PRESENTED  BY, PARTH  DHANANI 10 B P W 618 B.Pharm [ Hons.] BATCH: E
<ul><li>FIRST ESTABLISHED IN 1999 </li></ul><ul><li>FIRST CORPORATE HOSPITAL IN GUJARAT, SUCCESSFULLY RENDERING SERVICES F...
<ul><li>Orientation  - Introduction to hospital Staff  </li></ul><ul><li>Exposure  - In patient department </li></ul><ul><...
<ul><li>Out Patient Department </li></ul><ul><li>Introduction </li></ul><ul><li>Prescription fill </li></ul><ul><li>  Bill...
<ul><li>Attendance Policy </li></ul><ul><li>Dress Code </li></ul><ul><li>Posting </li></ul><ul><li>Narcotic Drugs Dispensi...
<ul><ul><ul><li>ICCU / CCU </li></ul></ul></ul><ul><ul><ul><li>Dialysis Centre </li></ul></ul></ul><ul><ul><ul><li>Lithotr...
<ul><li>Surgical Oncology Department </li></ul><ul><li>Medical Oncology Department </li></ul><ul><li>Psychiatry Department...
<ul><li>PATIENT NAME: XYZ  ROOM: I/9 </li></ul><ul><li>AGE: 46 YEARS </li></ul><ul><li>SEX: FEMALE </li></ul><ul><li>WEIGH...
 
 
 
DAY 1 DAY 2 DAY 3 Haemoglobin 14.7 12.6 --- Total count 14,900 11,400 --- Platelet count 2,33,000 2,46,000 2,37,000 RBS ↑s...
 
DRUG GENERIC NAME DAY 1 DAY 2 DAY 3 Inj. Magnex forte (3g) IN 100ccNS i.v. 12 hrly  Cefoperazone+ salbectam √ √ √ Inj. H.A...
DRUGS INTERACTIONS MANAGEMENT Ondansetron ↔ Tramadol Concurrent use of 5-HT3 receptor antagonists may reduce the analgesic...
<ul><li>Diclofenac is widely used analgesic. But in this case ,tramadol is used as diclofenac being belonging to NSAIDs cl...
<ul><li>NAME: LM  ROOM:111/1 </li></ul><ul><li>AGE: 68 YEARS </li></ul><ul><li>SEX: MALE </li></ul><ul><li>WEIGHT: 64Kg </...
 
 
 
DAY 1 DAY 2 Haemoglobin  ↓se 12.1 12.9 Total count 5900 5568 ESR 05  (1–25mm/hr) --- Platelet count 2,67,000 3,12,000 RBS ...
 
DRUG GENERIC NAME DAY 1 DAY 2 DAY3 DAY4 DAY5 DAY6 Tab. Clavix (75mg) BD Clopidogrel √ √ √ √ √ √ Tab. Ecospin (150mg) OD As...
DRUG GENERIC NAME DAY 1 DAY 2 DAY3 DAY4 DAY5 DAY6 Tab. Alprex (0.5mg)  1 HS Alprazolam √ √ √ √ √ √ Inj. KCl 3amp. In 50ccN...
DRUGS INTERACTIONS MANAGEMENT Furosemide  ↔ Metoprolol Diuretics and beta-blockers may increase the risk of hyperglycemia ...
<ul><li>PATIENT NAME: PQR  ROOM: I/3 </li></ul><ul><li>AGE: 50 YEARS </li></ul><ul><li>SEX: MALE </li></ul><ul><li>WEIGHT:...
 
 
 
DAY 1 DAY 2 DAY 3 DAY 4 Haemoglobin 11.8 10.1 8 9 Total count 3360 7900 6100 5130 Platelet count 2,33,000  (1,30,000—4,00,...
<ul><ul><li>Soft tissue opacity in both lower zones of peritoneal cavity. </li></ul></ul><ul><ul><li>Minimal right pleural...
DRUG GENERIC NAME DAY 1 DAY 2 DAY 3 Inj. Magnex forte (1.5g)  i.v. 8 hrly  Cefoperazone+ salbectam √ √ √ Inj. Pantodac (40...
<ul><li>Patient is initially given empirical therapy (cefoperazone + salbactam) to treat infection as culture test takes a...
 
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Interim Report

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FIRST ESTABLISHED IN 1999
FIRST CORPORATE HOSPITAL IN GUJARAT, SUCCESSFULLY RENDERING SERVICES FOR LAST ELEVEN YEARS
MULTISPECIALITY CLINICS IN ONE ROOF
IT HAS SERVED LARGE NUMBER OF PATIENTS OF GUJARAT, RAJASTHAN AND MADYAPRADESH STATE AND PROVIDED SUITABLE PLATFORM FOR DOCTORS TO WORK IN HARMONY

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Interim Report

  1. 1. PRESENTED BY, PARTH DHANANI 10 B P W 618 B.Pharm [ Hons.] BATCH: E
  2. 2. <ul><li>FIRST ESTABLISHED IN 1999 </li></ul><ul><li>FIRST CORPORATE HOSPITAL IN GUJARAT, SUCCESSFULLY RENDERING SERVICES FOR LAST ELEVEN YEARS </li></ul><ul><li>MULTISPECIALITY CLINICS IN ONE ROOF </li></ul><ul><li>IT HAS SERVED LARGE NUMBER OF PATIENTS OF GUJARAT, RAJASTHAN AND MADYAPRADESH STATE AND PROVIDED SUITABLE PLATFORM FOR DOCTORS TO WORK IN HARMONY </li></ul>
  3. 3. <ul><li>Orientation - Introduction to hospital Staff </li></ul><ul><li>Exposure - In patient department </li></ul><ul><li>Out patient department </li></ul><ul><li>IN Patient Department - Introduction </li></ul><ul><li> Prescription filling </li></ul><ul><li> Prescription return </li></ul><ul><li> Stock audit </li></ul><ul><li>Time Motion studies </li></ul><ul><li>Case Report Form </li></ul>
  4. 4. <ul><li>Out Patient Department </li></ul><ul><li>Introduction </li></ul><ul><li>Prescription fill </li></ul><ul><li> Billing </li></ul><ul><li>Vital statistics </li></ul><ul><li> </li></ul><ul><li>Total employees:116 </li></ul><ul><li> Number of Physician/surgeon:32 </li></ul><ul><li> licensed Bed:60 </li></ul><ul><li> Number of Admission:14250 </li></ul>
  5. 5. <ul><li>Attendance Policy </li></ul><ul><li>Dress Code </li></ul><ul><li>Posting </li></ul><ul><li>Narcotic Drugs Dispensing </li></ul><ul><li>List of Emergency Medication </li></ul><ul><li>Formulary </li></ul><ul><li>Dispensing Tips </li></ul><ul><li>Medication Error </li></ul><ul><li>Software Use for Billing </li></ul>
  6. 6. <ul><ul><ul><li>ICCU / CCU </li></ul></ul></ul><ul><ul><ul><li>Dialysis Centre </li></ul></ul></ul><ul><ul><ul><li>Lithotripsy Centre </li></ul></ul></ul><ul><ul><ul><li>Trauma Centre </li></ul></ul></ul><ul><ul><ul><li>Chemotherapy Centre </li></ul></ul></ul><ul><ul><ul><li>kidney Transplant Unit </li></ul></ul></ul><ul><ul><ul><li>X-ray / Sonography </li></ul></ul></ul><ul><ul><ul><li>Pathology Laboratory </li></ul></ul></ul><ul><ul><ul><li>Health Check-up </li></ul></ul></ul><ul><ul><ul><li>Close Monitoring </li></ul></ul></ul><ul><ul><ul><li>Medical Store </li></ul></ul></ul><ul><ul><ul><li>Ambulance </li></ul></ul></ul><ul><ul><ul><li>Cafeteria </li></ul></ul></ul><ul><ul><ul><li>STD / ISD / PCO </li></ul></ul></ul>
  7. 7. <ul><li>Surgical Oncology Department </li></ul><ul><li>Medical Oncology Department </li></ul><ul><li>Psychiatry Department </li></ul><ul><li>Gynec-endoscopy and Gynec-oncology Department </li></ul><ul><li>Orthopaedics Department </li></ul><ul><li>Plastic Surgery Department </li></ul><ul><li>Rheumatology Department </li></ul><ul><li>Paediatrics & Paediatric Surgery Department </li></ul><ul><li>Cardio Thoracic Surgery Department </li></ul><ul><li>Pulmonology Department </li></ul>
  8. 8. <ul><li>PATIENT NAME: XYZ ROOM: I/9 </li></ul><ul><li>AGE: 46 YEARS </li></ul><ul><li>SEX: FEMALE </li></ul><ul><li>WEIGHT: 69Kg </li></ul><ul><li>HEIGHT: 5’6’’ </li></ul>
  9. 12. DAY 1 DAY 2 DAY 3 Haemoglobin 14.7 12.6 --- Total count 14,900 11,400 --- Platelet count 2,33,000 2,46,000 2,37,000 RBS ↑se 425 (70-110) --- --- Creatinine 0.8 (0.6-1.2) 0.52 --- Urea 13.5 14.2 --- Sodium 137 139.33 --- Potassium ↓se 3.0 2.8 3.1 Calcium --- 8.3 --- SGPT ↑se 125 (0 - 35) --- 80.76 Serum Amylase ↑se 2415(35-120) --- --- Serum lipase ↑se 5580 (0-160) 1520 --- Serum AlkPo4ase --- 71 (70-120) 124.99
  10. 14. DRUG GENERIC NAME DAY 1 DAY 2 DAY 3 Inj. Magnex forte (3g) IN 100ccNS i.v. 12 hrly Cefoperazone+ salbectam √ √ √ Inj. H.Actrapid acc S/C 6 hrly Short acting insulin √ √ √ Inj. Pantodac (40mg) i.v. OD Pantoprazole √ √ √ Inj. Emeset 1 @ i.v. 8 hrly Ondansetron √ √ √ Inj. Contramol 1@(50mg) in 100ccNS i.v. 8 hrly Tramadol √ √ √ Inj. 150 ml RL 1@ at 200ml/hr Ringer Lactate √ √ √ Inj. KCl 1@ in 1NS@ , 2@/day Potassium √ √ √ Inj. Febrinil 1@ i.v. sos Paracetamol √ √ √
  11. 15. DRUGS INTERACTIONS MANAGEMENT Ondansetron ↔ Tramadol Concurrent use of 5-HT3 receptor antagonists may reduce the analgesic efficacy of tramadol. The proposed mechanism is antagonism of serotonin-mediated effects of tramadol at the spinal level. No particular intervention is required. However, the possibility of a diminished therapeutic response to tramadol should be considered during concomitant therapy with 5-HT3 receptor antagonists. Insulin ↔ lvp solution with potassium (KCl in NS) Potassium repletion may partially or completely reverse glucose intolerance in some patients with liver cirrhosis. The effect of insulin may be potentiated, and the risk of hypoglycemia increased. If coadministered, close monitoring of blood glucose level is required.
  12. 16. <ul><li>Diclofenac is widely used analgesic. But in this case ,tramadol is used as diclofenac being belonging to NSAIDs class, is nephrotoxic, which will further worsen the condition. </li></ul><ul><li>Food has to be administered by naso-jejunum route. </li></ul><ul><li>When patient begin to recover, he is first given clear water. If tolerated, then switched on to soft diet and finally, when patient begin to consume full diet, he is discharged from hospital. </li></ul><ul><li>Right now this patient is on soft diet. </li></ul>
  13. 17. <ul><li>NAME: LM ROOM:111/1 </li></ul><ul><li>AGE: 68 YEARS </li></ul><ul><li>SEX: MALE </li></ul><ul><li>WEIGHT: 64Kg </li></ul><ul><li>HEIGHT: 5’9’’ </li></ul>
  14. 21. DAY 1 DAY 2 Haemoglobin ↓se 12.1 12.9 Total count 5900 5568 ESR 05 (1–25mm/hr) --- Platelet count 2,67,000 3,12,000 RBS ↑se 158.8 (70 – 110) 179.03 Creatinine 0.7 0.67 Urea 17 14 Sodium ↓se 125.3 135.9 Potassium 3.31 2.97 SGPT 16 (0 – 35 U/L) --- pH ↓se 7.19 (7.38) --- pCO2 38 (35-45) --- pO2 ↓se 67 (80-100) --- Bicarbonate ↓se 14 (21-30 Meq/L) 16.6 CPK MB ↑se 33.99 (0-7ng/L) 24.03 Troponon I ↑se 10.5 (0-0.4) 6.1
  15. 23. DRUG GENERIC NAME DAY 1 DAY 2 DAY3 DAY4 DAY5 DAY6 Tab. Clavix (75mg) BD Clopidogrel √ √ √ √ √ √ Tab. Ecospin (150mg) OD Aspirin √ √ √ √ √ √ Inj. NTG 50mg in 50ml NS 1ml/hr Nitroglycerin √ √ √ √ √ --- Tab. Indur (30mg) 1-1-0 Isosrbide mononitrate --- --- --- --- --- √ Tab. Betaloc 50mg BD Metoprolol √ √ √ √ √ √ Tab. Atorva (40mg) 1HS Atorvastatin √ √ √ √ √ √ Tab. Ramace (2.5mg) 1 OD Ramipril √ √ √ √ √ √ Inj. Lasix 2amp. i.v. BD Furosemide √ √ --- --- --- --- Tab. Lasilactone (20+50) 1-1-0 Furosemide + Spironolactone --- --- √ √ √ √ Inj. Clexane (0.6mg) s.c. BD Low Mol.Wt. Heparin √ √ √ √ √ --- Liq. Looz 10ml HS Lactulose √ √ √ √ √ √
  16. 24. DRUG GENERIC NAME DAY 1 DAY 2 DAY3 DAY4 DAY5 DAY6 Tab. Alprex (0.5mg) 1 HS Alprazolam √ √ √ √ √ √ Inj. KCl 3amp. In 50ccNS 2ml/hr Potassium supplement --- √ √ √ √ √ Inj. Actrapid according to RBS Short acting insulin √ √ √ √ √ √
  17. 25. DRUGS INTERACTIONS MANAGEMENT Furosemide ↔ Metoprolol Diuretics and beta-blockers may increase the risk of hyperglycemia and hypertriglyceridemia in patients with diabetes or latent diabetes. Monitoring of serum potassium levels, blood pressure, and blood glucose is recommended during coadministration. Metoprolol ↔ Insulin Inhibition of catecholamine-mediated glycogenolysis and glucose mobilization in association with beta-blockade can potentiate insulin-induced hypoglycemia in diabetics and delay the recovery of normal blood glucose levels. Prolonged and severe hypoglycemia may occur. Patient should be instructed about the need for regular monitoring of blood glucose levels and be aware that certain symptoms of hypoglycemia such as tremors and tachycardia may be masked. Furosemide ↔ Ramipril Coadministration makes hypotension and hypovolemia more likely than does either drug alone. Some ACE inhibitors may attenuate the increase in the urinary excretion of sodium caused by some loop diuretics. The possibility of first-dose hypotensive effects may be minimized by initiating therapy with small doses of the ACE inhibitor, or either discontinuing the diuretic temporarily or increasing the salt intake approximately one week prior to initiating an ACE inhibitor. Heparin ↔ Nitroglycerin Concurrent administration of heparin and intravenous nitroglycerin may lead to a decreased anticoagulant effect. If coadministered, close evaluation of the coagulation status of the patient is required and heparin dose titrated as needed.
  18. 26. <ul><li>PATIENT NAME: PQR ROOM: I/3 </li></ul><ul><li>AGE: 50 YEARS </li></ul><ul><li>SEX: MALE </li></ul><ul><li>WEIGHT: 77 Kg </li></ul><ul><li>HEIGHT: 5’7’’ </li></ul>
  19. 30. DAY 1 DAY 2 DAY 3 DAY 4 Haemoglobin 11.8 10.1 8 9 Total count 3360 7900 6100 5130 Platelet count 2,33,000 (1,30,000—4,00,000) 2,46,000 2,37,000 2,41,000 Creatinine 0.89 1.20 --- --- Urea 13.5 14.2 --- --- Sodium 137 139.33 --- --- Potassium 4.7 3.68 3.75 --- Calcium --- 8 --- --- Chloride ↓se 4.37 (95-105) 4.89 --- --- SGPT ↑se 118.9 113 63.65 --- Serum Amylase ↑se 2415 --- --- --- Serum lipase ↑se 5580 1520 --- --- Serum AlkPo4ase --- 78 (30-120) 118.6 ---
  20. 31. <ul><ul><li>Soft tissue opacity in both lower zones of peritoneal cavity. </li></ul></ul><ul><ul><li>Minimal right pleural effusion </li></ul></ul>X-RAY <ul><ul><li>Mildly enlarged liver, spleen & kidney </li></ul></ul><ul><ul><li>Bowel: minimal dilation, excessive fluid filled </li></ul></ul>USG <ul><ul><li>PERITONITIS </li></ul></ul>DIAGNOSIS
  21. 32. DRUG GENERIC NAME DAY 1 DAY 2 DAY 3 Inj. Magnex forte (1.5g) i.v. 8 hrly Cefoperazone+ salbectam √ √ √ Inj. Pantodac (40mg) 1@ i.v. OD Pantoprazole √ √ √ Inj. Emeset 1 @ i.v. 8 hrly Ondansetron √ √ √ Inj. Contramol 1@(50mg) in 100ccNS i.v. sos for pain Tramadol √ √ √ DNS 500ml i.v. Dextrose √ --- --- DNS/RL 1@ i.v. 150ml/hr --- √ √ NS 120ml i.v. Chloride √ √ √ Inj. Febrinil 1@ i.v. sos Paracetamol √ √ √
  22. 33. <ul><li>Patient is initially given empirical therapy (cefoperazone + salbactam) to treat infection as culture test takes approximately 48–72 hours for indentification of organism. Subsequently definitive treatment is provided. </li></ul><ul><li>Drug interactions same as case-1 (pancreatitis) </li></ul>

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