussing the etiological agent with my unit PGs, as the patient is a carpenter, could the wood dust have caused damage to lungs which increased the predisposition for other organisms ?

Procedures done : 

1. Assisted in intubation of the patient 
2. Inserted iv cannula

3. Took several ABG samples during the course of this patient

4. Took venous blood sample for routine investigations.

5. Assisted in CPR 

Case 3 :

http://caseopinionsbyrollno05.blogspot.com/2022/09/70-year-old-female-with-shortness-of.html

1. What is the cause of rapid deterioration of this case?
A. The patient came to casualty with severe sob and fever. Her sob indicated that the problem is her lungs and the fever indicated that there is some infection. So, I had the opportunity of doing Rapid Antigen Test and RT-PCR in this patient which turned out negative. But, as this patient wasn't vaccinated against COVID-19, the lack of immunity could have led to the rapidly developed ARDS in this patient.

2. What is the cause of death in this patient?
A. Pulmonary edema as a post-dialysis complication could be the cause of death in this patient. 

Procedures done :
a. Inserted ryles
b. Inserted Foley's
c. ABGs (Arterial Blood Gas)

3. What could be the cause of deranged RFTs in this patient? Could there be a pre-existing unnoticed damage to the kidneys/could it be consequence of the infection/ could it be a consequence of the treatment?


Case 4

http://caseopinionsbyrollno05.blogspot.com/2022/09/50-year-old-male-with-fever-weakness.html

Case 5

http://caseopinionsbyrollno05.blogspot.com/2022/09/48-year-male-with-fever-and-headache.html

Case 6

https://caseopinionsbyrollno05.blogspot.com/2022/10/80-year-old-male-with-fever-and-burning.html?m=1

Questions around this case :

1. What is the cause of urinary incontinence in this patient?

Procedures :

1. Assisted in giving proctolytic enema to this patient