DOB- 7th January 1986
Nationality- Indian
Gender- Female
Medical Registration No- 67348 (WBMC)
GMC Registration No: 7906065
Date of Registration- 15th May, 2011
Relationship Status- Married to my wife, Shreya Dey
About Me :
I think that my job is to observe people and the world, and not to judge them. I always like to position myself away from so-called conclusions. I would like to leave everything wide open to all the possibilities in the world and that quality about me makes me a decorous emergency physician.
I enjoy both the pace and the diversity of Emergency Medicine; no other field seems to offer such a wide variety of experiences. I believe Emergency Physicians need a solid knowledge base in many different medical specialties, accompanied by excellent physical assessment and diagnostic skills. These characteristics fit my personality well; I requires stimulation and diversity in my work and personal life, yet I can be meticulous and detail-oriented when necessary. I am honest, hardworking and passionate about being a doctor. I allow my passion to find it's outlet in the work I do. I believe, the only way to do great work is to love what we do.
Career Goals:
Excellence is what I pursue, and success will follow reflexively.
Ever since I spend one and a half year of my career in the state of Uttarakhand, one among Indian Himalayan Region, I developed this passion about Wilderness Medicine.
I also intend to make Teaching part of my career, as a way to continue my academic, clinical, and personal growth, as well as to contribute making in future emergency medicine specialists. 'In learning I shall teach, and in teaching I shall learn.'
I look forward to involvement in Research opportunities so that I might contribute to the exciting and rapidly growing field of Emergency Medicine research.
My ultimate goal is to improve the practice and delivery of Emergency Medicine as a leader and teacher in the setting in which I practice and lead some EM development project in my home state of West Bengal, India.
I enjoy my time being in nature, travelling, painting and crafting and I love gardening and plants.
DETECTION OF ENDOTRACHEAL INTUBATION BY INSERTION DEPTH OF ENDOTRACHEAL TUBE, BILATERAL CHEST AUSCULTATION AND OBSERVATION OF BILATERAL CHEST MOVEMENT DURING EMERGENCY INTUBATION : PROSPECTIVE OBSERVATIONAL STUDY
Indian Journal of Emergency Medicine / Vol. 3 No. 1 / January - June 2017
I have done this prospective observational study in the Department of Emergency Medicine and Intensive Care units of Peerless Hospital and B.K. Roy Research Centre, Kolkata, over a period of approximately 1½ year, to compare the sensitivity and specificity of different bedside methods of verifying correct placement of the endotracheal tube, like: bilateral auscultation of the chest; observation and palpation of symmetrical chest movements; use of the ‘cm’ scale printed on the tube; a combination of all three methods. And whether sensitivity and specificity of these clinical methods would increase as a function of the Doctor’s experience.
June 2023
Acute Abdominal Presentation in Emergency and a Prodigious Diagnosis of Acute Epiploic Appendagitis: A Rare Case Report
DOI: http://dx.doi.org/10.21088/ijem.2395.311X.9223.5
Background: Appendices Epiploicae, also referred as Epiploic appendages, are 50-100 fat filled finger like projection from the serosal surface of large intestine. Epiploic Appendagitis is a self-limiting, benign disease process which results from the inflammation of these Appendices Epiplocae or thrombosis of the draining vein of Appendices Epiplocae.
Case Report: We report a case of 49 year old female, generally well, presented to the A & E with complaints of a painful lump in her left iliac fossa growing in size for last four weeks. She presented to us because of acute increase in size and pain, resulting in significant discomfort. Owing to her history of CIN-1 we arranged a CT abdomen and pelvis with contrast fearing some sinister underlying ongoing pathology causing her symptoms. But to our surprise Ct reported a underrated cause of her abdominal pain, Epiploic Appendagitis. We were surprised of her presentation as a hard abdominal lump which was quite unusual for EA to present as. We assume it was secondary to an extensive underlying local inflammatory reaction. Patient was reassured and treated with NSAID, antibiotics and follow up with surgery ambulatory care.
Conclusion: We authors are reporting this case of primary epiploic appendagitis because we think every emergency and primary care physicians should be aware of this very rare condition which might present to emergency as an acute abdominal presentation mimicking other common presentations like acute diverticulitis and acute appendicitis. Being aware of this condition is utmost important to diagnose it early and avoid more invasive surgical managements and unnecessary antibiotic usage.
December 2022
A Rare Case Report of Ludwig’s Angina: Early Detection and Prevention of Airway Catastrophe
DOI: 10.5455/IJMRCR.172-1667403497
Background: Ludwig’s angina is infection of the soft tissue or gangrenous cellulitis, starting from the floor of mouth or base of the tongue. It can then directly spread to the soft tissue of neck, result in significant oedema and distortion of the adjacent airway, yielding fatal airway obstruction.
Case Report: We report a case of 29 year old female who presented to our emergency department with sore throat for 2 weeks, fever for 12 days, progressively increasing pain in throat for 1 week. She was unable to swallow any solid as well as liquids since last night. In our case we picked up a diagnosis of Ludwig’s Angina quite early as we kept a high threshold of suspicion secondary to subtle signs of an impending airway problem: change in patient’s voice and subtle swelling of her chin described by the patient herself. A CT neck & floor of mouth confirmed our clinical suspicion and diagnosis of Ludwig's Angina. We managed her with aggressive early intravenous (IV) antibiotics, IV steroids and IV hydration and could prevent a fatal airway complication to transpire.
Why Should an Emergency Physician Be Aware of This? We, the authors believe that every emergency physicians must be aware of Ludwig’s Angina, though a rare condition but can give rise to fatal airway obstruction and airway management mishaps in emergency departments. We highlighted the importance to recognise early signs of threatened airway, which can be subtle to begin with and easily be missed, if not a very high suspicion, which only comes from being perspicacious about this condition. Early diagnosis and management can reduce mortality and morbidity significantly.
June 2022
A Case Report of Pediatric Cerebral Venous Thrombosis with Undiagnosed Complex Congenital Heart Disease: Tetralogy of Fallot with OS ASD: A Cataclysmic Ending
DOI: 10.4236/ojem.2022.102010
Cerebral Venous Sinus Thrombosis (CVST/CSVT) is occlusion of cerebral veins and venous sinuses of brain secondary to blood clot formation resulting in hindrance in the blood drainage system in brain, leading to disturbances the internal homeostasis of brain, raised intracranial pressure, cerebral edema, and 50% of cases will have venous infarction or venous hemorrhage (stroke). CVST although being a Rare disorder but may be more common in children than adults with greater risk in neonatal period i.e. first 28 days of life. Here we are discussing a case of Pediatric CVST in a 7-month-old baby boy who presented to Emergency Room (ER) with recurrent discrete episodes of vomiting, fever, seizures, drowsiness and respiratory distress. The fatal outcome in our child was attributed to delayed presentation in a tertiary care center, hence missed early diagnosis and treatment. In this child the CVST could be result of amalgamation of complex underlying ongoing multiple pathological processes: an acute systemic illness like sepsis, severe dehydration, undiagnosed and untreated complex congenital heart disease, tetralogy of fallot with osteum secondum atrial septal defect, worsening the coagulopathy. It takes this case even more unique. This discussion is to bring focus on the importance of knowledge about CVST amongst emergency physicians and primary care physicians, specially managing this rare disorder with flummox presentation mimicking other more common disorders, especially in pediatric and neonatal population where definitive history and chief complaints are often vague and difficult to obtain, making it more difficult to diagnose. We the authors hence reporting this case with intent to spread awareness of CVST, how to doubt it, detect it and then manage it, especially in places like Chhattisgarh, India, where CVST is not so uncommon. We believe early diagnosis, early presentation to tertiary care center with aggressive early treatment can significantly reduce the mortality. Should the parents brought the baby early to any tertiary care center owing to his complex deteriorating symptoms like high grade fever progressed to drowsiness and seizure episodes, could there be a different outcome for this child as well as his parents.
March 2022
An Unwonted, Pedagogic Case Report on Effort Thrombosis of Right Brachial Vein
Deep vein thrombosis (DVT) is one or more blood clots formed inside the deep vein in the body resulting in complete or partial blockage of blood flow through the affected vein. Upper Extremity DVT (UEDVT) accounts for 5% - 10% of all cases of DVTs. Previously it was thought to be a rare disorder. However in recent years with the advent of various indwelling intravenous devices, hypercoagulable state like COVID-19, secondary UEDVT did not remain infrequent presentation anymore. Though primary UEDVT, also known as Effort Thrombosis, that takes place without any underlying obvious pathology is a rare form till now. We presented a case of 46 years female who presented to the emergency with complaints of progressively increasing pain (7 days) and swelling (3 days) of her right forearm since last 7 days following strenuous and heavy work by her dominant/ right hand during the period of festival. She initially ignored her condition because of the Durga Puja festival. As her symptoms deteriorated she eventually had to attend the emergency department. Eventually an urgent ultrasonography color Doppler was done on emergency basis which diagnosed underlying DVT of her right brachial vein. She was managed with low molecular weight heparin, urgent fasciotomy owning to her impending compartment syndrome. Other tests ruled out any secondary underlying pathology. She improved and discharged without any complications on oral anticoagulant. Exigent events in her history were trauma followed by fall on her right elbow 2 months back and then presenting signs & symptoms commencing at the same region following strenuous, tedious activities over 7 days and consequential effort thrombosis of her right brachial vein. All of that compelled us to ruminate on rare differentials of her presentation and eventually come to this rare diagnosis. The author hence brought this pedagogic case to the readers, especially emergency & primary care physicians and emphasised the importance of being intuitive about rare but deadly differentials which come from proficiency & experience in the field of medicine.
December 2021
A Case Report on Atypical Presentation of Cerebral Venous Sinus Thrombosis, a Young Adult with Recurrent Fall: A Clinical Quandary
doi: 10.4236/ojem.2021.94017.
Cerebral Venous Sinus Thrombosis (CVST) is blood clot in draining veins and venous sinuses of brain, causing hindrance in the blood drainage system in brain, disturbing the internal homeostasis of brain, resulting in local oedema, ischemia, venous haemorrhage, damage to brain parenchyma and blood brain barrier. In our case report, we discussed a rare presentation of CVST, a 16-year-old young boy who presented in emergency with history recurrent fall, weakness, tingling numbness. What makes it challenging to diagnose in his unusual presentation without common symptoms and on examination no positive neurological finding. This case brings focus on the importance of knowledge about CVST among emergency physicians. CSVT is considered more commonly as a differential diagnosis of stroke in young age group owning to genetic predisposition, hot humid climate of the state leading to severe dehydration, dietary factors leading to vitamin B12 deficiency & hyper-homocysteinemia etc. Moreover, present COVID-19, inducing a hypercoagulable state among affected individuals gave CVST a new momentous among emergency physicians. An early diagnosis can be very fruitful as it might prevent long term disability and reduce mortality significantly.
August 2021
A Case Series of Spontaneous Secondary Pneumothorax in Post Covid Period: A Clinical Insight
http://www.medtextpublications.com/open-access/case-series-of-spontaneous-secondary-pneumothorax-in-post-covid-period-875.pdf
Introduction: We are in the era of novel coronavirus pandemic. Each wave is teaching us something new about the disease pathology, long term prognosis. Nonetheless, COVID-19 is giving rise to new challenges to the clinicians every day with its new found complications, long haul Covid symptoms. Secondary
spontaneous pneumothorax has been reported to be a rare complication, seen in 1%-2% of COVID-19 patients with a mean time occurrence of 24.3 days from the hospital admission during the early phase of intubation.
Case discussion: We report a case series of four patients in post COVID period presented with sudden onset respiratory distress and hypoxia, diagnosed with spontaneous secondary pneumothorax. Out of three only one patient received NIV support during his past treatment for COVID-19 and others were treated with oxygen. Therefore, barotrauma secondary to positive pressure ventilation and rupture of cystic bulla cannot be a sole cause of this complication. Persistent chronic inflammatory process and ischemic damage of alveoli are other possible etiologies.
Conclusion: We highlight in our case series the importance of clinical examination, especially chest auscultation, which most clinicians circumvent owing to the trepidation of contracting COVID-19. We also proposed large researches to identify causal association with pneumothorax and previous use of steroids to treat COVID-19, persistent inflammation, age, gender, comorbidity etc to prevent it, as it can be debilitating and fatal. A clinician should always keep pneumothorax as a differential in sudden deteriorating breathlessness and hypoxia in post COVID period as it may happen as late as >40 days from primary COVID diagnosis.
February 2021
PNEUMOMEDIASTINUM, TENSION PNEUMOPERITONIUM, SECONDARY TO BOWEL PERFORATION IN POST COVID-19 PATIENT: A CASE REPORT
https://www.anncaserep.com/open-access/pneumomediastinum-tension-pneumoperitoneum-secondary-to-bowel-perforation-in-post-covid-19-6681.pdf
We report a case of 85 years old female, in post COVID-19 period, presented
in emergency room with acute onset of pain abdomen and altered mental status with associated history of reduced oral intake for past 6 to 7 days. She was intubated and started on ventilator support secondary to severe respiratory acidosis and deteriorating sensorium. Cardboard rigidity was found during abdominal examination with absent bowel sounds, though family confirmed she was passing stool normally until the day before her presentation. CT chest revealed subcutaneous emphysema, pneumomediastinum and tension pneumoperitoneum with both lungs having obvious post COVID-19 pneumonia sequela. We managed her with intravenous fluid resuscitation, invasive ventilation, broad spectrum antibiotics and other supportive management. Surgery team managed her bowel perforation with bedside abdominal drain insertion in view of high risk for operation secondary to her co-morbid status. In spite of all efforts she died. We believed that our patient might had a complication of bowel perforation, most probably involving upper part of the gastrointestinal tract suggested by presence of subcutaneous emphysema in neck and pneumomediastinum, apart from tension pneumoperitoneum, as a post COVID-19 sequel. Apart from direct bowel wall inflammation by SARS-CoV-2, intestinal dysbiosis as well as immunological alteration in lung via gut-lung axis, local disseminated intravascular coagulation, vasculitis secondary to hypercoaguable state in COVID-19 infection, bowel edema leading to over distension of bowel all play important pathophysiology in bowel perforation, a possible fatal complication in COVID-19 patients, that physicians should be conversant of, especially in critically ill patients or with multiple comorbidity, as these patients may or may not present with gastrointestinal symptoms.
December 2020
EXTENSIVE ANTERIOR WALL ST ELEVATED MYOCARDIAL INFARCTION FOLLOWING STEERING WHEEL IMPACT AND BLUNT CHEST TRAUMA IN A ROAD TRAFFIC ACCIDENT: A RARE CASE REPROT
Article DOI:10.21474/IJAR01/12251
DOI URL: http://dx.doi.org/10.21474/IJAR01/12251
Blunt trauma chest may rarely lead to acute myocardial infarction. Shear force generated from trauma causes tearing, laceration of coronary vascular intima and results in intraluminal thrombosis. Left anterior descending (LAD) artery is the most common to be involved secondary to its proximity to anterior chest wall. We report a case of 38year old hypertensive male presented in emergency room with complaints of left sided chest pain & diaphoresis for one hour following trauma to his chest from steering wheel following a collision between two four wheeler. During primary survey as per ATLS guideline 12 ECG revealed acute extensive anterior wall STEMI. Other associated injuries were left frontal non hemorrhagic contusion, bilateral minimal pneumothorax, multiple bilateral rib fractures, mild hemoperitoneum with small hematoma in retroperitoneum and serosal surface of stomach. Urgent coronary angiography done by cardiologist on call and patient was diagnosed with single vessel coronary artery disease involving LAD with severe systolic LV dysfunction. Percutaneous transmural coronary angioplasty (PTCA) was done by a drug eluting stent in LAD. An emergency physician should consider cardiac complications in patients with chest trauma including myocardial infarction, early diagnosis of which is critical to save the myocardium. Any delay in diagnosis can be detrimental.
October 2019
A CASE REPORT ON PNEUMOMEDIASTINUM, PNEUMOTHORAX & SUBCUTANEOUS EMPHYSEMA FOLLOWING DROWNING.
Article DOI: 10.21474/IJAR01/9867
DOI URL: http://dx.doi.org/10.21474/IJAR01/9867
We report a case of 18 year old male patient with alleged history of drowning evacuated from water within 2 minutes of submersion, needed initial resuscitation and ventilator support. Chest x-ray and CT chest diagnosed him with pneumomediastinum, bilateral pneumothorax and subcutaneous emphysema. Incidence of pneumomediastinum is a rare. It is usually managed conservatively. We are considering our case to be secondary pneumomediastinum as it developed following drowning and positive pressure ventilation. Though in literature several cases allowed to be reported as spontaneous pneumomediastinum following drowning or other causes, even when a possible causative factor was identified. Good prognostic indicators in case of near drowning in the emergency include GCS>5/15, short submersion time and spontaneous respiration and cardiac activity. Though our had respiratory failure, he was managed conservatively successfully and discharged home. Presence of pneumomediastinum, pneumothorax are not poor prognostic indicators per se in case of near drowning and can be treated conservatively.
June 2019
A CASE REPORT ON NEAR FATAL PRESENTAION WITH SULFAMETURON-METHYL (NON UREA SYNTHETIC SULFONYLUREA) HERBICIDE POISONING.
Article DOI: 10.21474/IJAR01/9244
DOI URL: http://dx.doi.org/10.21474/IJAR01/9244
We present a case of a case of sulfonylurea herbicide poisoning of a 65 year containing Sulfometuron methyl (75%). Though the literature suggests they are less toxic to human in acute poisoning, in our case report patient presented with acute respiratory failure, ARDS, metabolic and respiratory acidosis.
Self-poisoning with these newer non-urea synthetic organic herbicides including metsulfuron-methyl is a newly emerging phenomenon in India. Limited information regarding their toxic effects in human poses several clinical challenges to the treating physician. Literature suggests they are less toxic to human in acute poisoning, which is contradictory to the presentation in our case. There is no specific antidote available for sulfometuron methyl poisoning. Thus further documentation and research are needed to contrive more organized understanding in the clinical presentation, fatal possible outcomes of these herbicides’ poisoning, thereby formulate a consensus regarding approach in the management.
September 2018
First Case Report on Metribuzine, A Herbicide Suicidal Poisoning, Presented with Fatal Metabolic Acidosis, Acute Renal Failure, Hypokalemia
Article DOI: 10.21474/IJAR01/7745
DOI URL: http://dx.doi.org/10.21474/IJAR01/7745
A 27 years female patient presented within 21 hours of alleged history of suicidal ingestion of Metribuzine, a herbicide, in a drowsy state and with acute renal failure.
Patient’s arterial blood gas revelaed severe fatal metabolic acidosis and hypokalemia. Inspite of aggressive resuscitation with early invasive positive pressure ventilation, intravenous crystalloid, intravenous potassium and soda bicarbonate, patient went into cardiac arrest and after 1 hour of high quality cardiopulmonary resuscitation patient died. During resuscitation clinical signs of pulmonary oedema and hemorrhage also noticed.
Metribuzine, inspite of being an widely used herbicide, no case has been reported so far, specially with fatal outcome. No data available in human. Animal studies conclude it is being a non acutely toxic herbicide in mammals. Though we differ seeing the fatal outcome in our case and suggest more extensive studies in human.
February 2018
A Case Report on Suicidal Liraglutide Overdose in a Non Diabetic Female Presented with Hypoglycemia
Indian Journal of Emergency Medicine Volume 4 Number 1, January - March 2018
DOI: http://dx.doi.org/10.21088/ijem.2395.311X.4118.12
A 27 years old non diabetic woman with suicidal liraglutide overdose presented in emergency with nausea, vomiting and burning pain abdomen.
Case Presentation: We reported her blood glucose of 54 mg/dl in emergency, have given her 25% dextrose intravenous bolus and started her on 10% dextrose intravenous infusion, with other supportive medications. Her symptoms improved with intravenous glucose infusion and blood glucose level maintained normal in next 24 hours. Her liver function test and serum amylase remained within normal range.
In our case one episode of hypoglycaemia was reported in emergency (blood glucose 54mg/dl and drowsiness), though hypoglycaemia was never reported in any previous case report of liraglutide overdose. So, hypoglycaemia, though rare, can still be a possible complication of liraglutide overdose.
June 2017
DIAGNOSTIC DILEMMA IN A CASE OF ISCHAEMIC CVA
Indian Journal of Emergency Medicine, Volume 3 Number 1, January - June 2017
DOI: http://dx.doi.org/10.21088/ijem.2395.311X.3117.20
Acute stroke patients may have ischaemic changes and/or QT prolongation in ECG and elevated cardiac troponins, probably as a result of neurogenic cardiac damage, which may arise diagnostic dilemma for the emergency physician as in this case of a 72 years aged female patient patient presented with history of chest pain which was resolved with pain medication. Later she developed slurring of speech, weakness of left side of body, hoarseness of voice, deviation of mouth to right.
June 2016
PERFORATION OF MECKEL’S DIVERTICULUM BY CHICKEN WISHBONE – A CASE REPORT AND REVIEW OF LITERATURE
Article DOI: 10.21474/IJAR01/693
DOI URL: http://dx.doi.org/10.21474/IJAR01/693
Acute abdomen caused by perforation of Meckel’s diverticulum by foreign body is extremely rare in adults. In this article, we report a case of perforated Meckel’s diverticulum by a chicken bone with localized peritonitis in a 16-year old boy who presented to the hospital with complains of abdominal pain, episodes of vomiting and fever mimicking acute appendicitis. The purpose of this report is a review of the literature and to record a further case of perforation of Meckel’s diverticulum by a foreign body.
June 2015
ANILINE POISONING: PITFALLS AND CONSIDERATIONS IN THE MANAGEMENT OF CHEMICALLY INDUCED METHEMOGLOBINEMIA
INDIAN JOURNAL OF EMERGENCY MEDICINE VOL. 1 NO.1 JANUARY - JUNE 2015
http://nebula.wsimg.com/28797e46f40a6bd6a07206a4a2461f03?AccessKeyId=0F2E591B4F2C16921212&disposition=0&alloworigin=1
Aniline toxicity most frequently causes methemoglobinemia and haemolytic anaemia. We report the case of an 18 years old previously healthy male who presented to our Emergency Department (ED) with a history of bluish discoloration of fingers and mouth, weakness and uneasiness and subsequently diagnosed to have methaeglobinemia. On our literature search, we found that previous studies have shown that clinicians, in general, have a low index of suspicion of this potentially life threatening condition that often results in a delay in reaching the correct diagnosis and starting appropriate treatment. We take this opportunity to and discuss the possible pitfalls and considerations in the management of chemically induced methemoglobinemia.
Create & Recycle :