Intensive Care Unit	Hospital Complex (Yard) From 2nd department of internal medicine.

We did a Summer practice during summer vacation in 2016. It took place in the ICU of 2nd Dept of Internal Medicine. We saw many cases and learned many things.

1. Beautifully cared leg
   Beautifully cared leg

   Suicide case. I wonder why she took care of her leg when she knows she is going to kill herself.

   She was unconcious; She took 600 Units of insulin tyring to kill herself. She took the amount of insulin orally; she did not inject it thus she survived but insulin dropped his blood sugar dramatically enough to make her unconcious. She survived but the quickly-lowered blood sugar level which had been sustained for a long time enough, seemed to damage her brain.

   She is in her 30's. Her child has Type1 Diabete Melitus and that is why she has that amount of insulin.

   Very sad. there is no non-sad ending though.

2. Purple Urine

An old lady was dead in the hospital. Somehow the color of urine is purple. I asked my tutors but they said they don't know the cause.


Purple Urine
3. Defibrilator
This is the first time I saw using it in front of me, although we saw it being used in movies. It was used a couple of times during my practice.

Defibrilator
1. Septic Dying Patient: She was at the last stage. She had hemo-culture and she was found infected with multi-resistance pseudomonas and enterococcus. HR: 150 -> suddenly 60 -> V. Fib. 3 amples of epinephrine and defibrilator with 270Jule(maximum). the normal ecg came back but it went down again. That was her last moment. My tutor mentioned it would be useless to defibrilate again.
2. Ventricular Arrythmia: Pacemaker patient. Defibrilation brought back to pacemaker rhythm. (not sure. I am sure it was a pacemaker patient.)
3. I think there is another case...
4. Blood Transfusion
We did blood transfusion on two patients. There are three pieces of blood test on the table; one from the patient, one from the blood bag, one from the other bag. We checked the blood types before blood transfusion.
Preparation of Blood Transfusion
5. Endoscope
We could see Colonoscopy and Gastroscopy. The right photo shows a mass from colonoscope. The patient has many masses on the wall of the colon. A couple of more masses were taken for biopsy.

Endscope	Mass from colonoscope

6. Case of Atrial Fibrillation
A patient has arrived by ambulance. She was crying and under a panic. She seems to have had palpitation. The ECG was like below. She said she had the symptoms for 2 days.
Atrial Fibrillation(No P wave + Fast Irregular Rhythm, HR=200/min)

As a standard treatment: GI bleeding was quickly checked and low molecular heparin was administered subcutaneously in abdomen to prevent thrombosis and embolism.

1. Beta blocker given: 2 hours, no change. HR=180-190.
2. Verapamil(Ca2+ channel blocker); 2 hours, no change. HR=the same.
3. Mg2+. no change.
4. Digoxin. no change.
It is already too long time for her to have A. Fib. Propafenone(anti-arrthmic agent) is given and HR became 90-100.

Why did not HR decrease even though she was given various medications, which usually works? Answer: She had been under hyperthyroidism. I was told once by a cardiologist that it was a typical case so that you have to exclude hyperthroidism first...

Now treatment is not on A. Fib but focusing on the underlying cause of increased TH. T3, T4 increased, TSH 0. Primary hyperthyroidism. endocrinologist was called and ultrasonography. He said it has a sign of Gravis. Anti-TSH Receptor Ab test is ordered.

7. Gluten Free Diet

My tutor was eating this. Why? He said he was diagnosed Celiac Disease(Gluten sensitivity) just two weeks ago. He was diagnosed by detecting Antibody against Ab to transglutaminase. He was not diagnosed until now.


Gluten Free Cracker

He can not eat gluten containing food. That would cause choronic duodenitis, which can become malignant. Next day he ate white rice only...

8. Intra-Department Conference
There is an intra-department conference; it is for sharing information about patients among doctors and professors. (It is done in Hungarian so I did not understand anything.)
Intra-Department Conference for Sharing Information of Patients