SELF ASSESSMENT

During the unit duty:

Case: http://pranaykumar32.blogspot.com/2022/10/a-62-year-old-male-co-4-5-episodes-of.html

1) what is the cause of seizures? 

Uncontrolled sugars. 

2) Mechanism by which high  sugars cause seizures ? 

A threshold glucose concentration is necessary to support synaptic transmission. Elevated extracellular glucose is associated with neuronal hyperexcitability, hyperglycemia exacerbates ischemia-induced brain damage.Hyperglycemia also lowers the threshold of seizure activity. This is the main mechanism by which diabetes induced seizures are most common. 

3) Does hypoglycemia cause seizures? 

Yes, extremes of sugars either high or low cause seizures. 

A diabetic seizure occurs when the sugar levels in the blood are extremely low (below 30 mg/dL). The brain needs glucose to function properly. When there is a drop in blood sugar, the actions of the neurons in the brain decrease and the person experiences a seizure. 

4) How seizure occurs in hypoglycemic conditions?

There is rise in brain osmolality secondary to an increased net transport into brain of Na+ and K+, probably caused by insulin, per se. As hypoglycemia persists, there is also depletion of energy-supplying substrates (glucose, lactate, glutamate) in the brain, an event which coincides altered brain function. The brain edema observed during hypoxia is largely due to an increase in brain osmolality secondary to accumulation of lactate. 

Case:

http://pranaykumar32.blogspot.com/2022/10/a-45-yr-old-male-co-fever-since-5.html

1) what are the opportunistic infections in HIV patients? 

This patient is having Giardia as an isolated organism in stool. 

Learning impact-

#collected 24hrs stools every day and initially it was pea soup colored and was watery consistency with 5-6episodes of loose stools per day. I've seen how the given medications gradually decreased the episodes , color and consistency to normal. 

#potassium correction was given for his weakness. 

2) what is the mechanism of watery diarrhea? 

Secretory diarrhea is the diarrhea for this patient. 

Activation of Cl⁻ channels in the apical membrane of enterocytes, including the cystic fibrosis transmembrane conductance regulator and Ca²⁺-activated Cl⁻ channels, increases fluid secretion, while inhibition of Na⁺ transport reduces fluid absorption. 

Case: http://pranaykumar32.blogspot.com/2022/10/a-55yr-old-female-complains-of.html

#I've done the procedure of ascitic tap for a 45 year old who is a chronic alcoholic. 

#I've seen the 2D ECHO and the changes of LVH in it. 

 
During the nephrology duty:
1) Assisted in a central line procedure under Dr.keerthi mam
2)Monitored Blood Pressures of the patients during dialysis, in the CKD ward.
3) while I was monitoring vitals , a patient had the Blood pressure-190/100 at 2:00AM.I've informed Dr.sailesh sir and he told to give Lasix and Nicardia,I got to know the role of lasix in CKD  patients in clinical practice . That's the first IV I've given under Dr. sailesh sir.

During  the ward duty:
1) I've learnt to take the venous blood samples for few patients.
2) I've taken ABG sample for 2 patients.
3) Monitored vitals for the ward patients.
4) Inserted Foley's for male and female patients.

During ICU duty:
1) Performed CPR for 2 patients
One in the dialysis ward who got cardiac arrest.
The other one is a 22 year old female who got pulmonary embolism and also got cardiac arrest . During CPR she got bleed from the mouth. 

After that the saturations also started to raise and then it gradually fallen. Central pulses are absent. 
2) Assisted in Intubation.

3) I've Learnt the role of atracurium in patients with high Respiratory Rate. 

4) learned to connect the oxygen mask and the no: of litres of water to be adjusted based on requirement and CPAP. 

5) I've placed the canula in correct position.initially got double punctured and later on I placed it correctly. 

During the OP:

1)The prevalance of co-morbid conditions (DM, HTN) in elderly age group I've seen. 

2) Learnt that why serum creatinine value is important in Diabetics. 

3) I've learnt the dose of thyroxine Adjusted according to the weight. 

4) I've seen a 30 yr old male patient with Hiiccups since 1 day. It subsided as soon as T. Baclofen was given. 

During psychiatry :

1) Alcohol dependance- I've learnt the role of Loraz in alcohol withdrwal(1unit=30ml alcohol and we substitute 1 tablet of loraz for that) ,learnt the role of Baclofen in decreasing the cravings. Since thiamine is deficient in the we substitute that. 

2) Schizophrenia- I saw a 60 year male having delusion of infidelity, persecution, visual hallucinations. He was given Risperidone and Trihexyphenidyl(for side effect of Risperidone). 

3) I've learnt how aggression(target oriented) is different from irritability(Generalized) for a person. 

4) panic attack- Loraz is given for the patient. 

5) I've learnt how we treat a patient with anger(uncontrolled anger, immediate- Haloperidol. Moderate anger- sodium valproate, mild anger -Loraz)