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Today, a 2nd-year med student asked me why we can't completely clear HIV from the body like other viruses and the answer is the closest thing to a horror movie in modern medicine
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Dr. Priyam Bordoloi
4.5K posts
Dr. Priyam Bordoloi
@DocPriyamMD
MBBS | MD Internal Medicine Resident | Evidence-Based Medicine Advocate | Unreserved | ⚠️Views are my own.
India Katılım Mart 2016
438 Takip Edilen29.9K Takipçiler
@santheepnair @DrDatta_AIIMS @DrDhruvchauhan Govt also don't get subsidized labour from other sector employees. Whole medical colleges are running on residents and interns, your point?
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@DrDatta_AIIMS doctor
govt dont spend one crore each on studies of private sector employees
@DrDhruvchauhan
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Yes! Shut down OPDs in government hospitals at 1 PM! Lesssgoooo! 🚀
Indian Tech & Infra@IndianTechGuide
🚨 Breaking News: "All workers in the private or government sector must be given a rest period from 1 PM to 4 PM in Delhi." - Delhi Government.
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@medcrux Exactly. In anaphylaxis, Adrenaline is the definitive treatment for the Airway. No point checking the ABCs if you aren't giving the Epi immediately
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This is a classic anaphylaxis picture—multiple bee stings with throat tightness is a red flag.
First thing to think of is ABC, but here the airway is at risk.
👉 The most important step is to give IM adrenaline immediately (0.3–0.5 mg, 1:1000, in the lateral thigh). Don’t wait.
Why? Because it quickly:
•Reduces airway swelling
•Relieves bronchospasm
•Supports blood pressure
After that, you can move on to:
•Oxygen
•IV fluids if needed
•Antihistamines and steroids (supportive)
If symptoms worsen, be ready for airway support.
👉 Key takeaway: In suspected anaphylaxis, adrenaline comes first—always.
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Last night while on ER duty, a man presented with multiple BEE stings. He was tachycardic and complaining of a tightness in his throat. What is the first priority in his management?
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@Dr_Chibuike_M The positioning nuance is high-yield,legs up to support the heart, but sit them up if the airway obstruction is the immediate threat. Great detail!
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1. Administer Epinephrine: 0.3–0.5 mg of 1:1000 epinephrine via intramuscular injection, typically into the anterolateral thigh.
2. Secure the Airway: If the patient is struggling to breathe, they should be allowed to sit up, otherwise, they should lie flat with legs elevated to improve blood flow to the heart.
3. Remove Stingers: The stinger should be removed by scraping it off, as residual stingers can continue to release venom.
4. Oxygen and Fluids: Provide high-flow oxygen and initiate IV fluid resuscitation.
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@drobiy12 True! Just a small tweak: Epi is the real hero that reverses airway edema. Antihistamines are just the 'sidekick' for the rash and itch. Mast cells are the source, histamine is the messenger
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Ensure airway is preserved.
Bee stings will intiate a cascade a anaphylactic reactions causing release of histamine and mast cells which will cause bronchospasm and breathing difficulties, priority is to ensure airway and secured and give some anti-allergy as soon as possible to reverse the developing cascade
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Prioritize these three:
Remove the stinger ASAP: Use a credit card or fingernail to flick it out.
Ice it: Helps with pain and limits swelling.
Avoid Home Remedies: Skip the mud or toothpaste; they just increase infection risk.
If you feel faint or your throat tightens, head to the ER immediately
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@DocPriyamMD Dr any first aid we can take from our side for BEE sting before we reach hospital ?
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@Dr_Jamesdgreat Exactly. IM is the gold standard,much faster peak plasma concentration than SC. It’s the first and most important move!
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This is a textbook-perfect summary! Especially glad you mentioned the supine position with legs elevated..vital for maintaining venous return. Regarding the stinger: current evidence suggests speed of removal is more important than the 'scrape vs. squeeze' technique. Get it out ASAP!
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Management of Bee Sting Anaphylaxis
Immediate Actions and Airway Management
• Anaphylaxis from bee stings – Priority: IM Epinephrine ASAPABC: Secure airway (throat tightness → prepare for intubation), high-flow O2, supine + legs elevated.
• Remove stinger by scraping.
Primary Treatment with Epinephrine
• 1st line: Epinephrine 0.3–0.5 mg IM (1:1000) anterolateral thigh.
Adjunctive Therapies and Symptom Management
• Supportive: IV NS bolus for hypotension/tachycardia.
• H1+H2 blockers (e.g., diphenhydramine + famotidine).
• Steroids (methylpred 1–2 mg/kg IV) for biphasic prevention.
• Nebs if wheezing.
Monitoring and Diagnostic Considerations
• Observe 4–6+ hrs for biphasic reaction.
• Tryptase if needed.
Post-Treatment and Long-Term Planning
• Discharge: 2 EpiPens, allergy plan, allergist referral for venom immunotherapy.
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Correct about the speed! Just a small physiological tweak: in anaphylaxis, we actually rely on Epinephrine for vasoconstriction via alpha1 receptors to reverse the drop in blood pressure.
Vasodilation is what we’re trying to fix! Beta 2 handles the bronchodilation. Great points otherwise!
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@DocPriyamMD Epinephrine exists in rapid shots and it's action of reducing bronchospasms, ensure vasodilation and reduction of oedema is rapid.
You can give the patient epinephrine shots then go ahead and administer antihistamines.
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@daoo100 B) Osmotic Demyelination Syndrome
The Trident Sign on T2/FLAIR MRI is classic for Central Pontine Myelinolysis. Rapid shifts in osmolarity lead to selective destruction of myelin in the basis pontis, sparing the corticospinal tracts
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You are completely missing the point. Nobody is talking about replacing specialists or treating every condition ourselves.
This is about the academic reality of an Internal Medicine residency where the syllabus has no boundaries.
In just the last month, my internals included Schizophrenia and Pemphigus.
Two weeks ago, I had to interpret an MRI plate without a report. A week ago, it was muscle attachments of the tibial tuberosity. Three days ago, Mastoiditis. Yesterday, the full biochemical pathway of the Urea cycle.
This post is for the IM residents who relate to the fact that we can never tell a senior or an examiner that a topic is out of our branch. Every other specialty is needed, but only one is expected to master this level of depth across the entire medical spectrum. I do not understand why you are choosing to get offended over a discussion about academic vastness.
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1. No.
Neither myocardial infarction (MI) should be treated by psychiatrists, nor should psychiatric manifestations of systemic diseases be treated by internists.
2. And of course, since every specialist starts as an MBBS graduate, we should all just practice every single branch of medicine. Boundaries? Specialties? Those are for lesser mortals, right?
If you don’t look a patient with schizophrenia, cataract, or appendicitis straight in the eye and admit you’re not a specialist in it, well, that would just be terribly unethical.
I’m basically a walking encyclopedia of all medical science.
but heaven forbid I suffer from any delusions of grandiosity.
Dr. Priyam Bordoloi@DocPriyamMD
The fruit analogy misses the point entirely. A psychiatrist is not expected to manage a myocardial infarction or acute renal failure. However, an Internist is expected to recognize and manage the psychiatric manifestations of systemic diseases. This is about the sheer scope of the burden. Comparing undergraduate study to the expectations of an MD residency is a massive reach. Nobody is going to ask the pathology of appendicitis to an ENT, the biochemistry of the Krebs cycle to an Ophthalmologist, or the clinical details of Ewing’s sarcoma to a Microbiologist. But we are expected to know all of it. In Internal Medicine, we do not have the luxury of saying a medical condition is out of our syllabus. We can never tell a senior or a student that a topic is not our branch.
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I already mentioned that this is not about comparison. Every specialty is essential and vital. This is strictly about the vast, oceanic breadth and depth of Internal Medicine. We do not have the luxury of saying a medical condition is out of our syllabus
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Dr. Priyam Bordoloi@DocPriyamMD
Please do not treat this as a comparison. Every specialty is essential. Internal Medicine definitely cannot perform a cholecystectomy, appendectomy, or mastoidectomy. We do not provide anesthesia, perform eye surgeries, or reduce fractures. There is a vital need for every branch. This is strictly about the scope and immense vastness of the branch. We are expected to answer anything in the medical world. Whether it is the surgical name for a tumor, the biochemistry of a pathway, or the treatment for scabies, it can and will be asked. Just few days back I was asked to read a complex MRI by my consultant. We can never say, Sir, it is out of syllabus. In Internal Medicine, everything on the planet is in the syllabus.
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The fruit analogy misses the point entirely. A psychiatrist is not expected to manage a myocardial infarction or acute renal failure. However, an Internist is expected to recognize and manage the psychiatric manifestations of systemic diseases. This is about the sheer scope of the burden.
Comparing undergraduate study to the expectations of an MD residency is a massive reach. Nobody is going to ask the pathology of appendicitis to an ENT, the biochemistry of the Krebs cycle to an Ophthalmologist, or the clinical details of Ewing’s sarcoma to a Microbiologist.
But we are expected to know all of it.
In Internal Medicine, we do not have the luxury of saying a medical condition is out of our syllabus. We can never tell a senior or a student that a topic is not our branch.
The mood doctor@Chulbulpanda420
1. No, Internal Medicine is not the most and comprehensive branch in existence. 2. Every branch is fascinating in its own way. There are complexities in each specialty that doctors from other branches may never fully understand. 3. Every psychiatrist, paediatrician, ophthalmologist, microbiologist, and so on, also studied Internal Medicine during their undergraduate (UG) years. Does that mean they are all Internal Medicine specialists? There is currently a trend on medical Twitter where people try to show the supremacy of their own specialty. Everyone wants to prove that their branch is the best. I love mangoes in summer, but I also love apples in winter. The two are simply not comparable. Hope this helps.
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@Rheumat_Aravind Many consider Rheumatology the most academic subspecialty of all, but you can’t even begin to solve those complex multisystem puzzles without having the entire Internal Medicine foundation hardwired into your brain first
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@DocPriyamMD Rheumatology point of view:
Internal Medicine is the core to learn Rheumatology.
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No disrespect to other specialties, but Internal Medicine is objectively the most fascinating and comprehensive branch in existence. It is the de facto face of any hospital or medical college.
Beyond the obvious sub-specialties like Cardiology, Neurology, Pulmonology, Gastroenterology, Nephrology, Endocrinology, Oncology, and Rheumatology, the academic depth is staggering. We are expected to master Pharmacology, Biochemistry, Physiology, Microbiology, and Pathology at almost the same level as the MDs in those respective foundational branches.
In my experience, we have to know Anatomy, including every joint and muscle attachment, just as well as the surgical teams. While we do not perform the surgeries, we are expected to know the names of General Surgery and Orthopedic procedures along with their specific complications.
Then there is the high-pressure environment of ICU critical care and casualty emergency medicine. We are the ones managing the most unstable patients at the frontlines and making the most critical split-second decisions.
The list continues. We manage conditions typically handled by ENT and Ophthalmology. We are responsible for the complexities of pregnancy, including physiological changes, gestational diabetes, and seizures.
Even the university exams demand we act as specialists in Dermatology for conditions like Pemphigus or Psychiatry for Schizophrenia or Bipolar disorder.
We are even expected to interpret X-rays, CTs and MRIs just as well as a Radiologist in medical colleges
Finally, there is Pediatrics, where we must master the approach to malnutrition, short stature, and almost the entire spectrum of childhood illness.
Is there any other branch that is truly as vast as Internal Medicine? I do not think so.
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@RelatableLuo Actually in my country it is the opposite of underrated. Internal Medicine is so highly sought after that only the toppers have access to it. It is usually the first branch to get exhausted during counseling.
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@DocPriyamMD Imed is one of the most underrated speciality
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@joseph_britz It is not bias if it is the truth, Sir! Glad to see the passion for Internal Medicine stays even after a full career.
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@DocPriyamMD Not arguing with any of this, but, I confess, I may be biased.
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@ArghaDas947014 OMFS is definitely one of the most grueling and diverse paths out there. They bridge the gap between surgery and medicine in a very unique way
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@DocPriyamMD Sir please don't take it otherwise
In dentistry there is a branch called Oral and maxillofacial surgery
Where they have Casualty postings,Med postings,Surgery posting,Optha and ENT postings Even Ortho and Radio in Some
They Don't posses the skill set of an Internist but(1/N)
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@realBrosky Exactly. The job description is basically a "Yes" to everything medical
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@DocPriyamMD So it's safe to say Internal medicine is that specialty where the job description starts as doctor and quietly expands into part time radiologist, pharmacist, pediatrician, psychiatrist, and emergency response unit 😊
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@deadtorise_08 Haha, the Anesthesia + Medicine duo really is the ultimate backbone of hospital stability. Surgeons might get the aura after a successful procedure, but we’re the ones managing the physiological chaos behind the scenes to make it possible
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@DocPriyamMD I think Anaesthesia and Medicine mog all other specialities but that’s just my opinion
I do find surgical branches aura farming branches
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@drmathewjohn Coming from an Endocrinologist, that means a lot, Sir! But honestly, you haven't really moved on from the dream. You’re just practicing the most refined, high-level version of Internal Medicine
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@DocPriyamMD I started with a dream of being a physician. But, in real-world, the market forces demand a specialist. And hence I moved on. Agree that internal medicine is always the best.
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