IM Site Evaluation Reflection

   For my site evaluation I chose two most interesting cases I’ve encountered to present.

The first case was a 50 y/o woman who was a stepdown from the ICU that has a very interesting and mysterious course. At least 2 times a day she was going into a hypotensive crisis and was diagnosed with a sepsis of unknown origin. I followed her for over 10 days and she had countless consults, none really providing us with the source.

   Second was a 45 y/o gentleman with no PMH, relatively healthy with no history of substance or alcohol abuse, who presented with AKI. Upon further investigation he admitted that in the past week he has been forgetting to bring his water bottle to work (he worked outdoors and we are in July right now) and the only liquid he had was his usual morning cup of coffee. He has also mentioned that he had a family member in town who has been cooking meals high in salt for his family. After a treatment course with fluids only, his AKI resolved. This was a great learning opportunity reminding me of the importance of the thorough social history and an opportunity to provide patient education on the importance of staying hydrated. I always recommend all my patients to start their day with a tall glass of warm water with lemon. Such ritual ensures that we at least drink one glass of water before our day starts.

   The gentleman did have a recent COVID infection and, since I knew that COVID was in some cases associated with AKI, the article I chose to present was about the COVID related AKI. I was excited to find a Medline indexed article that came out only 3 weeks ago that built on our previous knowledge of this relation.

   Overall the site evaluations were valuable ways to exchange knowledge and preceptor’s willingness to do them online made it a smooth and pleasant experience.

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