Days of life in medicine

At 2 am, a 67 year old man, Hypertensive and Diabetic since 20 years, already a known case of Chronic Kidney Disease on Maintenance Hemodialysis since 10 years presented 1 month late for his Hemodialysis, came with the complains of  Facial Puffiness and Abdominal distension since 1 month and also told that his bilateral pedal edema had progressed upto his thighs over the last 2 weeks. Dyspnea grade 4 since 2 days, Reduced urine output since 2 days. He was Pale with pitting type of pedal edema. His Respiratory rate was 27 cpm, Pulse rate of 100 bpm, Blood Pressure of 70/60mmhg with a Saturation of 79 % on Room Air. On Auscultation of his lungs fields, there were Bilateral coarse inspiratory crackles all over his lung fields. Heart sounds S1,S2 could be auscultated.  His Abdomen was distended. Patient was put on Oxygen supplementation  NORADRENALINE infusion was started at 8 mcg/min  His ECG showed Sinus tachycardia with no P waves, Wide QRS...

My day started on 9th May 2020 with Morning rounds of my patients in Nephrology ward with my intern. At around 11am , A Patient presented to the casualty, A 60 year old man, Farmer from a local village, Occasional Alcoholic since 25 years and Chronic Beedi Smoker since 25 years, who was diagnosed to be hypertensive and diabetic 6 months back.  He apparently had no medical issues until an year back when he started getting breathless on walking for a few miles and he gradually started experiencing breathlessness even on rest, on & off though he had no complains of associated chest pain, palpitations, nausea, vomitings or associated giddiness. One fine morning, before he started for work he observed his feet were swollen upto his ankles for which he decided not to consult a doctor and managed by resting for a few days. Over the next few days the swelling in his feet gradually progressed up to his thighs and it alarmed him when he had developed facial puffiness. He also sta...

BRAIN STEM STROKES: Here's a brief discussion regarding the Ventral Midbrain Syndromes which I've gone through on 9th & 10th of May. Will update regarding the other syndromes in my further posts. The posterior surface of midbrain has a Tectum portion & a Tegmental portion. The Tectum portion consists of Corpora Quadrigemina & 4th cranial nerve where as the Tegmental portion comprises of Floor of the 4th ventricle, Median Sulcus, Facial colliculus & Sulcus Limitans.  Three important Ventral Midbrain Syndromes are  : 1) Weber syndrome 2) Claude syndrome 3) Benedikt syndrome These occur due to the involvement of P1 segment of Posterior cerebral artery.  Posterior Cerebral Artery is divided into P1 & P2 segment ( proximal & distal to Posterior communication artery)  1) Weber Syndrome:   The lesion is at the level of crus cerebri, here you can see the location of the cor...