My experience with general cellular and neural cellular pathology in a case based blended learning ecosystem's (CBBLE)

Greetings, this is Sai Deepthika Vathada, a medical undergraduate student studying in India. I would like to share some of my experiences in the general medicine department and what I have gained from it. 

I would like to take this opportunity to thank my HOD SIR and  all my seniors and professors for providing me with a space to grow and gain knowledge.I am grateful for the opportunities that have been provided to me to enhance my skills and knowledge through various integrated clinical learning. These experiences have not only expanded my medical knowledge but have also exposed me to the latest advancements in the field.

CBBLE PAJR PARTICIPATORY LEARNING ACTION RESEARCH DISCLAIMER

NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS/HER GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.

Case 1: 

https://saideepthikavrollno138.blogspot.com/2023/03/50yr-old-male-with-weakness-in-left-ul.html

So let's start this blog with my very first encounter with a patient from the general medicine department. I entered the AMC looking at one particular patient who was laying on the first bed, talking to his wife in distress, not able to get a coherent word out of his mouth. As I walked further towards him, slightly intrigued, I realized I couldn't make out what he was saying as his speech was slurred and he was growing quite restless trying to make them understand. That is when I knew I had to help him, to understand him, to make him comfortable. I approached him with a smile on my face, and asked him directly what was wrong, as he tried to explain his wife caught up and explained what she has observed from the past 3 days. She explained that he suddenly in the afternoon noticed a tingling sensation and weakness in his left upper and lower limb but they didn't find it worrisome so they didn't come to the hospital but instead went to the RMP doctor near him who gave him some kind of unknown medication which relieved the tingling sensation. The following day, he couldn't get off the bed in the morning and his mouth deviated to the right side. Then they realized it was serious and rushed to the hospital. 

To understand more about this case I researched and the best article I came across was: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146965/

This experience has taught me that, no matter how minuscule the problem might seem at the start, it's always important not to dismiss the patient and attend as soon as possible. 

Case 2: 

A 35 year old patient walked into the AMC, as he had been experiencing troubling symptoms. He noticed blood in his stools and had been feeling increasingly short of breath. Concerned about his health, As he entered the AMC, he felt a mix of anxiety and hope. He was greeted by a friendly nurse who asked him to sit comfortably on the bed. After which i have approached the patient and took a detailed history and examination.

case details:

https://saideepthikavrollno138.blogspot.com/2023/04/35-year-old-male-with-cheif-complains.html

PAJR CASE DISCUSSION:

[06/04/23, 9:55:57 AM] 35M Recent fever, Pruritus, Anaemia 1 mth

 hemorrhoids 1 yr Telangana PaJR:

AMC bed 3

Date of Admission :- 05.04.2023

S

C/o Itching all over the body

O

Patient is c/c/c 
Temp:- 97.4° F 
PR- 82 bpm
RR-22 cpm
BP-  120/80mmHg
Spo2-100% at room Air 
GRBS- 180 mg%
Input -900ml
Output -750ml
CVS- S1s2present, no murmurs heard
RS-B/L air entry present 
  N vesicular breath sounds 
PA- distended,NT
CNS - NFND

A

1)Severe Iron deficiency Anemia secondary to blood loss by haemorraoids (grade 1) and active fissure (11'0 clock)
2)HFPEF(63%) High output failure secondary to beri beri ,anemia
3)Acute febrile illness
4)Anemia induced pruritis
5)Alcohol dependence syndrome
6) 2 PRBC. Transfusion done on 7/4/2023 and 10/4/2023
Hi
P:
1)INJ.FALCIGO 120mg/IV
2)T.OROFER -XT PO/BD
3)T.BENFOTHIAMINE 100mg/OD
[12/04/23, 9:56:04 AM] ~ Middle Aged Man: Project : undifferentiated fever with diagnostic and therapeutic uncertainty
Patient treated with antibacterials first followed by antimalarials and still there is no resolution of this uncertainty.
his today's fever chart 
Very often our patients just recover on their own or because of or inspite of the therapeutic uncertainty cocktail they receive? 
AMC bed 3
Date of Admission :- 05.04.2023
 
S
Fever spikes present 
9/4/2023 @9pm - 100.9°F
C/o Generalized weakness
C/o Headache
Itching all over the body
Stools passed (not blood stained)
O
Patient is c/c/c 
Temp:- 98.2° F 
PR- 94 bpm
RR-24  cpm
BP-  90/70mmHg
Spo2-100% at room Air 
GRBS- 91 mg%
Input -1200 ml
Output -700ml
CVS- S1s2present, no murmurs heard
RS-B/L air entry present 
       N vesicular breath sounds 
PA- distended,NT
CNS - NFND

A
1)Severe Iron deficiency Anemia secondary to blood loss by haemorraoids (grade 1) and active fissure (11'0 clock)
2)HFPEF(63%) High output failure secondary to beri beri ,anemia
3)Acute febrile illness
4)Anemia induced pruritis
5)Alcohol dependence syndrome
6) 1 PRBC. Transfusion done on 7/4/2023
P:
1)INJ.MONOCEF 1 gm /IV/BD
2)INJ.THIAMINE 100mg in 100 ml NS IV/OD
3)INJ.NEOMOL 1gm IV /sos if temp greater than 101°F
4)INJ.LASIX 40mg  IV /BD
5)SYRUP. LACTULOSE 10ml po/BD
6)T.PAN 40mg po/bd
7)T TECZINE 5mg PO/OD
8)T. PARACETAMOL 650mg PO /sos
9)T.LORAZEPAM 2mg OD
10)T.BACLOFEN XL 20mg OD
11)LIQUID PARAFFIN L/A BD
12)OINT.SMUTH for L/A
13)SITZ BATH WITH BETADINE -QID
14) Temperature monitoring 4th hourly
15)Tepid sponging and ice packs if temp greater than 99°F
16) 2 egg whites / day
AMC bed 3
Date of Admission :- 05.04.2023
 
S
C/o Itching all over the body

O
Patient is c/c/c 
Temp:- 97.4° F 
PR- 82 bpm
RR-22 cpm
BP-  120/80mmHg
Spo2-100% at room Air 
GRBS- 180 mg%
Input -900ml
Output -750ml
CVS- S1s2present, no murmurs heard
RS-B/L air entry present 
       N vesicular breath sounds 
PA- distended,NT
CNS - NFND

A
1)Severe Iron deficiency Anemia secondary to blood loss by haemorraoids (grade 1) and active fissure (11'0 clock)
2)HFPEF(63%) High output failure secondary to beri beri ,anemia
3)Acute febrile illness
4)Anemia induced pruritis
5)Alcohol dependence syndrome
6) 2 PRBC. Transfusion done on 7/4/2023 and 10/4/2023

P:
1)INJ.FALCIGO 120mg/IV
2)T.OROFER -XT PO/BD
3)T.BENFOTHIAMINE 100mg/OD
‎[12/04/23, 9:56:18 AM] ~ Basani Sravanthi: ‎image omitted
[12/04/23, 9:58:36 AM] ~ Basani Sravanthi: ‎This message was deleted.
[12/04/23, 9:58:59 AM] ~ Middle Aged Man: ‎~ Middle Aged Man changed the subject to “35M Recent fever, Pruritus, Anaemia hemorrhoids ?duration Telangana PaJR”
[12/04/23, 10:02:57 AM] ~ Middle Aged Man: ‎~ Middle Aged Man changed the subject to “35M Recent fever, Pruritus, Anaemia 1 mth hemorrhoids 1 yr Telangana PaJR”
[12/04/23, 10:02:15 AM] ~ Middle Aged Man: As per your case report history there is no mention of fever. Was this nosocomial or community acquired? Why did start on monocef from day 1? Welcome drink antibiotic stewardship? 
[12/04/23, 10:04:15 AM] ~ Middle Aged Man: 
Fascinating utility of a comorbidity thesis here

AMC bed 3
Date of Admission :- 05.04.2023
 
S
C/o Itching all over the body

O
Patient is c/c/c 
Temp:- 97.4° F 
PR- 82 bpm
RR-22 cpm
BP-  120/80mmHg
Spo2-100% at room Air 
GRBS- 180 mg%
Input -900ml
Output -750ml
CVS- S1s2present, no murmurs heard
RS-B/L air entry present 
       N vesicular breath sounds 
PA- distended,NT
CNS - NFND

A
1)Severe Iron deficiency Anemia secondary to blood loss by haemorraoids (grade 1) and active fissure (11'0 clock)
2)HFPEF(63%) High output failure secondary to,anemia
3)Acute febrile illness
4)Anemia induced pruritis
5)Alcohol dependence syndrome
6) 2 PRBC. Transfusion done on 7/4/2023 and 10/4/2023

P:
1)T.OROFER -XT PO/BD
2)T.BENFOTHIAMINE 100mg/OD
[12/04/23, 11:39:27 AM] ~ Middle Aged Man: What is his diet like? Is it iron deficient?
[12/04/23, 12:46:02 PM] ~ Vivek Kurma: Dietary History 
He takes a cup of tea at 8 am 
At 9 am he takes 
1 cup of rice with pickle or 4 idlis with chutney or 3 chapatis with pickle 
Lunch at 1 pm
2 cups of rice 
Half cup vegetable curry 
1 cup rasam 
1 cup curd 
He consumes meat Twice a week in lunch
Evening 
1 cup of tea with some bhajiya/buiscuits (2-3)
Night 
2 cups rice 
Half cup curry 
1 cup rasam
1 cup curd 
(5 days in a week)

Or 

3 chapatis with 1 cup Curry (2 days in a week)
[12/04/23, 2:33:17 PM] ~ Middle Aged Man: Now tell us about the iron content in each consumption
[07/05/23, 6:25:50 PM] ~ Middle Aged Man: What were the clinical pointers to suspect DVT in this patient and get this expensive lower limb Doppler test? 
[07/05/23, 6:30:15 PM] ~ Navya Lakkakula: That was another pts report sir 
[07/05/23, 6:37:59 PM] ~ Middle Aged Man: Who's was it? 
[07/05/23, 6:38:57 PM] ~ Navya Lakkakula: Yes sir she is our nephro intern

conclusion:

.the field of general medicine is incredibly important and plays a vital role in providing comprehensive care to patients. It requires a diverse skill set and the ability to diagnose and treat a wide range of medical conditions.

.Working in general medicine allowed me to witness the resilience of the human spirit. I have encountered patients from all walks of life, each with their unique stories and experiences. Being a part of their healthcare journey gave me a profound understanding of the impact that medical care can have on individuals and their families.

thank you.