INTERNSHIP LEARNING AND PROCEDURES PERFORMED
MY INTERNSHIP:-
Iam posted in medicine posting from 31 st july to 30 sept
Of this
ICU :- (1st august -6 th august)
Learned about VENTILATOR
Assisted in 6 intubations
Done CPR
TOOK SAMPLES
ABGs were taken by me
Done procedure’s :- 4 ryles ; 5 foleys catheterisation
Learned how to use bipap machine
NEPHRO :- (7 th august - 12 th august )
Learned about procedures like central line .
Monitored patients in dialysis
Learned about the process of dialysis ; types of dialysis ;
Assisted in 4 central lines
Complications of dialysis
Done CPR.
WARD :-
Monitored patients in the nyt
Took samples of FBS ; PLBS; HBA1C ; RFT ; LFT
Done IV canulation
PSYCHIATRY:- 15 August to 1 st sept
MY PSYCHIATRY :-
I came across a patient , who was diagnosed with DISSOCIATIVE DISORDER.
Diagnosis
DISSOCIATIVE DISORDER
Case History and Clinical Findings
CHIEF COMPLAINTS:
EPISODES OF STIFFNESS AND PAIN IN THE LIMBS, INVOLUNTARY MOVEMENTS OF BODY SINCE 15 DAYS
THESE EPISODES WERE ASSOCIATED WITH MAKING ANIMAL SOUNDS SINCE 5 DAYS
BACKGROUND HISTORY:
ABOUT 5 YEARS AGO, PATIENT STARTED HAVING POSSESSION EPISODES ON FESTIVALS.
EACH EPISODE LASTING FOR ~15 MIN AND SUBSIDED ON IT'S OWN.
PERSONAL STRESSORS +
ABOUT 10 MONTHS AGO, HE HAD AN EPISODE OF INVOLUNTARY MOVEMENTS OF BODY AND STIFFNESS OF LIMBS AT NIGHT FOR WHICH HE WAS IMMEDIATELY TAKEN TO A HOSPITAL. AFTER RULING OUT THE MEDICAL CAUSES, PATIENT WAS REFERRED TO A PSYCHIATRIST AND WAS ON REGULAR TREATMENT SINCE THEN. HE WAS MAINTAINING WELL ON THE MEDICATION WITH AVERAGE OF 1 EPISODE PER 1-2 MONTHS TILL JUNE
2023.
HISTORY OF PRESENTING ILLNESS:
ABOUT 15 DAYS AGO. AFTER RETURNING FROM WORK, HE WAS TALKING TO HIS SISTERS KIDS, WHEN HE SUDDENLY FELT UNKNOWN FEARFULNESS ASSOCIATED WITH COLD FLUSHING OF LIMBS. HE TOOK THE SOS MEDICATION PRESCRIBED AND WENT TO SLEEP.
NEXT DAY WHEN HE WOKE UP HE COULD NOT MOVE HIS LEGS AND WA IN EXTREME PAIN.
FOR THIS, HE WAS IMMEDIATELY TAKEN BACK TO HIS VILLAGE. VISITED HIS PSYCHIATRIST AND WAS PRESCRIBED MEDICATION FOR THE COMPLAINTS. ABOUT 10 DAYS LATER HE HAD AN EPISODE OF INVOLUNTARY MOVEMENTS OF BODY, STIFFNESS OF LIMBS, TAKEN TO HIS PSYCHIATRIST WHERE MEDICATION WAS PRESCRIBED. HE WAS ALSO TAKEN TO NEUROLOGIST WHERE BLOOD TESTS AND NERVE CONDUCT TESTS WERE DONE - ALL WERE WITHIN NORMAL LIMITS. SINCE THE LAST 5 DAYS, OD REPORTS PATIENT STARTED MAKING NOISES OF ANIMALS ALONG WITH INVOLUNTARY MOVEMENTS OF BODY AND STIFFNESS OF LIMBS, SOS MEDICATION IN HOSPITAL WAS GIVEN - SUBSIDED. OD REPORTS EACH EPISODE, IF UNTREATED MAY LAST FOR 1-2 HRS, THE NUMBER OF ANIMAL NOISES INCREASES AND EACH EPISODE IS PRECEDED BY PAIN IN HIS LOWER LIMBS AND BACK.THESE EPISODES INCREASED IN FREQUENCY FROM 1 PER DAY TO 2
EPISODES PER DAY IN THE LAST 5 DAYS. HE WAS REFEREED TO KIMS, NKP BY HIS PSYCHIATRIST FOR OBSERVATION AND FURTHER EVALUATION.
SLEEP NORMAL, APPETITE NORMAL
PAST HISTORY:
AS DESCRIBED IN BACKGROUND HISTORY
NOT A KNOWN CASE OF DM,HTN, ASTHMA, TB, CVA, CAD
FAMILY HISTORY:
H/O? PSYCHOSIS IN PATERNAL GRAND MOTHER
HO ORGANIC PSYCHOSIS IN BROTHER FOLLOWING A HEAD INJURY 20 YRS AGO, ?ON TREATMENT.
Treatment Given(Enter only Generic Name)
1. PATIENT AND OD PSYCHOEDUCATED
2. BRIEF COUNSELLING GIVEN
3. TAB.PAROXETINE 25 MG + TAB.CLONAZEPAM 0.5 MG(2/8/2023 TO 5/8/2023)
4. TAB.PREGABALIN M 75 MG(2/8/2023 TO 5/8/2023)
X-X-1
5.TAB,OLANZAPINE 5 MG(2/8/2023 TO 5/8/2023)
6.TAB TOFISOPAM 50 MG (2/8/2023 TO 4/8/2023)
1-X-…_-X
7.TAB. DESVENLAFAXINE 50 MG (2/8/2023 TO 5/8/2023)
1-X-…_-X
8.TAB.CLONAZEPAM 0.25 MG (2/8/2023 TO 4/8/2023)
1--1-……-X
1. TAB.PANTOP 40 MG(2/8/2023 TO 5/8/2023)
2. TAB CLONAZEPAM 0.5 MG
REVIEW IN 5 DAYS/SOS IN PSYCHIATRIC OPD.
I monitored him strictly for his episodes
And during my Monitoring he had 4 episodes in 3 days where I gave lorazepam I.v stat
And also saw different opd patients of
1.DISSOCIATIVE DISORDER
2.ADHD
3.OCD
4. ALCOHOL DEPENDENCE SYNDROME
5. SCHIZOPHRENIA
.
LEARNED
CBT ( cognitive behavioural therapy)
After this my
UNITS STARTED ON 1 st sept and it was till
30 th September
This are the cases I documented in my posting :-
Case 2:- https://kattaphanikeerthanarollno72.blogspot.com/2023/09/a-70-year-old-male-presented-to-opd.html
Case 3:- https://kattaphanikeerthanarollno72.blogspot.com/2023/09/52-year-old-female-with-chief.html
.
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