I should have shared my objectives before this rotation commenced. Lesson learnt for future. My Objectives for this rotation:
1. Do at least 4 discharge counsels
2. Understand the concepts of fluid/electrolyte imbalance and employ the knowledge in the care of at least one patient
3. Apply the concepts of clinical pharmacokinetics in care of at least 3 patients
The second week was intense and packed with tonnes new knowledge. We discussed my mid-point evaluation yesterday. I do have to say this has been the worst mid-point evaluation so far but I now I am aware of what I need to work on and how to make the best use of these two weeks. Dr. Dillon has been asking me to do things for the past two weeks but it took me a while to get a hang of things and I have finally started feeling more comfortable with the process. There are a lot of areas I need to work on for the next two weeks: 1. Be more prepared with discussions 2. Be more articulate about my recommendations 3. See more patients 4. Write chart appropriate notes 5. Practice reading ekgs 6. Prioritize DRPs. The main thing I need to work on is being more efficient. No doubt I have been working hard for the past two weeks but I need to move to the next level of working smart. This can be only accomplished by doing tasks and not fearing failure. If I do it wrong the first time, the next time would get better.
Conditions I have come across:
Wernike-Korsakoff’s syndrome: alcohol misuse can lead to thiamine deficiency which may lead to Wernike-Korsakoff syndrome. Wernicke’s disease is an illness of acute onset characterized by a trial of symptoms that include global confusion, ataxia, and paralysis of eye movements (diploplia, strabismus and nystagmus) It is a neurological emergency that must be treated with parenteral thiamine administration. Delay in treatment increases the risk of permanent defect in retentive memory and learning known as Korsakoff psychosis.
Withdrawal seizures: Chronic alcohol use suppresses a # of neurotransmitters particularly GABA (responsible for sedation, muscle relaxation and raising seizure threshold). Alcohol reduction–GABA deficiency–anxiety, increased psychomotor activity–predisposition to seizures.
repeated withdrawals–risk of seizures increases-phenomenon known as “kindling”. If there is documented history of alcohol withdrawal seizures, give prophylactic dose of diazepam 20 mg PO x 3 doses
The CIWA-AR tool measures 10 symptoms of alcohol withdrawal with a range of scores:
Paroxysmal sweats (0-7)
Tactile disturbance (0-7)
Auditory disturbance (0-7)
Visual disturbance (0-7)
1. Have you ever felt the need to CUT DOWN on drinking?
2. Have you ever felt annoyed by criticism of your drinking?
3. Have you ever felt guilty about your drinking?
4. Have you ever had a drink (or drug) first thing in the morning to steady your nerves or get rid of a hangover (EYE-OPENER)?
5. When did you have your last drink?