Pt.

Kamlapati Tripathi
District Hospital Chandauli (U.P.)
Pt. Kamlapati Tripathi District Hospital Chandauli is the Government hospital
of chandauli District and under the guidance of my Chief Pharmacist Mr. R.K.
Yadav, I have performed my hospital training and marked a recommendable
position in the Hospital. It is situated at G.T. Road chandauli, Varanasi-
221001(U.P.) near bank of baroda

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 FIRST AID TREATMENT
First aid is the assistance given to any person suffering a
sudden illness or injury, with care provided to preserve life, prevent the
condition from worsening, and/or promote recovery. It includes initial
intervention in a serious condition prior to professional medical help being
available, such as performing CPR while awaiting an ambulance, as well as the
complete treatment of minor conditions, such as applying a plaster to a cut. First
aid is generally performed by the layperson, with many people trained in
providing basic levels of first aid, and others willing to do so from acquired
knowledge. Mental health first aid is an extension of the concept of first aid to
cover mental health.

 Aims
The key aims of first aid can be summarised in three key points, sometimes known as 'the
three P's':-

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 Preserve life:

the overriding aim of all medical care, including first aid, is to save lives and minimize the
threat of death.

 Prevent further harm:

also sometimes called prevent the condition from worsening, or danger of further injury, this
covers both external factors, such as moving a patient away from any cause of harm, and
applying first aid techniques to prevent worsening of the condition, such as applying pressure
to stop a bleed becoming dangerous.

 Promote recovery:

first aid also involves trying to start the recovery process from the illness or injury, and in
some cases might involve completing a treatment, such as in the case of applying a plaster to
a small wound.

 Specific disciplines
There are several types of first aid (and first aider) which require specific additional training.
These are usually undertaken to fulfill the demands of the work or activity undertaken.

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  Aquatic/Marine first aid

It is usually practiced by professionals such as lifeguards, professional mariners or in diver

rescue, and covers the specific problems which may be faced after water-based rescue and/or
delayed MedEvac.

 Battlefield first aid

takes into account the specific needs of treating wounded combatants and non-
combatants during armed conflict.

 Hyperbaric first aid

may be practiced by SCUBA diving professionals, who need to treat conditions
such as the bends.

 Oxygen first aid

is the providing of oxygen to casualties who suffer from conditions resulting
in hypoxia.

 Wilderness first aid

is the provision of first aid under conditions where the arrival of emergency
responders or the evacuation of an injured person may be delayed due to
constraints of terrain, weather, and available persons or equipment. It may be
necessary to care for an injured person for several hours or days.

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  Mental health first aid
is taught independently of physical first aid. How to support someone
experiencing a mental health problem or in a crisis situation. Also how to
identify the first signs of someone developing mental ill health and guide
people towards appropriate help.

 First aid services

Symbols
Although commonly associated with first aid, the symbol of a red cross is an
official protective symbol of the Red Cross. According to theGeneva
Conventions and other international laws, the use of this and similar symbols is
reserved for official agencies of the International Red Cross and Red
Crescent, and as a protective emblem for medical personnel and facilities in
combat situations. Use by any other person or organization is illegal, and may
lead to prosecution.

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ISO First Aid Symbol


St. Andrew's First Aid Badge



Symbol of the Red Cross



Maltese or Amalfi Cross

Star of life

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Conditions that often require first aid

 Altitude sickness, which can begin in susceptible people at altitudes as low

as 5,000 feet, can cause potentially fatal swelling of the brain or lungs.
 Anaphylaxis, a life-threatening condition in which the airway can become
constricted and the patient may go into shock. The reaction can be caused by
a systemic allergic reaction to allergens such as insect bites or peanuts.
Anaphylaxis is initially treated with injection of epinephrine.
 Battlefield first aid—This protocol refers to treating shrapnel, gunshot
wounds, burns, bone fractures, etc. as seen either in the ‘traditional’
battlefield setting or in an area subject to damage by large-scale weaponry,
such as a bomb blast.
 Bone fracture, a break in a bone initially treated by stabilizing the fracture
with a splint.
 Burns, which can result in damage to tissues and loss of body fluids through
the burn site.
 Cardiac Arrest, which will lead to death unless CPR preferably combined
with an AED is started within minutes. There is often no time to wait for the
emergency services to arrive as 92 percent of people suffering a sudden
cardiac arrest die before reaching hospital according to the American Heart
Association.
 Heart attack, or inadequate blood flow to the blood vessels supplying the
heart muscle.
 Heat stroke, also known as sunstroke or hyperthermia, which tends to occur
during heavy exercise in high humidity, or with inadequate water, though it
may occur spontaneously in some chronically ill persons. Sunstroke,
especially when the victim has been unconscious, often causes major
damage to body systems such as brain, kidney, liver, gastric
tract. Unconsciousness for more than two hours usually leads to permanent
disability. Emergency treatment involves rapid cooling of the patient.
 Heavy bleeding, treated by applying pressure (manually and later with
a pressure bandage) to the wound site and elevating the limb if possible.
 Hyperglycemia (diabetic coma) and Hypoglycemia (insulin shock).
 Insect and animal bites and stings.
 Poisoning, which can occur by injection, inhalation, absorption, or ingestion.
 Muscle strains and Sprains, a temporary dislocation of a joint that
immediately reduces automatically but may result in ligament damage.
 Wounds and bleeding,including lacerations, incisions and abrasions, Gastroi
ntestinal bleeding, avulsions and Sucking chest wounds, treated with
an occlusive dressing to let air out but not in.

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~8~
 WOUND DRESSING

A dressing is used by a doctor, caregiver and/or patient to help a wound heal

and prevent further issues like infection or complications. Dressings are
designed to be in direct contact with the wound, which is different from a
bandage that holds the dressing in place.
Dressings serve a variety of purposes depending on the type, severity and
position of the wound. Aside from the major function of reducing the risk
of infection, dressings are also important to help:
 Stop bleeding and start clotting so the wound can heal
 Absorb any excess blood, plasma or other fluids
 Wound debridement
 Begin the healing process

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What type of wound care dressing is right for my wound?

Hydrocolloid:
Hydrocolloid dressings are used on burns, light to moderately draining
wounds, necrotic wounds, under compression wraps,pressure
ulcers and venous ulcers.
Hydrogel:
This type of dressing is for wounds with little to no excess fluid, painful
wounds, necrotic wounds, pressure ulcers, donor sites, second degree or
higher burns and infected wounds.
Alginate:
Alginate dressings are used for moderate to high amounts of wound
drainage, venous ulcers, packing wounds and pressure ulcers in stage III or
IV.
Collagen:
A collagen dressing can be used for chronic or stalled wounds, ulcers, bed
sores, transplant sites, surgical wounds, second degree or higher burns and
wounds with large surface areas.
In addition to the wound product categories listed above, there are other wound
dressings available, such as foams and compressionin addition to secondary and
cover dressings like wraps, gauze and tape.

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 ARTIFICIAL RESPIRATION

Respiration is the act of assisting or stimulating respiration, a metabolic

process referring to the overall exchange of gases in the body by pulmonary
ventilation, external respiration, and internal respiration. Assistance takes many
forms, but generally entails providing air for a person who is not breathing or is
not making sufficient respiratory effort on his/her own (although it must be used
on a patient with a beating heart or as part of cardiopulmonary resuscitation to
achieve the internal respiration). This method of insufflation has been proved
more effective than methods which involve mechanical manipulation of the
patient's chest or arms, such as the Silvester method.
It is also known as Expired Air Resuscitation (EAR), Expired Air
Ventilation (EAV), mouth-to-mouth resuscitation, rescue breathingor
colloquially the kiss of life.
Artificial respiration is a part of most protocols for performing cardiopulmonary
resuscitation (CPR) making it an essential skill for first aid. The performance of
artificial respiration in its own is now limited in most protocols tohealth
professionals, whereas lay first aiders are advised to undertake full CPR in any
case where the patient is not breathing sufficiently.

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Insufflations

Mouth-to-mouth insufflation
Insufflation, also known as 'rescue breaths' or 'ventilations', is the act of
mechanically forcing air into a patient's respiratory system. This can be
achieved via a number of methods, which will depend on the situation and
equipment available. All methods require good airway management to perform,
which ensures that the method is effective. These methods include:

 Mouth to mouth - This involves the rescuer making a seal between his or
her mouth and the patient's mouth and 'blowing', to pass air into the
patient's body
 Mouth to nose - In some instances, the rescuer may need or wish to form
a seal with the patient's nose. Typical reasons for this
include maxillofacial injuries, performing the procedure in water or the
remains of vomit in the mouth
 Mouth to mask – Most organisations recommend the use of some sort of
barrier between rescuer and patient to reduce cross infection risk. One
popular type is the 'pocket mask'. This may be able to provide higher tidal
volumes than a Bag Valve Mask

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 DIFFERENT ROUTES OF INJECTION

Injections:
1. Intra muscular
2. Intra venous
3. Intra-arterial
4. Intra-cardiac
5. Intra-thecal
6. Intraosseous- into bone marrow
7. Intrapleural
8. Intraperitoneal
9. Intra-articular
10.Intradermal (Intracutaneous)
11.Subcutaneous route (Hypodermic)

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 Intramuscular route:
Intramuscular route might be applied to the
buttock, thigh and deltoid.The volume used is
3 ml.

Advantages:
1. Absorption is rapid than subcutaneous
route.
2. Oily preparations can be used.
3. Irritative substances might be given
4. Slow releasing drugs can be given by this
route.
Disadvantages
Using this route might cause nerve or vein
damage.

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 Intravenous injections:
Intravenous injections might be applied to the
cubital, basilic and cephalic veins.
Advantages:
1. Immediate action takes place
2. This route is preferred in emergency situations
3. This route is preferred for unconscious
patients.
4. Titration of dose is possible.
5. Large volume of fluids might be injected by
this route
6. Diluted irritant might be injected
7. Absorption is not required
8. No first pass effect takes place.
Disadvantages:
1. There is no retreat
2. This method is more risky
3. Sepsis-Infection might occur
4. Phlebitis(Inflammation of the blood vessel) might occur
5. Infiltration of surrounding tissues might result.
6. This method is not suitable for oily preparations
7. This method is not suitable for insoluble preparations
Intra arterial route:
This method is used for chemotherapy in cases of malignant tumors and in
angiography.
Intra dermal route:
This route is mostly used for diagnostic purposes and is involved in:
 Schick test for Diphtheria
 Dick test for Scarlet fever
 Vaccines include DBT, BCG and polio
 Sensitivity is to penicillin
Intra cardiac route
Injection can be applied to the left ventricle in case of cardiac arrest.
Intra thecal route:
Intrathecal route involves the subarachnoid space. Injection may be applied for
the lumbar puncture, for spinal anesthesia and for diagnostic purposes. This
technique requires special precautions.

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Intra-articular route:
Intra-articular route involves injection into the joint cavity. Corticosteroids may
be injected by this route in acute arthritis.
Intra peritoneal route:
Intraperitoneal route may be used for peritoneal dialysis.
Intra pleural route:
Penicillin may be injected in cases of lung empyma by intrapleural route.
Injection into bone marrow
This route may be used for diagnostic or therapeutic purposes.
Hypospray/Jet Injection:
This method is needleless and is subcutaneous done by applying pressure over
the skin. The drug solution is retained under pressure in a container called
‘gun’. It is held with nozzle against the skin. Pressure on the nozzle allows a
fine jet of solution to emerge with great force. The solution can penetrate the
skin and subcutaneous tissue to a variable depth as determined by the pressure.

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 PATIENT OBSERVATION CHART

1. Observation Chart
Ensuring that patients who
deteriorate receive appropriate and
timely care is a key safety and quality
challenge. All patients should receive
comprehensive care regardless of their
location in the hospital or the time of
day. Even though a range of systems
have been introduced to better manage
clinical deterioration, this area needs to
remain a high priority while patients
continue to experience preventable
adverse events because their
deterioration is not identified or properly
managed. The objective of an
observation chart is to present the most
important vital signs for detecting

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deterioration in most patients in a user-friendly manner.
a) Single parameter tool (track and trigger) - Vital signs are compared with a
simple set of criteria with predefined thresholds, with a response algorithm
being activated when any criterion is met”.
The main vital signs are graphed so that trends can be easily ‘tracked’. There are
also colour coded zones to indicate when patient observations are likely to
represent deterioration, where a response is ‘triggered’. Incorporating call
criteria in observation charts is an effective way in which to highlight possible
deterioration and assist clinicians with making decisions as to when to ‘trigger’
a response, whether that be for a clinical review or rapid response call.
b) Aggregate scoring system - Core observations attract a weighted Score.
“Weighted scores are assigned to physiological values and compared with
predefined trigger thresholds. The main vital signs are collected and points are
allocated. The points for each observation are added to give a score that helps
identify patients with subtle signs of deterioration. A supporting Action Plan
triggers certain actions when certain scores are reached.
c) Combination system - Single or multiple parameter systems used in
combination with aggregate weighted scoring systems.
d) Non track and trigger - Other observations charts may include the
collection of vital signs with no scoring or no criteria for a response

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 PRESCRIPTION AND DISPENSING
PRESCRIPTION
A prescription contains handwritten instructions for the dispensing and
administering of medications. It can be more than an order for drugs as it can
also include instructions for a therapist, the patient, nurse, caretaker, pharmacist
or a lab technician for orders for lab tests, X-rays, and other assessments.

Prescriptions have five sections:

 Superscription - the heading with

the date and the patient’s name,
address, age, etc.
 Symbol Rx - the Rx stands for
"recipe" which in Latin means "to
take."

 Inscription - the information about

the medication. It has the name of
the ingredients and the amount
needed. It includes the main
ingredient, anything that helps in
the action of the drug, something to
modify the effects of the main drug,
and the "vehicle" which makes the
medicine more pleasant to take.

 Subscription - The subscription

section tells the pharmacist how to
dispense the drug. This will have instructions on compounding the drug
and the amount needed.

 Signature - The signature has the directions that are to be printed on the
medicine. The word "sig" means "write on label."

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Variances in Prescription Wording

Prescriptions vary from state to state and doctor to doctor:

 Sometimes the doctor will write "dispense as written," "do not

substitute," or "medically necessary."
 Sometimes the age of the child is required and often the doctor will put
the condition that is being treated.
 Sometimes there is a label box. If the doctor checks this, the pharmacist
labels the medicine; if not, he only puts the instructions for taking it.

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 DISPENSING PROCEDURE
• Ensure that the prescription has the name and signature of the prescriber and
the stamp of the health centre.

• Calculate the total cost of the drug to be dispensed on the basis of the
prescription where applicable.

• Inform the patient about the cost of the drug.

• Issue a receipt for all payments.

• Hand over the dispensed drug as in

• Ensure that the prescription is dated and has the name of the patient.

• If the prescription has not been written in a known (local) health centre, the
prescriber of the centre should endorse it.

• Avoid dispensing without a prescription or from an unauthorized prescriber.

• Check the name of the prescribed drug against that of the container.

• Check the expiration date on the container

Correct drug dispensing

Dispensed drugs should be appropriately labelled so that the patient can benefit
optimally from the use of the drug. Expired drugs should not be
dispensed. Correct dispensing ensures that:

• The right patient is served,

• A desired dosage form of the correct drug is given,
• The prescribed dosage and quantity are given,
• The right container that maintains the potency of the drugs is used,
• The container is appropriately labelled,
• Clear instructions are delivered verbally to the patient.

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~ 22 ~
 SIMPLE DIAGNOSTIC REPORTS
Assuming that the tests are correctly and completely scored, the first step in
writing a diagnostic report is to organize your data including test scores,
observations, case history and interview data, and other information
meticulously by area. That is, for each heading in the report you must gather all
the relevant information you possess. Use the Summary and Test Interpretation
Form (STIF) for this purpose.
Organizing the Tests
For the sections of the report that discuss testing, use the STIF to identify the
tests you gave that are relevant, to record the scores of those tests, to interpret
those scores, to add relevant observations, and to make notes to yourself about
how results from one test or section relate to other tests. Do this for each section
of the STIF.

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WRITING THE REPORT

Getting Started
The Diagnostic Report Form (DRF) is available in both printed and computer
versions. If you have any facility at all using a computer, you will make the
most efficient use of your time by far if you compose the report at the computer.
It is entirely feasible to do so if you have done a good job of getting organized
with the STIF. The computer version was designed to help you write the report
as efficiently as possible. The DRF provides much of the structure of the report.
You don't have to worry about organization, headings, and so on. It also takes
the drudgery out of the parts of the report that actually report test scores.
These are the features of diagnostic reports that rarely change from one to the
next. Reporting the score of the PPVT in one report is pretty much the same as
reporting it in another.
You can see that this is an enormous time saver. You don't have to organize the
report from scratch. Nor do you have to worry about
how to word much of it.

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COVER PAGE/IDENTIFYING INFORMATION

Fill in the name, address and other identifying information on the cover page. In
the final version the cover page will be printed on DePaul letterhead.
INSTRUMENTS OF EVALUATION
Here we want to list every test that was given to the child being described in the
report. The list of tests on the cover page contains most of the tests regularly
administered. Delete the tests not given.
REFERRAL AND IDENTIFYING DATA
In this section you encounter the first of the
optional language of the DRF. Certain
conventions will be followed throughout.
Choice of Words. Words or phrases in
parentheses are choices. Select the appropriate
choice (or substitute your own) and delete the
other choices.MENTAL ABILITY-Now that
the stage is set with as much background
information as possible, we are ready to move
into the various areas of testing, starting with
mental ability. From here on out, each section
will follow the same format and structure for
discussing testing: scores and interpretation,
examples and discussion, summary and
integration.
Reporting Results. Notice that this section
contains a mix of norm-referenced and
criterion referenced tests. On the criterion
referenced tests there are no scores to report.
However, you should describe in detail what
the child can and cannot do. You can describe
what letters the child knows the name of and
which ones he does not; which letter he
knows the sounds for and which he does not;
which letters he can write and so on. Include
as much information as possible from
observations and the tests you gave.The final
paragraph should contain a summary and interpretation of the child's reading
readiness. You should decide whether the child's readiness skills are well
enough developed for reading instruction and fill in the blank with your
appraisal. If the child is OK you could say: 20 In general readiness skills are in
the average range and Johnny should be able to profit from beginning reading
instruction.

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SONOGRAPHY REPORTS

PATHOLOGICAL REPORTS

~ 26 ~
REPORT SUMMARY
The summary of the report is perhaps the most important section, not only
because it is where all the pieces get tied up into one final portrait of the child,
but also because it is sometimes the only part of the report that is read. So it
must be well done.

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 POSTMORTEM

An autopsy—also known as a post-

mortem examination, necropsy,
or autopsia cadaverum —is a highly
specialized surgical procedure that
consists of a thorough examination of
a corpse by dissection to determine the
cause and manner of death and to
evaluate any disease or injury that may
be present. It is usually performed by a
specialized medical doctor called
a pathologist.
Autopsies are performed for either
legal or medical purposes. For
example, a forensic autopsy is carried
out when the cause of death may be a
criminal matter, while a clinical or
academic autopsy is performed to find
the medical cause of death and is used
in cases of unknown or uncertain
death, or for research purposes.
Autopsies can be further classified into
cases where external examination suffices,
and those where the body is dissected and
internal examination is conducted. Permission from next of kin may be required
for internal autopsy in some cases. Once an internal autopsy is complete the
body is reconstituted by sewing it back together.

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Type
There are four main types of autopsies

 Medico-Legal Autopsy or Forensic or coroner's autopsies seek to find the

cause and manner of death and to identify the decedent. They are generally
performed, as prescribed by applicable law, in cases of violent, suspicious or
sudden deaths, deaths without medical assistance or during surgical
procedures.

 Clinical or Pathological autopsies are performed to diagnose a particular

disease or for research purposes. They aim to determine, clarify, or confirm
medical diagnoses that remained unknown or unclear prior to the patient's
death.
 Anatomical or academic autopsies are performed by students of anatomy for
study purpose only.
 Virtual or medical imaging autopsies are performed utilizing imaging
technology only, primarily magnetic resonance imaging (MRI) and
computed tomography (CT).

Purpose
The principal aim of an autopsy is to determine the cause of death, the state of
health of the person before he or she died, and whether any medical
diagnosis and treatment before death was appropriate.
When a person has given permission in advance of their death, autopsies may
also be carried out for the purposes of teaching or medical research.
An autopsy is frequently performed in cases of sudden death, where a doctor is
not able to write a death certificate, or when death is believed to result from
an unnatural cause. These examinations are performed under a legal authority
(Medical Examiner or Coroner or Procurator Fiscal) and do not require the
consent of relatives of the deceased. The most extreme example is the
examination of murder victims, especially when medical examiners are looking
for signs of death or the murder method, such as bullet wounds and exit points,
signs of strangulation, or traces of poison. Some religions
including Judaism and Islam usually discourage the performing of autopsies on
their adherents.[1]Organizations such as Zaka in Israel and Misaskim in the
United States generally guide families how to ensure that an unnecessary
autopsy is not made.

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 CONCLUSION

During training procedures I have got lot of knowledge about flowing-

Stated project a training regarding each and every first aid procedures, It
includes checking the symptoms and treating at small scale in first aids and later
transferring for surgical procedures. I got known regarding artificial respiration
process and wound dressing.

In Prescription reading, its parts and the abbreviations used are studied by me in
this project it’s truly a scandalous matter for pharmacists study. Later the
dispensing procedure is stated therefore which was practiced by me all around
the training at regular intervals.

In Simple diagnostic reports those are easy to study in case of pathological

reports but a bit of difficulty arises in reading radiological reports .

Sites of injection which includes knowledge of syringes, routes of injections.

Routes of injections such as I.V., I.M., I.D., Subcutaneous etc.

Therefor I have got a marvelous experiance by this training.

Shesh Narayan Sharma

~ 30 ~
References

1. First aid manual: 9th edition. Dorling Kindersley. 2009. ISBN 978 1
4053 3537 9.
2. Jump up^ "Duct tape for the win! Using household items for first aid
needs.". CPR Seattle.
3. ^ Jump up to:a b c Pearn, John (1994). "The earliest days of first aid". The
BritishMedicalJournal. 309:17181720. doi:10.1136/bmj.309.6970.1718.
PMC 2542683 . PMID 7820000.
4. Mehta R.M, “Pharmaceutics-I” IVTH edition VallabhPrakashan (page no-
269-274).
5. www.wikipedia.org
6. http://4my3939.blogspot.in/
7. Elizabeth C Burton, Kim A Collins. Religions and the Autopsy,
EMedicine. Retrieved 2012-09-12.
8. Jump up^ Ravakhah K (2006). "Death certificates are not reliable:
revivification of the autopsy". South. Med. J. 99 (7): 728–
33. doi:10.1097/01.smj.0000224337.77074.57. PMID 16866055.
9. Jump up^ Shojania KG, Burton EC, McDonald KM, Goldman L (2003).
"Changes in rates of autopsy-detected diagnostic errors over time: a
systematicreview". JAMA. 289 (21):284956. doi:10.1001/jama.289.21.28
49. PMID 12783916.

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HOSPITAL TRAINING CER TIFICATE

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