TO STUDY PATTERN OF EMERGENCY CASES COMING TO HOSPITAL SO AS TO IMPROVE THE EMERGENCY CARE DIPLOMA HOSPITAL MANAGEMENT THESIS (NIHFW,NEW DELHI)

THESIS/ DHM/5438/2017-18/DR RASHMI RANJAN GURU
DIPLOMA IN HOSPITAL MANAGEMENT
PROJECT TITLE
TO STUDY PATTERN OF EMERGENCY CASES COMING TO HOSPITAL SO AS
TO IMPROVE THE EMERGENCY CARE
Submitted By
Dr Rashmi Ranjan Guru
DHM/5438/2017-18
1

INSTITUTE HOSPITAL
INDIAN INSTITUTE OF TECHNOLOGY ROORKEE
CERTIFICATE BY THE GUIDE
This is to certify that the work which is being presented in this thesis entitled “ TO
STUDY PATTERN OF EMERGENCY CASES COMING TO HOSPITAL SO AS TO
IMPROVE THE EMERGENCY CARE ” in partial fulfilment of the requirements for the
award of the Degree of DIPLOMA IN HOSPITAL MANAGEMENT and submitted at the
NIHFW, NEW DELHI is an authentic record of candidate’s own work had been carried out
during the period from February 2018 to April 2018 under the supervision of Dr.Akhilesh
Kumar , Medical officer , Institute Hospital, Indian Institute of Technology Roorkee,
Roorkee.
Dr. Akhilesh Kumar, MD
MEDICAL OFFICER
INSTITUTE HOSPITAL
IIT ROORKEE.
2

CERTIFICATE BY THE CANDIDATE
I hereby certify that the work which is being presented in this synopsis entitled
“TO STUDY PATTERN OF EMERGENCY CASES COMING TO HOSPITAL SO AS TO
IMPROVE THE EMERGENCY CARE” in partial fulfilment of the requirements for the
award of the Degree of DIPLOMA IN HOSPITAL MANAGEMENT and submitted at the
NIHFW, NEW DELHI is an authentic record of my own work and had carried out during the
period from February, 2018 to April, 2018 under the supervision of Dr. Akhilesh Kumar,
Medical officer, Institute Hospital, Indian Institute of Technology Roorkee, Roorkee.
The matter presented in the thesis has not been submitted by me for the award of any other
degree of this or any other Institute.
Dr. RASHMI RANJAN
GURU
DHM/5438/2017-18
3

ACKNOWLEDGEMENT
First and foremost, I offer my sincere gratitude to my guide, Dr. Akhilesh Kumar,
Paediatrics, Medical officer, IIT ROORKEE Hospital, roorkee who guided me at every step
and in his unique way made this project a smooth and hassle free experience. Apart from
being my guide he is an excellent paediatrician, administrator of IIT Roorkee. I would thank
him for his suggestions, encouragement, constant inspiration. I would also like to thank Dr.
Vandana (i/c Chief medical officer), Dr. Anjula (Gynaecologist), Dr Farman (Medicine), Dr
Alok (Non-invasive cardiologist), Dr Raja, Dr Avneesh, all pharmacists & all nurses of my
hospital for participating in project work and giving their valuable suggestions. I am very
much thankful to Dr. N C DAS, NIHFW and Dr. Vandana, NIHFW for their timely reply to
my doubts and valuable suggestions to make the thesis successful. A big heartful of thanks
and love for My Spouse Dr. SWAYAMPRAVA DALAI, B.Tech., M. Tech, PhD
NANOBIOTECHNOLOGY, VIT, VELLORE who has edited my thesis and made necessary
corrections. My parents and in laws blessings added fruits to my thesis. My special thanks to
Dr. Suman Sourav Baral , PhD, IIT Rk for providing all raw materials, energy and ideas to
make this thesis. My son Ayaan is ultimate source of energy to forget all the stress due to
patient load, hospital conflicts and other administrative work pressure of my hospital.
I shall always remain indebted to my hospital and my patients without whom this thesis study
would not have been possible.
DR. RASHMI RANJAN GURU
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DHM/5438/2017-18
BODYCONTENTS
INDEX PAGE NO.
I. SUMMARY OF THE PROJECT 08
II. INTRODUCTION AND RATIONAL 10
III. AIMS & OBJECTIVES 13
IV. REVIEW OF LITERATURE 15
V. RESEARCH METHODOLOGY 25
VI. PROCEEDING WITH STUDY 28
CONCLUDING PART
VII. REFERENCES 38
VIII. ANNEXURES 41
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ABBREVIATIONS
ABBREVIATIONS PAGE
NO
HBV: HEPATITIS B VIRUS
23
HCV: HEPATITIS C VIRUS
23
HIV: HUMAN IMMUNODEFICIENCY VIRUS
23
PPE: PERSONAL PROTECTIVE EQUIPMENTS
23
AMI: ACUTE MYOCARDIAL INFARCTION
17
CVA: CEREBROVASCULAR ACCIDENT
18
RTA: ROAD TRAFFIC ACCIDENT
15
MLC: MEDICO LEGAL CASES
22
TIA: TRANSIENT ISCHAEMIC ATTACK
18
6

UTI: URINARY TRACT INFECTION
13
EMT: EMERGENCY MEDICAL TEAM
11
GUIDE TO GRAPHS AND TABLES PAGE
NO
Table 1. showing status of healthcare in India with comparison to others 17
Table 2. showing status of manpower in rural India 17
Table 3. Showing name of emergency cases 29
coming to emergency room -
Table 4. showing Gender and Age distribution 30
Table 5. showing no. of different emergency cases coming to the emergency 31
room among first 100 patients)
Table 6. showing resource utilisation for emergency care 32
Fig.1. In the X-axis the emergency cases 33
have been taken and the Y-axis no of cases of a specific disease have been taken)
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SUMMARY
8

SUMMARY
Emergency conditions are unavoidable critical health conditions, requiring immediate
intervention and treatment. Emergency treatment in our country is quite unregulated and
below the benchmark, which is due to untrained medical staffs, bad transportation facility and
inadequate preparedness. Many emergency cases in our country do not even reach hospital.
In rural areas, the primary health centres and community health centres are generally not
sufficient to provide adequate emergency services considering the low ratio of staffs,
equipment and lifesaving drugs to the large population. Road traffic accident, acute
myocardial infarction, cerebrovascular accidents are now days taking many lives due to lack
of golden hour treatment. Orthopaedic cases lose their limbs due compartment syndrome
developed due to lack of in time emergency care. The cardiac arrest cases cannot survive due
to lack of knowledge about defibrillation in proper time. Acute MI cases are neglected in
primary centres due to lack of drugs and ECG machine. They could not be able to survive due
to delayed treatment. Lack of investigation laboratory round the clock in primary and
community health centres the patients could not be saved due to acidosis or alkalosis of blood
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and severe haemorrhage cases. The upgradation of present emergency service is very
essential at the moment based on type of cases visiting emergency. So it is very necessary to
develop the emergency care to save valuable lives of people and providing facility at
minimum cost.
INTRODUCTION
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INTRODUCTION
Emergency treatment in our country is quite unregulated and below the benchmark, which is
due to untrained medical staffs, bad transportation facility and mishandling. Hence, the
upregulation and upgradation of present emergency service is very essential at the moment.
OVERVIEW OF THE INSTITUTION OF STUDY -
Indian Institute of Technology - Roorkee is among the foremost of institutes of national
importance in higher technological education and in engineering, basic and applied research.
Since its establishment, the Institute has played a vital role in providing the technical
manpower and know-how to the country and in pursuit of research. The Institute ranks
amongst the best technological institutions in the world and has contributed to all sectors of
technological development. It has also been considered a trend-setter in the area of education
and research in the field of science, technology, and engineering. On September 21, 2001, an
Ordinance issued by the Government of India declared it as the nation's seventh Indian
Institute of Technology. The Ordinance is now converted into an Act by the Parliament to
make IIT, Roorkee as an "Institution of National Importance".
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Health facility is being provided by the institute hospital to a total population of 13,000
campus residents which includes 8000 students. IITR has self-funds for the emergency
treatment of staffs and students which gets transferred to the treating hospital within 24 hrs of
admission. The retired staffs have MEDIFARE insurance scheme which is funded by IITR
(up to 12 Lacs). Students have separate insurance scheme provided by ORIENTAL insurance
company (TPA- Punjab National Bank).
So per month around 12000 patients came to hospital for OPD consultation (daily average
no. of patients 400) and around 2000 patients for emergency consultations per month.
INSTITUTE HOSPITAL, IIT ROORKEE (under MHRD, Govt. of India) is a 50 bedded
hospital with strength of OPD 500 patients/per day, IPD 15 patients/per day, emergency 50
patients /per day. The hospital is situated in the IIT campus, city of Roorkee, district
Hardwar, state-Uttrakhand. The hospital is covering area of 5000 square feet geographical
area.
MAJOR PROBLEM AREAS FACED BY THE
INSTITUTE HOSPITAL –
The hospital has daily 40- 50 emergency patient strength. The emergency has four beds out of
which two are equipped with monitor, ventilator, defrillator, oxygen central line, ECG, blood
pressure measuring equipment, emergency medicine carrying crash crat. All these
equipments are old and non-functional. now a days the modern instruments are coming with
high cost. The institute is having many issues fir buying the equipments. So my project is
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select the cases coming to the emergency at higher rate and improve the emergency facility in
that direction of treatment. The staffs in the hospital are untrained for emergency treatment
so second target to train the staffs and to do the mock drills for their improvement.
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AIMS & OBJECTIVES
AIMS & OBJECTIVES
AIMS:
1. To analyse & study the Emergency cases coming to hospital.
2. To study the benefit of emergency planning & management for patient care.
OBJECTIVES:
1. To improve the facility that could benefit the safety of patient & staff.
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2. To make cost effective and upgraded emergency room
3. To train staffs for life saving procedure.
4. To make an EMERGENCY MEDICAL TEAM for ambulance service at minimal
cost.
5. Enlisting emergency lifesaving drugs and their easy handling.
USE OF FINDINGS IN THE INTEREST OF THE ORGANISATION OR
COMMUNITY - The emergency patient data will be used to know the cases coming to the
hospital on that basis the emergency room will be developed in term of necessary drugs,
equipments, staff training, staff recruitment at low possible cost. The project work can be
used for developing emergency room in primary health centre, community health centre,
district headquarter hospitals, a minimised cost.
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REVIEWOF LITERATURE
REVIEW OF LITERATURE
It was the American College of Emergency Physicians (ACEP), the recognition of emergency
medicine training programs by the AMA and the AOA, and in 1979 a historical vote by the
American Board of Medical Specialties that emergency medicine became a recognized
medical specialty in the US.(Yale School of Medicine, 19 November 2010, Retrieved 18
March 2011). The first emergency medicine residency program in the world was begun in
1970 at the University of Cincinnati and the first Department of Emergency Medicine at a US
medical school was founded in 1971 at the University of Southern California.
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In 1990 the UK's Casualty Surgeons Association changed its name to the British Association
for Accident and Emergency Medicine, and subsequently became the British Association for
Emergency Medicine (BAEM) in 2004. In 1993, an intercollegiate Faculty of Accident and
Emergency Medicine (FAEM) was formed as a "daughter college" of six medical royal
colleges in England and Scotland to arrange professional examinations and training. In 2005,
the BAEM and the FAEM were merged to form the College of Emergency Medicine, now
the Royal College of Emergency Medicine, which conducts membership and fellowship
examinations and publishes guidelines and standards for the practise of emergency medicine.
(http//rcem.ac.uk). In India the healthcare facility is behind all other countries in world..
Rural India is lacking behind in terms of facility and manpower.
Table 1. showing status of healthcare in India with comparison to others
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Table 2. showing status of manpower in rural india
Emergency care designed to help medical students, resident physicians-in-training, and
practicing clinicians teaches the fundamentals of emergency medicine (EM) clinical practice
in a case-based format. Ten of the most common chief complaints for EM are abdominal
pain; fever; chest pain; shortness of breath; headache; back pain; pelvic discomfort; ear, nose,
and throat complaints; traumatic injuries; and altered mental status (Jeanmonod et al., 2010).
The common causes of pain abdomen coming to emergency are epigastric pain (Viniol et al,
October 2014). The epigastric pain most common cause is gastritis. Peptic ulcer disease and
gastric cancer are the secondary cause which are oftenly cause of chronic pain. Gastritis is
inflammation of the lining of the stomach. It may occur as a short episode or may be of a long
duration. There may be no symptoms but, when symptoms are present, the most common is
upper abdominal pain. Other possible symptoms include nausea and vomiting, bloating, loss
of appetite and heartburn. Complications may include bleeding, stomach ulcers, and stomach
tumours. When due to autoimmune problems, low red blood cells due to not enough vitamin
B12 may occur, a condition known as pernicious anaemia. Common causes include infection
with Helicobacter pylori and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Less
common causes include alcohol, smoking, cocaine, severe illness, autoimmune problems,
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radiation therapy and Crohn's disease. Endoscopy, a type of X-ray known as an upper
gastrointestinal series, blood tests, and stool tests may help with diagnosis. The symptoms of
gastritis may be a presentation of a myocardial infarction. Other conditions with similar
symptoms include inflammation of the pancreas, gallbladder problems, and peptic ulcer
disease.
fever is the most common cause of increasing patient load in emergency (Schaffner A etal
March 2006). maximum number of patients admitted in IPD through emergency. Malaria,
dengue, common viral fever, pneumonia, UTI are being common causes of fever. fever in
paediatric patients is important to rule out pneumonia as per IMNCI guidelines. Fever, also
known as pyrexia and febrile response, is defined as having a temperature above the normal
range due to an increase in the body's temperature set-point. There is not a single agreed-
upon upper limit for normal temperature with sources using values between 37.5 and 38.3 °C
(99.5 and 100.9 °F). The increase in set-point triggers increased muscle contractions and
causes a feeling of cold. This results in greater heat production and efforts to conserve
heat. When the set-point temperature returns to normal, a person feels hot, becomes flushed,
and may begin to sweat. Rarely a fever may trigger a febrile seizure. This is more common in
young children. Fevers do not typically go higher than 41 to 42 °C (105.8 to 107.6 °F).
A fever can be caused by many medical conditions ranging from non-serious to life
threatening. This includes viral, bacterial and parasitic infections such as the common
cold, urinary tract infections, meningitis, malaria and appendicitis among others. Non-
infectious causes include vasculitis, deep vein thrombosis, side effects of medication,
and cancer among others. It differs from hyperthermia, in that hyperthermia is an increase in
body temperature over the temperature set-point, due to either too much heat production or
not enough heat loss. Treatment to reduce fever is generally not required. Treatment of
associated pain and inflammation, however, may be useful and help a person
rest. Medications such as ibuprofen or paracetamol (acetaminophen) may help with this as
well as lower temperature. Measures such as putting a cool damp cloth on the forehead and
having a slightly warm bath are not useful and may simply make a person more
uncomfortable. Children younger than three months require medical attention, as might
people with serious medical problems such as a compromised immune system or people with
other symptoms. Hyperthermia does require treatment. Fever is one of the most
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common medical signs. It is part of about 30% of healthcare visits by children and occurs in
up to 75% of adults who are seriously sick. While fever is a useful defence mechanism,
treating fever does not appear to worsen outcomes. Fever is viewed with greater concern by
parents and healthcare professionals than it usually deserves, a phenomenon known as fever
phobia. Patients coming to emergency due to shortness of breath the most common causes are
acute asthma, COPD, heart failure (Schrijvers D, van Fraeyenhove F 2010). Most of the
patients become stable after loading doses of drugs. So these are the most frequently found
cases in emergency room of the hospital. Causes of acute shortness of breath
include:asthma,COPD flare, allergic reaction (such as from a bee sting),carbon monoxide
poisoning, heart attack, low blood pressure,pneumonia,anemia (low red blood cell count/ low
haemoglobin ),upper airway obstruction (throat blockage),heart failure, enlarged heart,
abnormal heartbeat,choking,foreign object inhaled into the lungs, Guillain-Barre Syndrome,
myasthenia gravis, pulmonary embolism (blood clot in the lungs). In chronic shortness of
breath, it is most often due to: Severe asthma,COPD,abnormal heart function,obesity,other
lung disease,croup,lung cancer,pleurisy,pulmonary edema,pulmonary fibrosis and other
interstitial lung diseases, pulmonary,sarcoidosis,tuberculosis.
Chronic Headache most suspected case coming to emergency room. These patients become
stable after pain management (Tfelt-Hansen P, Lous , Olesen J 1981). Headache is the
symptom of pain anywhere in the region of the head or neck. It occurs in migraines (sharp,
or throbbing pains), tension-type headaches, and cluster headaches. Frequent headaches
can affect relationships and employment. There is also an increased risk of depression in
those with severe headaches. There are a number of different classification systems for
headaches. The most well-recognized is that of the International Headache Society. Causes of
headaches may include dehydration, fatigue, sleep deprivation, stress, the effects of
medications, the effects of recreational drugs, viral infections, loud noises, common colds,
head injury, rapid ingestion of a very cold food or beverage, and dental or sinus issues.
Treatment of a headache depends on the underlying cause, but commonly involves pain
medication. A headache is one of the most commonly experienced of all physical discomforts
and brings the patient to hospital emergency in small setups.
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Acute back pain and road traffic accidents(RTA) are most common orthopaedic cases
coming to emergency department. orthopaedic cases are admitted to IPD in most of the cases.
Road traffic accident is one of the main acute emergency in India (Gupta, ICMR, 2014).
Low back pain (LBP) is a common disorder involving the muscles, nerves, and bones of
the back. Pain can vary from a dull constant ache to a sudden sharp feeling. Low back pain
may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12
weeks), or chronic (more than 12 weeks). The condition may be further classified by the
underlying cause as either mechanical, non-mechanical, or referred pain. The symptoms of
low back pain usually improve within a few weeks from the time they start, with 40-90% of
people completely better by six weeks.
In most episodes of low back pain, a specific underlying cause is not identified or even
looked for, with the pain believed to be due to mechanical problems such as muscle or joint
strain. If the pain does not go away with conservative treatment or if it is accompanied by
"red flags" such as unexplained weight loss, fever, or significant problems with feeling or
movement, further testing may be needed to look for a serious underlying problem. Some low
back pain is caused by damaged intervertebral discs, and the straight leg raise test is useful to
identify this cause. In those with chronic pain, the pain processing system may malfunction,
causing large amounts of pain in response to non-serious events. Initial management with
non–medication based treatments is recommended. NSAIDs are recommended if these are
not sufficiently effective. Normal activity should be continued as much as the pain
allows. Medications are recommended for the duration that they are helpful. A number of
other options are available for those who do not improve with usual treatment. Opioids may
be useful if simple pain medications are not enough, but they are not generally recommended
due to side effects. Surgery may be beneficial for those with disc-related chronic pain and
disability or spinal stenosis. No clear benefit has been found for other cases of non-specific
low back pain. Low back pain often affects mood, which may be improved
by counselling or antidepressants. Additionally, there are many alternative
medicine therapies, including the Alexander technique and herbal remedies, but there is not
enough evidence to recommend them confidently.
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Acute gastroenteritis is the OPD case where patients are coming to the emergency when
dehydration condition developed by the patient. These are the cases frequently coming to
hospital of educational institute like IIT Roorkee where large no of students and unskilled
people staying. Gastroenteritis, may be in some cases infectious diarrhoea, is inflammation
of the gastrointestinal tract that involves the stomach and small intestine. Symptoms may
include diarrhoea, vomiting, and abdominal pain. Fever, lack of energy, and dehydration may
also occur. Gastroenteritis can be due to infections by viruses, bacteria, parasites, and fungus.
The most common cause is viruses. In children rotavirus is the most common cause of severe
disease. In adults, norovirus and Campylobacter are common. Transmission may occur due to
eating improperly prepared foods, drinking contaminated water, or through close contact with
an individual who is infected. Testing to confirm the diagnosis is typically not needed.
ENT cases like epistaxis (nasal bleeding), ear pain / otitis are frequently coming to the
emergency. Critical surgical cases are being referred to the higher super speciality hospital.
A nosebleed, also known as epistaxis, is the common occurrence of bleeding from the nose. It
is usually noticed when blood drains out through the nostrils. There are two types: anterior
(the most common), and posterior (less common, more likely to require medical attention).
Sometimes in more severe cases, the blood can come up the nasolacrimal duct and out from
the eye. Fresh blood and clotted blood can also flow down into the stomach and
cause nausea and vomiting. (Wilson, I. Dodd 1990). Although the sight of large amounts of
blood can be alarming and may warrant medical attention, nosebleeds are rarely fatal,
accounting for only 4 of the 2.4 million deaths in the U.S. in 1999. About 60% of people have
a nosebleed at some point in their life. About 10% of nosebleeds are serious coming to
emergency.
Otitis is a general term for inflammation or infection of the ear. It is subdivided into three
types. Otitis externa, external otitis, or "swimmer's ear" involves the outer ear and ear canal.
In external otitis, the ear hurts when touched or pulled. Otitis media or middle ear infection
involves the middle ear. In otitis media, the ear is infected or clogged with fluid behind the
ear drum, in the normally air-filled middle-ear space. This very common childhood infection
sometimes requires a surgical procedure called myringotomy and tube insertion. Otitis
interna or labyrinthitis involves the inner ear. The inner ear includes sensory organs for
balance and hearing. When the inner ear is inflamed, vertigo is a common symptom. The pain
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and watery discharge brings the patient to the emergency and also OPD.
Ophthalmology cases like foreign body in eye, eye pain, ocular injury are most frequent
cases coming to the emergency. Serious eye cases are referred to higher centre for further
management. Physical or chemical injuries of the eye can be a serious threat to vision if not
treated appropriately and in a timely fashion. The most obvious presentation of ocular (eye)
injuries is redness and pain of the affected eyes. This is not, however, universally true, as
tiny metallic projectiles may cause neither symptom. Tiny metallic projectiles should be
suspected when a patient reports metal on metal contact, such as with hammering a metal
surface. Intraocular foreign bodies do not cause pain because of the lack of nerve endings in
the vitreous humour and retina that can transmit pain sensations. As such, general
or emergency department doctors should refer cases involving the posterior segment of the
eye or intraocular foreign bodies to an ophthalmologist. Ideally, ointment would not be used
when referring to an ophthalmologist, since it diminishes the ability to carry out a
thorough eye examination. (Feist RM et al, Jan 1991)
Acute Myocardial Infarction is one of the main causes of death in our country due to
improper diagnosis. Cardiac enzyme markers are best marker for AMI cases (Prof. Deepak
Agarwal, AIIMS NEW DELHI, 2015). Myocardial infarction (MI), commonly known as a
heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage
to the muscle. The most common symptom is chest pain or discomfort which may travel into
the shoulder, arm, back, neck, or jaw. Often it occurs in the centre or left side of the chest and
lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other
symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, or feeling
tired. About 30% of people have atypical symptoms. Women more often have atypical
symptoms than men. Among those over 75 years old, about 5% have had an MI with little or
no history of symptoms. An MI may cause heart failure, an irregular heartbeat, cardiogenic
shock, or cardiac arrest. Most MIs occur due to disease. Risk factors include high blood
pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, and
excessive alcohol intake, among others. The complete blockage of a coronary artery caused
by a rupture of an atherosclerotic plaque is usually the underlying mechanism of an MI. MIs
are less commonly caused by coronary artery spasms, which may be due to cocaine,
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significant emotional stress, and extreme cold, among others. A number of tests are useful to
help with diagnosis, including electrocardiograms (ECGs), blood tests, and coronary
angiography. An ECG, which is a recording of the heart's electrical activity, may confirm an
ST elevation MI (STEMI) if ST elevation is present. Commonly used blood tests include
troponin and less often creatine kinase MB. Treatment of an MI is time-critical. Aspirin is an
appropriate immediate treatment for a suspected MI. Nitro-glycerine or opioids may be used
to help with chest pain; however, they do not improve overall outcomes. Supplemental
oxygen is recommended in those with low oxygen levels or shortness of breath. In a STEMI,
treatments attempt to restore blood flow to the heart, and include percutaneous coronary
intervention (PCI), where the arteries are pushed open and may be stented, or thrombolysis,
where the blockage is removed using medications. People who have a non-ST elevation
myocardial infarction (NSTEMI) are often managed with the blood thinner heparin, with the
additional use of PCI in those at high risk. In people with blockages of multiple coronary
arteries and diabetes, coronary artery bypass surgery (CABG) may be recommended rather
than angioplasty. After an MI, lifestyle modifications, along with long term treatment with
aspirin, beta blockers, and statins, are typically recommended. Worldwide, about 15.9 million
myocardial infarctions occurred in 2015. More than 3 million people had an ST elevation MI
and more than 4 million had an NSTEMI. STEMIs occur about twice as often in men as
women. About one million people have an MI each year in the United States. In the
developed world the risk of death in those who have had an STEMI is about 10%. Rates of
MI for a given age have decreased globally between 1990 and 2010. In 2011, AMI was one
of the top five most expensive conditions during inpatient hospitalizations in the US, with a
cost of about $11.5 billion for 612,000 hospital stays.
Neurological cases like Cerebro vascular accident (CVA), Transient ischaemic attack (TIA)
either ischaemic or haemorrhagic coming to the emergency in very less number. But they
very important to get treatment in golden hours. Emergency thrombolysis and maintainace of
blood pressure is very important for the survival of the patient’s life. Immediate referral to
higher centre is very important part of emergency treatment.
1% of total psychiatric patient population attempting suicide die because of the post attempt
complications (Kar et al., 2014). Suicide is the act of intentionally causing one's own death.
Risk factors include mental disorders such as depression, bipolar disorder, schizophrenia,
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personality disorders, and substance abuse including alcoholism and the use of
benzodiazepines. Other suicides are impulsive acts due to stress such as from financial
difficulties, troubles with relationships, or bullying. Those who have previously attempted
suicide are at a higher risk for future attempts. Suicide prevention efforts include limiting
access to methods of suicide such as firearms, drugs, and poisons; treating mental disorders
and substance misuse; proper media reporting of suicide; and improving economic
conditions.
RESEARCH
METHODOLOGY
25

MATERIALS AND METHOD
STUDY CENTRE AND STUDY LOCATION –
IIT Roorkee is situated at the foothill of the Himalayas, in Hardwar district, within the state
of Uttarakhand. Roorkee is a quiet town of moderate size in the district of Haridwar
(Uttarakhand), is located on the banks of the upper Ganga Canal, which takes off at
Haridwar, 30km away. It is the gateway to the pilgrim centres of Hardwar, Rishikesh,
Badrinath and Kedarnath, and tourist attractions of Dehradun and Mussoorie. Roorkee is well
connected to Delhi by rail and road. It is situated on National Highways 58 and 73 and is on
Amritsar-Howrah main rail route.
Institute hospital IIT Roorkee, is a 50 beded hospital offering OPD, emergency and IPD,
laboratory, X-ray and ECG services to faculty, staffs and students. Ambulance services for
referring patients to higher centres works in optimal.
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STUDY DESIGN-
It was a short term cross sectional descriptive study conducted in Feb, 2018 in Emergency
Department of the institute hospital of IIT Roorkee.
METHOD OF DATA COLLECTION-
The data regarding patient complain, treatment and proceedings were obtained from the
emergency records. The investigator approached patients/attendants presented in the EOPD
during the data collection hours and asked them about their background characteristics and
time of entry in the EOPD. They were further asked to document the waiting period for a
service by asking a question “for what service the patient is waiting for and from how much
time?” The consent for undertaking the study was obtained from in-charge, ED of the
institute. The data was analysed using the statistical package for the social sciences version
16.
TYPE OF DATA COLLECTION: Retrospective
STUDY PERIOD- February 2018- April 2018
STUDY POPULATION- The institute caters to medical care needs of around
12000 populations, which includes students, staffs and ex-service men and their families.
In 2010-11, the institute catered to a yearly load of around 16,57,200 out-patients and 64,969
inpatients, whereas the ED of the Institute attended to 52,894 out-patients and 32,563
inpatients.
SAMPLE SIZE: Percentage patients selected came to emergency room in selected
period
MODE OF SAMPLE SELECTION: stratified random
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PROCEEDING WITH STUDY
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DATA COLLECTION AND COMPILATION:
Data collection will be done from the emergency register.
As 2651 no of patients had come to emergency in 3 months duration from February 2018 to
April 2018 among them first 100 no of patients has been taken in calculation.
VARIABLES n (%)
GENDER
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MALE 1466 (55.3)
FEMALE 1185 (44.7)
AGE GROUP
INFANT 103 (3.9)
CHILD 472 (17.8)
ADULT 1779 (67.1)
GERIATRIC 297 (11.2)
Table 3. Gender and Age distribution (n= number)
11 Categories of emergency cases has been selected which are most frequent in our setup.
These are given below:
1. AMI / ACUTE CHEST PAIN
2. PAIN ABDOMEN
3. OBSTETRIC EMERGENCY CASES
4. ORTHOPEDIC FRACTURES / INJURY / BACK PAIN
5. CVA/ NEURO CASES
6. ACUTE GASTROENTERITIS / GASTRITIS
7. FEVER
30

8. DEHYDRATION
9. PNEUMONIA / COPD/ ASTHMA
10. SUICIDAL CASES ( HANGING & POISONING )
11. Miscellaneous
(Table 4. Showing name of emergency cases coming to emergency room)
First 100 numbers of patients have been divided in 11 case types given in the table below:
SERIAL
NO.
NAME OF EMERGENCY
CASE
PERCENTAGE OF
PATIENTS
1 AMI/ CHEST PAIN 08
2 PAIN ABDOMEN 08
3 OBSTETRIC EMERGENCY
CASES
03
4 ORTHOPEDIC FRACTURES/
INJURY/ BACK PAIN
08
5 CVA/ NEURO CASES 02
6 ACUTE GASTROENTERITIS/
GASTRITIS
18
7 FEVER 30
8 DEHYDRATION 05
9 PNEUMONIA/ COPD/
ASTHMA
10
31

10 SUICIDAL CASES
(HANGING & POISONING)
02
11 MISCELLANEOUS 06
(Table 5. showing no. of different emergency cases coming to the emergency room
among first 100 patients)
In fig. 1. The statistics of emergency cases with types of diseases coming to emergency has
been studied.
32

Fig. 1. STATISTICS OF EMREGENCY CASES AMONG FIRST 100 CASES
X-axis showing the emergency cases have been taken
Y-axis showing percentage of specific disease have been taken
ED RESOURCE UTILIZATION FOR EMERGENCY
ROOM -
ED procedures were performed on 58.9% (n=100) of patients. The most common procedures
were intravenous catheter (IV) placement (47.7%, n=48) and electrocardiography (ECG)
(28.5%, n=29), as shown in Table 6. The most common tests requested were complete blood
count (CBC) (53.8%, n=54) and X-rays (25.8%, n=26), as shown in Table 6. The most
commonly requested consultations were internal medicine, cardiology and surgery.
33

VARIABLES n (%)
Most common consultations in emergency
Internal Medicine 28 (27.3)
Cardiac patients 7 (6.9)
Surgery 6 (5.7)
Paediatrics 4 (3.7)
Most common lab tests
Complete Blood Count 54 (53.8)
Creatinine 40 (39.5)
BUN 37 (36.8)
Most Common Imaging
Studies
X-ray 26 (25.8)
Most Common Procedures
IV Placement 48 (47.7)
ECG 29 (28.5)
Wound Care 17 (1.4)
Suturing 10 (10.0)
Urinary Catheterization 1 (0.8)
Table 6. showing resource utilisation for emergency care
DATA ANALYSIS AND DISCUSSION:
From the above histogram graph it is found that fever patients are highest in number as
reason is IIT RK is a educational institute and always there is in and out of foreign and
domestic people. So there is always inflow of common rhinovirus causing URTI and
common viral fever. 12000 students are staying inside hostel so dengue, malaria are most of
the cases spread to the mass. The emergency drug list should contain NSAIDS tabs and
injection form with Intravenous fluids.
Gastritis is the second most cause of epigastric pain in the emergency room. The reason being
mess food and outside food taken by the students causing gastritis. The emergency drug list
must contain PPI tabs and injectable form.
34

Third most common cases being shortness of breath. Due to large no of unskilled smoker
people inside campus the rate of COPD is more. The drugs for nebulisation like
levosalbutamol, budesinide, formeterol, salmeterol, fruticasone respules shoud be present .
three nebulisation machine should be in hospital. out of them two in emergency and one in
IPD. ECG facility must to rule out the breathlessness of cardiac reason.
Pain abdomen is frequent cases in emergency room due to large no. of students inside
campus. So drugs like PPI. Drotaverin, mefenamic acid, tramadol, hyoscine, fortwin
injectables should be kept. Tabs like norfloxacin , ofloxacin-ornidazole , metronidazole,
nitazoxamide, ciprofloxacin to be kept in emergency room. Also in most cases stones are
behind cause of pain abdomen. For this injectable pain killers and oral tablets to be kept.
AMI is most serious condition for patient’s life. The stress factor in educational institute and
food habit aggravates the condition. ECG facility is most important equipment for the
diagnosis of AMI. Emergency drugs like Tab aspirin (325mg), Tab clopidogrel (150-300mg),
Tab
atorvastatin (80mg), metoprolol (50mg), Inj. Low molecular wt. heparin (5000 IU)
subcutaneous dose to be kept.
Road traffic accident (RTA) and sports injury cases coming to emergency are to be treated as
soon as possible. Medico Legal Case (MLC) is to be filed and injury report to be written for
future use. For this dressing of wound, haemostasis, fracture stabilisation by use of slab, anti-
tetanus treatment to be given in emergency. Complicated cases are to be referred to higher
centre with emergency medical team.
35

Dehydration and hypoglycaemia cases mostly coming to emergency during examination
times and patients with gastroenteritis. So intravenous fluids like DNS, NS, RL, 25%D,
10%D, 5%D are to be kept in emergency.
Obstetric cases like antepartum haemorrhage, miscarriage, Placenta prevea, abruption
placentae, prepartum delivery coming to emergency very less oftenly. To maintain the vitals
in safe range till the arrival of gynaecologist or the patient reaches higher centre the
emergency has to keep necessary drugs and fluids.
Neurological cases like Cerebro vascular accident either ischaemic or haemorrhagic coming
to the emergency in very less number. But they very important to get treatment in golden
hours. Emergency thrombolysis and maintainace of blood pressure is very important for the
survival of the patients life. Immediate referral to higher centre is very important part of
emergency treatment.
Finally the manpower appointment is main concern including doctors, paramedical staffs,
attendants and sweepers.
CONCLUSION OF THE FINDINGS
CONCLUSIONS FOR AIMS 1 & 2 –
Aim no. 1 is to analyse & study the Emergency cases coming to the hospital. After data
analysis and discussion, it is found that the cases like fever, gastroenteritis, gastritis, shortness
of breath, acute chest pain, orthopaedic emergency, pain abdomen coming to emergency very
36

oftenly and cases like obstetric and neurocases coming to the emergency room somewhat in
less proportion.
Aim no.2 is to study the benefit of emergency planning & management for patient care. By
this study the emergency room can be pre-prepared for the case coming to our hospital. So
that the patient will get immediate treatment within platinum minutes which is very important
for the survival of the patient. Prepreparedness for the upcoming case of the emergency group
increases the management of patient care to a higher level.
CONCLUSION FOR OBJECTIVES 1 to 5 –
Objective no. 1 is to improve the facility that could affect the safety of patient & staff. After
the completion of the study the emergency room is developed for improved facility as per the
cases coming to the hospital. The developed facility of the emergency will work at the
optimum for the safety of the patient and the staff. Safety measures and barrier safety
measures are to be provided to the staffs during emergency work as the past history of
chronic disease (HBV, HCV, HIV) status of the patient was not known.
37

Objective no.2 is to make cost effective and upgraded emergency room which can be
possible by making the emergency room as per the cases coming to hospital.
Objective no.3 is to train staffs for life saving procedure in emergency room. Basic life
support(BLS), advanced cardiac life support (ACLS) mock drills are to be done on monthly
basis to update the knowledge of the staffs.
Objective no. 4 is to make EMERGENCY MEDICAL TEAM for ambulance service at
minimal cost. The EMT ideally consists of trained pharmacists, trained male nurse, trained
attendants and trained ambulance driver. The ambulance should be fully equipped with
emergency drugs, oxygen cylinder, ventilator, BiPAP, nebuliser, IV fluids.
Objective no. 5 is to enlist emergency lifesaving drugs and their easy handling. As per the
case basis number of emergency drugs are to be listed and kept in emergency room. one crash
crat is to be arranged in emergency to bring all the emergency drugs at once along with the
ECG machine as we have to take care of the platinum minutes for patient survival.
38

REFERENCES
REFERENCES-
1. "What is Emergency Medicine?". Yale School of Medicine. Archived from the
original on 19 November 2010. Retrieved 18 March 2011.
2. Case Studies in Emergency Medicine By Rebecca Jeanmonod, MD, Michelle
Tomassi, MD, Dan Mayer , MD (eds .). New York : Cambridge University Press ,
2010
39

3. Royal College of Emergency Medicine – Excellence in Emergency
Care http://www.rcem.ac.uk/
4. Viniol, A; Keunecke, C; Biroga, T; Stadje, R; Dornieden, K; Bösner, S; Donner-
Banzhoff, N; Haasenritter, J; Becker, A (October 2014). "Studies of the symptom
abdominal pain--a systematic review and meta-analysis". Family practice. 31 (5):
517–29. doi:10.1093/fampra/cmu036. PMID 24987023.
5. Schaffner, A (March 2006). "[Fever--useful or noxious symptom that should be
treated?]". Therapeutische Umschau. Revue therapeutique. 63 (3): 185–8.
6. Schrijvers D, van Fraeyenhove F (2010). "Emergencies in palliative care". Cancer
J. 16 (5): 514–20.
7. "Headache disorders Fact sheet N°277". October 2012. Archived from the original on
16 February 2016. Retrieved 15 February 2016.
40

8. Dr. AMIT GUPTA ICMR "An intervention study on comprehensive emergency
care and trauma registry for road traffic injuries in India: Jai Prakash Narayan Apex
Trauma Centre (JPNTC), AIIMS"
9. Schlossberg, David (2015). Clinical infectious disease (Second ed.).
p. 334. ISBN 9781107038912. Archived from the original on 2017-09-08.
10. Wilson, I. Dodd (1990). Walker, H. Kenneth; Hall, W. Dallas; Hurst, J. Willis,
eds. Clinical Methods: The History, Physical, and Laboratory Examinations (3rd ed.).
11. Feist RM, Lim JI, Joondeph BC, Pflugfelder SC, Mieler WF, Ticho BH, Resnick K
(Jan 1991). "Penetrating ocular injury from contaminated eating utensils". Archives of
Ophthalmology. 109 (1): 23–30
12. Kar N, Arun M, Mohanty MK, Bastia BK.Scale for assessment of lethality /
comlicationshas been studied in suicide attempt. Indian J Psychiatry. 2014 Oct;56
(4):337-43.
13. A Review of the Literature From 2012 Gabrielle A. Jacquet, MD, MPH, Mark Foran,
MD, MPH, Susan Bartels, MD, MPH, Torben Kim Becker, MD, DrMed, Erika D.
Schroeder, MD, MPH, Herbert C. Duber, MD, MPH, Elizabeth Goldberg, MD,
Hannah Cockrell, and Adam C. Levine, MD, MPH, for the Global Emergency
Medicine Literature Review (GEMLR) Group.
14. Garling P. Final Report of the Special Commission of Inquiry into Acute Care
Services in NSW Public Hospitals. S.C.o.I.A.C.S.i.N.P. Hospitals; Valenzuela TD,
Copass MK. Clinical research on out-of-hospital emergency care. New England
Journal of Medicine. 2001;345(9):689–690. 2008.
41

ANNEXURE
42

ANNEXURE
DATA SHEET COLLECTION
INSTITUTE HOSPITAL
INDIAN INSTITUTE OF TECHNOLOGY ROORKEE
Patient wise List - for the Period: Feb 01,2018 to Apr 20,2018
-----------------------------------------------------------------------------------------------
SNo RegnID Booklet Patient Name DoctorID PatSymptoms/Remarks
-----------------------------------------------------------------------------------------------
1 94409 17112060 RAJNISH ANITA EAR PAIN
Feb 01,2018 User:SANDHYA
02:16:33Hrs Medicines: DICLO N PARA TAB#1,
2 94410 15920029 SANJAY SINGH SAMANT AKHILESH HEADACHE
Feb 01,2018 User:KUSUM
15:08:04Hrs Medicines: PARACETAMOL-TABS#2,
3 94411 269-A J.P. SINGHAL AKHILESH CC RESP....DUOLIN....1
RESP BUDECORT...1
Feb 01,2018 User:GULAFSHA
16:22:55Hrs Medicines:
4 94412 16114015 ANKUR PARIHAR AKHILESH FEVER REFUSE ADMISSION/ ADV TO VISIT C/M OPD
17:47:35Hrs Medicines: PARACETAMOL 650MG TAB#4, LEVOCETIRIZINE-TABS#2, ORS-POWDER#3,
DEXTROMETHORPHAN#2,
5 94413 17118036 KUMAR AMAN AKHILESH CC ADV TO VISIT C/M OPD
17:52:48Hrs Medicines: ANTICOUGH AND ANTICOLDTABLETS#2, LEVOCETIRIZINE-TABS#2, ORS-POWDER#2,
6 94414 17513009 SHAILASH KR GUPTA AKHILESH COUGH ADV TO VISIT C./M OPD
18:19:19Hrs Medicines: ANTICOUGH AND ANTICOLDTABLETS#2, CETRIZINE-TABS#1,
7 94415 16616006 ANJALI SONKRIYA AKHILESH ALLERGY ADV TO VISIT C/M OPD
18:42:09Hrs Medicines: LEVOCETIRIZINE-TABS#1, PHENIRAMINE MALEATE-TAB#1,
43

8 94416 100725-A SRI YASHPAL SINGH AKHILESH WOUND ADV TO VISIT C/M OPD
19:10:47Hrs Medicines: AMOXYCILLIN+POTASSIUM CLAVULANATE TAB#2,
9 94417 16118016 ARNAB AKHILESH COLD ADV TO VISIT C/M OPD
19:42:41Hrs Medicines: ANTICOUGH AND ANTICOLDTABLETS#3, CETRIZINE-TABS#1,
10 94418 16903038 ANKITA SINGH AKHILESH HEADCHE ADV TO VISIT C/M OPD
19:52:45Hrs Medicines: DICLOFENAC INJ#1,
11 94419 100733-D MISS. AKSHITA ALOK ABD PAIN , WANT REF ON CALL 6861 LATE ENTRY DUE
TO SERVER PROBLEM ,
REF TO PHYSICIAN / PEDIATRICIAN AT ROORKEE 1/02/2018
Feb 02,2018 User:ALOK
12 94420 17514016 YASH ALOK ACUTE VERTIGO AND MUSCULAR PAIN , RBS 100 BP 120/80 PR
80 REFUSE FOR ADMISSION DUE TO EXAM
00:55:27Hrs Medicines: INJ STEMTIL#1, DICLOFENAC INJ#1,
13 94421 16115089 RAHUL YADAV ALOK INJURY
00:58:59Hrs Medicines: TAB IBU + PARA#2, CIPROFLOXACIN-TABS#2, TETANUS TOXOID-INJ#1, BANDGE-
2.5INCH#1,
14 94422 200993-B SMT.RANI ALOK FVR , SHIVERING REFUSE FOR ADMISSION
01:06:41Hrs Medicines: CEFIXIME-200MG-TABS#2, OFLOXACIN-TABS#2, TAB IBU + PARA#2,
PANTOPRAZOLE40+DOMPERIDONE 10MG#2,
15 94423 2500-B JAI MALA VERMA ALOK VOMITING , PAIN
01:08:24Hrs Medicines: DICLOFENAC INJ#1, INJ.EMSET#1, PANTOPRAZOLE I.V INJ.#1, OFLOXIN+ORNIDAZOLE-
TABS#2,
16 94424 200949-D RAJESH KUMAR ALOK COUGH AND FEVER
01:09:46Hrs Medicines: CETRIZINE-TABS#2, TAB IBU + PARA#2, TAB DEXTROMETHORPHAN#2,
17 94425 2258-B SUKHBIRI DEVI ALOK HTN
01:11:20Hrs Medicines: AMLODIPINE-5MG-TABS#1,
44

18 94426 14117052 RAHUL ALOK PAIN
01:11:55Hrs Medicines: RANITIDINE-TABS#2, TAB IBU + PARA#2,
-----------------------------------------------------------------------------------------------
Printed On: Apr 20,2018 15:43:37 Page: 1
-----------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------
19 94427 17810031 AKHILESH ALOK ABD PAIN
01:13:28Hrs Medicines: DICYCLOMINE+MEFENAMIC ACID TAB#2, OFLOXIN+ORNIDAZOLE-TABS#2,
20 94428 201264-A ROHIT KUMAR ALOK COLD
01:14:14Hrs Medicines: CETRIZINE-TABS#5,
21 94429 201264-B MRS. POOJA KHANTWAL ALOK COLD
01:14:44Hrs Medicines: CETRIZINE-TABS#5,
22 94430 14118085 SAKSHAM ALOK PAIN ALLERGIC
02:26:54Hrs Medicines: LEVOCETIRIZINE-TABS#1, TAB IBU + PARA#1,
23 94431 200478-B SITA YADAV ALOK PAIN
02:28:57Hrs Medicines: DICLOFENAC INJ#1, PANTOPRAZOLE I.V INJ.#1,
24 94432 17810031 AKHILESH ALOK ABD PAIN
05:12:42Hrs Medicines: DICYCLOMINE+PARACETAMOL-TABS#1, PANTOPRAZOLE40+DOMPERIDONE 10MG#1,
25 94433 33-852-A MANJU..MISHRA ALOK WRONG ENTRY
26 94434 33-852A SMT.MANJU MISHRA ALOK PAIN
05:24:17Hrs Medicines: DICLOFENAC INJ#1, PANTOPRAZOLE-40MG. TAB.#1,
27 94435 17810031 AKHILESH ALOK ABD PAIN ADMIT
45

28 94436 14115064 SAI KRISHNA ALOK SHIVERING
07:31:49Hrs Medicines: RANITIDINE-TABS#1, TAB IBU + PARA#1,
29 94437 201139-B SMT.HARBIRI AVANEESH VOMITING ,HTN
Feb 02,2018 User:SHARMA
09:39:05Hrs Medicines: PANTOPRAZOLE I.V INJ.#1, INJ.EMSET#2, DEPIN 5MG#1,
30 94438 33-196E ABHISHEK AVANEESH HEADCHE
11:44:19Hrs Medicines: IBUPROFEN + PARACETAMOL-TABS#2,
31 94439 17113041 HARKESH KOLI AVANEESH CC ADV TO VISIT C/M OPD
Feb 02,2018 User:AVANEESH
13:42:50Hrs Medicines: ANTICOUGH AND ANTICOLDTABLETS#1, LEVOCETIRIZINE-TABS#2,
32 94440 17531009 MANISH KR GUPTA RAJADEY INJURY DRESSING DONE
Feb 02,2018 User:ROHIT
14:26:02Hrs Medicines: IBUPROFEN + PARACETAMOL-TABS#2,
33 94441 17918008 HABIB RAJADEY INJURY ON BOTH KNEE
15:24:40Hrs Medicines: BANDGE-6INCH#2, TETANUS TOXOID-INJ#1, SERRATIOPEPTIDASE+DICLOFENAC
POTASSIUM#2, TRYPSIN/CHYMOTRYPSIN-TABS#2,
34 94442 200443-A RAJESH PAL RAJADEY PAIN
17:10:22Hrs Medicines: DICLOFENAC INJ#1, DISPO 2 ML#1,
35 94443 200543-B SMT. ANITA DEVI RAJADEY PAIN ABDOMEN
BP-178/100MMHG
17:53:36Hrs Medicines: PANTOPRAZOLE I.V INJ.#1, DICLOFENAC INJ#1, CAP DEPIN 5MG#1,
36 94444 2419-a R.C.TYAGI RAJADEY RBS-488 THEN-460MG/DL
DKA WITH SEVERE COMPLICATION
REF TO HIGHER CENTRE
17:56:57Hrs Medicines: VIGGO#1, IV SET#1, NORMAL SALINE-INJ#1, INSULIN#10,
37 94445 17116080 YOGENDRA RAJADEY CC
18:11:09Hrs Medicines: ANTICOLD-COZY-PLUS-TABS#2,
46

38 94446 17533001 AHAMOD ZAKARIYA RAJADEY MIN INJURY
18:56:38Hrs Medicines: TETANUS TOXOID-INJ#1, TETANUS TOXOID-INJ#1, AMOXYCILLIN-500MG-CAPS#2,
ACECLOFENAC+PARACETAMOL TAB#2, B-COMLEX +LACTOBASILEX-CAP#2,
39 94447 201152-b KUSUM PAL AKHILESH VOMITING AND PAIN
Feb 02,2018 User:AKHILESH
20:45:05Hrs Medicines: DICLOFENAC INJ#1, INJ.EMSET#1, PANTOPRAZOLE I.V INJ.#1, TRAMADOL+PARACETAMOL
TAB#2, DICYCLOMINE+PARACETAMOL-TABS#2, RANITIDINE-TABS#2, DISP 2CC + 5CC#3,
40 94448 16121022 PASHUPATI AKHILESH HEADACHE
21:23:58Hrs Medicines: ACECLOFENAC+PARACETAMOL TAB#1,
41 94449 100773-C MISS PRAPTI AKHILESH FVR
21:24:48Hrs Medicines: TAB MEFANAMIC DISPERSIBLE#2,
42 94450 100759-A DR GURU AKHILESH STOMACH ULCER
21:25:49Hrs Medicines: OFLOXIN+ORNIDAZOLE-TABS#2, PANTOPRAZOLE40+DOMPERIDONE 10MG#2, SYP
SUCRALFATE#1,
43 94451 14119057 VAIBHAV AKHILESH PAIN
21:30:26Hrs Medicines: TAB LOBAK#2, RANITIDINE-TABS#2,
44 94452 17114025 DEEPIKA AKHILESH FVR , VOMITING REFUSE FOR ADMISSION
21:44:09Hrs Medicines: ALPRAZOLAM-0.25MG-TABS#1, TAB IBU + PARA#2, TAB EMSET#2, INJ.EMSET#1, DISP
2CC#1,
45 94453 529-B DEEPESH RATHOR AKHILESH COUGH AND COLD
22:24:46Hrs Medicines: CEFIXIME-DT-100MG-TABS#2, TAB MEFANAMIC#2, TAB ALEX#2,
46 94454 529-A NEETU RATHORE AKHILESH COLD AND FVR
22:24:59Hrs Medicines: ANTICOUGH AND ANTICOLDTABLETS#2, LEVOCETIRIZINE-TABS#1, TAB ALEX#1,
47 94455 1056-B AARAV SHARMA AKHILESH FVR AND VOMITING
22:30:10Hrs Medicines: TAB MEFANAMIC DT#2, TAB EMSET DT#2,
48 94456 200682-A SATPAL GIRI AKHILESH FVR AND VOMITING , WANT MEDICINE REFUSE FOR
ADMISSION
47

22:34:23Hrs Medicines: INJ.EMSET#1, PARACETAMOL 650MG TAB#2, PANTOPRAZOLE-40MG. TAB.#2,
LEVOCETIRIZINE-TABS#1, TAB EMSET#2, DISP 2CC#1,
49 94457 17410015 KANSHIK AKHILESH COLD
22:37:30Hrs Medicines: CEFIXIME+CLOXACILLIN&LACTIC ACID BACILLUS#2, PARACETAMOL-TABS#2,
LEVOCETIRIZINE-TABS#2,
50 94458 201035-B SMT SHASHI DEVI AKHILESH PAIN AND VOMITING , BP 124/88 PR 102
06:58:08Hrs Medicines: INJ.EMSET#1, PANTOPRAZOLE I.V INJ.#1, DICLOFENAC INJ#1, RANITIDINE-TABS#2, TAB
EMSET#2, DISP 2CC + 5 CC#3,
51 94459 980-A NEERJA VIBHU ACIDTY
13:12:20Hrs Medicines: PANTOPRAZOLE40+DOMPERIDONE 10MG#4, B-COMLEX +LACTOBASILEX-CAP#4, ORS-
POWDER#4,
52 94460 100633-C PREM LATA VIBHU HT
13:18:06Hrs Medicines: DEPIN 10MG#1,
53 94461 17531012 PIYUSH GOEL AVANEESH FEVER
PHARYNGITIS ALREADY HAVE REST OF MEDICINE
14:50:15Hrs Medicines: MONTRAL#2,
54 94462 SDF1116-D DIKSHA YADAV AVANEESH VOMITING AND ABD PAIN INJ...PAN 40 ...1
INJ EMSET...1
16:39:29Hrs Medicines: INJ BASCOPAN#1, DIS-SYRING 2CC#2, DISP-SYRING 5CC#1,
55 94463 269-A J.P. SINGHAL AVANEESH COUGH RESP...DUOLIN...1
RESP ...BUDECORT..1
56 94464 200439-C KM.SWATI SINGH AVANEESH UTI
BACK PAIN
17:43:31Hrs Medicines: DISODIUM HYDROGEN CITRATE-LIQUID#1, ACECLOFENAC 100MG#2,
DICYCLOMINE+MEFENAMIC ACID TAB#2, PANTOPRAZOLE40+DOMPERIDONE 10MG#2,
57 94465 14919008 SARITA AVANEESH FEVER
COUGH
48

18:29:55Hrs Medicines: ANTITUSSIVES, DECONGESTANT-D-100ML#1, PARACETAMOL 650MG TAB#4,
AMOXYCILLIN+POTASSIUM CLAVULANATE TAB#4, MONTRAL#4,
58 94466 16112098 UTKARSH AVANEESH INJURY ON RIGHT TOE
18:53:32Hrs Medicines: BANDGE-2.5INCH#1, TETANUS TOXOID-INJ#1,
59 94467 16612007 NIRAJ RAI AVANEESH FEVER
COLD
18:58:24Hrs Medicines: PARACETAMOL-TABS#4, LEVOCETIRIZINE-TABS#3,
60 94468 14114051 SAURABH AVANEESH FEVER
61 94469 17122003 ADITYA AVANEESH DAIRRHEA
FEVER
19:07:24Hrs Medicines: OFLOXIN+ORNIDAZOLE-TABS#4, PANTOPRAZOLE40+DOMPERIDONE 10MG#4, ORS-
POWDER#4, PARACETAMOL 650MG TAB#5,
62 94470 17523021 SIDDHARTH AVANEESH UPPER BACK PAIN
63 94471 17111035 VIPUL AVANEESH COLD
HEADACHE
19:21:39Hrs Medicines: ANTICOLD-COZY-PLUS-TABS#4, TAB. ACECLOFENAC#2,
64 94472 16616026 VIJAY KUMAR JOSHI AVANEESH RUNNING NOSE
COLD
FEVER
HEADACHE
19:31:42Hrs Medicines: LEVOCETIRIZINE-TABS#3, PARACETAMOL-TABS#4, TAB ACECLOFENAC#2,
65 94473 200678-a LOKESH KUMAR AVANEESH HEADACHE
19:46:15Hrs Medicines: TAB. ACECLOFENAC#2,
66 94474 17410020 NISHANT AVANEESH HEADACHE
49

67 94475 16553013 VIKASH KUMAR AVANEESH FEVER
COLD
19:52:42Hrs Medicines: ACECLOFENAC+PARACETAMOL TAB#4, LEVOCETIRIZINE-TABS#3,
68 94476 15925006 NEHA KANAUJIA VIBHU INJURY RT ELBO
20:21:18Hrs Medicines: TRYPSIN +DICLO#3, RANITIDINE-TABS#3,
69 94477 16525004 JITESH SAWANNI VIBHU FEVER
20:50:45Hrs Medicines: PARACETAMOL 650MG TAB#4, CEFIXIME-200MG-TABS#3, RANITIDINE-TABS#3,
70 94478 15116062 TEJENDRA VIBHU FEVER/THROAT PAIN
20:57:04Hrs Medicines: AMOXYCILLIN+POTASSIUM CLAVULANATE TAB#3, RANITIDINE-TABS#3, PARACETAMOL
650MG TAB#4, CETRIZINE-TABS#3,
71 94479 200649-A RAJENDER KUMAR SAINI VIBHU HTN
21:05:21Hrs Medicines: AMLODIPINE+ATENALOL-TABS#2,
72 94480 17115078 SANYAM AGARWAL VIBHU URTI
21:30:12Hrs Medicines: AMOXYCILLIN+POTASSIUM CLAVULANATE TAB#3, PARACETAMOL 650MG TAB#4,
RANITIDINE-TABS#2, LEVOCETIRIZINE-TABS#3,
73 94481 15117038 HARSHIT VIBHU COUGH
23:39:52Hrs Medicines: ANTICOUGH AND ANTICOLDTABLETS#3, CETRIZINE-TABS#3, ALEX LOZENGES#3,
74 94482 15113099 ROHIT VERMA VIBHU LOOSE MOTION ADMITTED IN WARD
00:09:44Hrs Medicines: B-COMLEX +LACTOBASILEX-CAP#3,
75 94483 16526024 VIVEK VIBHU HEAD ACHE
02:31:29Hrs Medicines: ACECLOFENAC+PARACETAMOL TAB#2, RABEPRAZOLE 20MG +DOMPERIDONE30 CAP#2,
FLUNARIZINE-TABS#2, ALPRAZOLAM 0.5MG#1, DICLOFENAC INJ#1,
76 94484 13110020 MUKUL ANAND VIBHU FEVER.TONSILL ADMIT
50

77 94485 40090-C SANDHYA DUBE VIBHU VOMITING.110/70
07:49:40Hrs Medicines: ORS-POWDER#3, PANTOPRAZOLE40+DOMPERIDONE 10MG#3,
78 94486 201139-B SMT.HARBIRI RAJADEY ADV
09:15:28Hrs Medicines: BETAHISTINE DIHDROCHLORIDE-TABS#4,
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79 94487 200160-A MUKESH RAGHAV RAJADEY CC FEVER, BODY PAIN
09:42:15Hrs Medicines: ANTICOUGH AND ANTICOLDTABLETS#2, RANITIDINE-TABS#2, IBUPROFEN +
PARACETAMOL-TABS#2,
80 94488 14119020 DURGESH YADAV RAJADEY
81 94489 16410014 HIMANSHU RAJADEY CC
09:54:22Hrs Medicines: ANTICOUGH AND ANTICOLDTABLETS#2,
82 94490 201330-C ANSHIKA GUPTA RAJADEY FEVER
10:01:46Hrs Medicines: CEFIXIME - SYRUP#1,
83 94491 2850-A ARVIND TOMAR RAJADEY PAIN
10:26:03Hrs Medicines: CEFIXIME+CLOXACILLIN&LACTIC ACID BACILLUS#2, DICLO PARA TAB..#2,
84 94492 100701-B MRS KSHRI RAMAANI RAJADEY VERTIGO
10:29:24Hrs Medicines: BETAHISTINE DIHDROCHLORIDE-TABS#2, PROCHLORPERAZINE MALEATE-TABS#1,
ORS..#1,
85 94493 15910022 VEERENDRA SAHU RAJADEY CC
10:36:20Hrs Medicines: PARACETAMOL-TABS#4, ANTITUSSIVES, DECONGESTANT-D-100ML#1,
AMOXYCILLIN+POTASSIUM CLAVULANATE TAB#4, MONTELEUKAST TAB..#3,
86 94494 17908017 PUSHP RAJ PATEL RAJADEY ALLERGY
51

10:50:45Hrs Medicines: FEXOFINADINE TAB..#2,
87 94495 200424-A ANOOP KR RAJADEY THROAT INFECTION
10:53:40Hrs Medicines: LEVOCETIRIZINE-TABS#2, CEFIXIME-200MG-TABS#2, B-COMLEX +LACTOBASILEX-CAP#1,
88 94496 15117001 ABHINAV JAIN RAJADEY CC
89 94497 17118051 PRANJAL RAJADEY CC, FEVER
11:56:12Hrs Medicines: ANTICOUGH AND ANTICOLDTABLETS#2, PARACETAMOL-TABS#3,
AMOXYCILLIN+POTASSIUM CLAVULANATE TAB#2,
90 94498 100019-D SUHAS AVANEESH LEG INJURY
12:19:17Hrs Medicines: BANDGE-6INCH#8,
91 94499 201031-A RAM GOPAL AVANEESH VOMITING NAUSEA
12:38:55Hrs Medicines: INJ.EMSET#1, PANTOPRAZOLE-40MG. TAB.#1, TETANUS TOXOID-INJ#1, DISPOSAL SYRING
5CC#3, IBUPROFEN + PARACETAMOL-TABS#2,
92 94500 GUEST1045 HARSH AVANEESH CC
13:19:17Hrs Medicines: IBUPROFEN + PARACETAMOL-TABS#2, ANTICOUGH AND ANTICOLDTABLETS#2,
93 94501 200827-A CHANDRA MOHINI AVANEESH COUGH
13:46:34Hrs Medicines: ANTITUSSIVES, DECONGESTANT-D-100ML#1,
94 94502 16112062 RAHUL VIBHU ABD PAIN ADV TO VISIT C/M OPD
14:41:51Hrs Medicines: PANTOPRAZOLE40+DOMPERIDONE 10MG#3, DICYCLOMINE+MEFENAMIC ACID TAB#2,
95 94503 15902007 MANOJ PANWAR VIBHU HEADACHE ADV TO VISIT C/M OPD
16:44:48Hrs Medicines: ACECLOFENAC+PARACETAMOL TAB#3,
96 94504 17112072 SHIVANI VIBHU COUGH ADV TO VISIT C/M OPD
97 94505 17117093 UTKRISH VIBHU RASHES ADV TO VISIT C/M OPD
52

16:47:02Hrs Medicines: CETRIZINE-TABS#2, CEFIXIME-200MG-TABS#2,
98 94506 15110026 TUSHAR VIBHU ABD PAIN ADV TO VISIT C/M OPD
16:49:25Hrs Medicines: DICYCLOMINE+MEFENAMIC ACID TAB#3, PANTOPRAZOLE-40MG. TAB.#3,
99 94507 17615007 HIMANK JOSHI VIBHU TOOTH PAIN ADV TO VISIT C/M OPD
16:50:51Hrs Medicines: KETOROLAC TROMETHAMINE D.T.10MG#3,
100 94508 17117042 KESHVAM VIBHU ABD PAIN ADV TO VISIT C/M OPD
16:51:45Hrs Medicines: RANITIDINE-TABS#2, DICYCLOMINE+MEFENAMIC ACID TAB#2,
101 94509 3439-A BALESHVAR VIBHU COLD ND SHIVERING
17:08:09Hrs Medicines: IBUPROFEN + PARACETAMOL-TABS#1, ANTICOUGH AND ANTICOLDTABLETS#2,
CETRIZINE-TABS#1,
102 94510 16612006 SOYEB ALLAM VIBHU
103 94511 16612006 SOYEB ALLAM VIBHU AGE
18:11:34Hrs Medicines: PANTOPRAZOLE-40MG. TAB.#1, OFLOXIN+ORNIDAZOLE-TABS#2,
DICYCLOMINE+MEFENAMIC ACID TAB#2, B-COMLEX +LACTOBASILEX-CAP#2,
104 94512 15119044 RAM NIWAS VIBHU HIGH FEVER , COUGH ADMIT
18:41:52Hrs Medicines: PARACETAMOL 650MG TAB#1,
105 94513 201293-D YUKTA SAINI VIBHU COLD
18:45:24Hrs Medicines: ANTITUSSIVES, DECONGESTAN-FEBRES PLUS-SYRUP#1, CETRIZINE-TABS#3,
106 94514 939-C PRAKHAR BANA VIBHU CC
18:47:51Hrs Medicines: ANTITUSSIVES, DECONGESTAN-FEBRES PLUS-SYRUP#1,
107 94515 15113099 ROHIT VERMA VIBHU AGE ADV TO VISIT C/M OPD
19:04:00Hrs Medicines: PANTOPRAZOLE-40MG. TAB.#2, OFLOXIN+ORNIDAZOLE-TABS#2,
DICYCLOMINE+MEFENAMIC ACID TAB#2, PARACETAMOL 650MG TAB#2,
53

TO STUDY PATTERN OF EMERGENCY CASES COMING TO HOSPITAL SO AS TO IMPROVE THE EMERGENCY CARE DIPLOMA HOSPITAL MANAGEMENT THESIS (NIHFW,NEW DELHI)

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