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1
A
Report on
HOSPITAL TRAINING-I
By
AJAY SINGH TOMAR
(Roll. No: -1500450004)
Faculty of Pharmacy
RAJA BALWANT SINGH ENGINEERING TECHNICAL CAMPUS,
BICHPURI, AGRA
to the
DR. A.P.J ABDUL KALAM TECHNICAL UNIVERSITY, LUCKNOW
December 2017
2
ACKNOWLEDGMENT
I wish to express my heartfull gratitude to my institution faculty of pharmacy Raja Balwant
Singh Engineering Technical Campus, Bichpuri,Agra.
I praise god,thealmighty,merciful and passionate, for providing me this opportunity and
granting me the capability to proceed successfully.
The appear in its current form due to the assistance and Guidance of several people. I would
like to offer my sincere thanks to all.
First and for most I would like to thanks to Dr. Akhand Pratap Singh, Director, Dr. N. K.
Yadav, Dean (Faculty of Pharmacy). Dr.Pratima singh(Head of Department), Dr.V. K.
Srivastava(Incharge - Faculty of Pharmacy).
They gave me an excellence opportunity to learn the subjects. I express my sincere gratitude to
all those who have directly or indirectly helped me in the completion of project.
I am highly Indebted to Mr Sumit Kaushik, Dr. Shyamveer Singh and my other teaching staff
which includes respected Mr Krishna Kumar Agrawal,Mr. Tripanshu Gupta, Mr. Amit Yadav, Ms.
Jyoti Verma and other respected faculty members.
Above all I am Thankful to my parents who are the foundation stone of the Platform on which I
am standing on.
My work is the result of their blessings and hardship.
AJAY SINGH TOMAR
3
CERTIFICATE
4
5
Table of Contents
Sr.no Topic PAGE NO.
1. Introduction 6 – 7
2. Introduction of First Aid 7 - 10
6. Different Route of Injection 10 – 11
8. Artificial Respiration 12 – 14
9. Dressing of Wounds 15 – 16
10. Study of Patient Observation Chart 17
11. Prescription 18
12. Dispensing 19 – 20
13. Simple Diagnostic Report 20 – 22
14. Conclusion 23
6
List of Figures
Sr.no Legends PAGE NO.
1. Overview of Hospital 6
2. Layout of hospital 7
3. First Aid Kit 8
4. Intramuscular Injection 10
5. Intravenous Injection 11
6. Intra-peritoneal Injection 11
7. Artificial Respiration 12
8. Mouth to Mouth respiration 12
9. Mouth to Nose 13
10. Checking nerve Impulse 13
11. Chest Compression 14
12. Dressing The Wound 15
13. Patient Observation Chart 17
14. Prescription Letter 18
15. Dispensing Area 19
16. Blood Test Report 20
17. Pathology Report 21
18. X-Ray 21
19. MRI Scan 22
20 CT Scan 22
7
Introduction
Fig. 1 Overview of Hospital
Hospital -A hospital is a health care institution providing patient treatment with specialized staff and
equipment. The best known type of hospital is the general hospital which has an emergency
department .a district hospital typically is the major health care facility in its region, with large number
of beds for intensive care and long –term care. Specialised hospitals include trauma centres,
rehabilitation hospitals include trauma centres, rehabilitation hospitals, children`s hospitals, seniors
hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems and
certain disease categories. Specialized hospital can help reduce health care costs compared to general
hospitals. The medical 0facility similar than a hospital is generally cared a clinic. Hospitals have a
range of department e.g., surgery, and urgent care, specialist units such as cardiology .some hospitals
have outpatientdepartments and some chronic treatment units .common support units include a
pharmacy, pathology, and radiology. Hospitals consist of departments, traditionally called wards,
especially when they have beds for inpatients, when they are sometimes also called inpatient wards.
Hospitals may have acute services such as anemergency department or specialist trauma centre, burn
unit, surgery, or urgent care. These may then be backed up by more specialist units such as the
following:
 Emergency department
 Free Ambulance service (24*7)
 Paediatric intensive care unit
 Isolated Tuberculosis check-up centre
8
In addition, there is the department of nursing, often headed by a chief nursing officer or director of
nursing. This department is responsible for the administration of professional nursing practice,
research, and policy for the hospital. Nursing permit every part of a hospital. Many units or wards have
both a nursing and a medical director that serve as administrators for their respective disciplines within
that specialty. For example, in an intensive care nursery, the director of neonatology is responsible for
the medical staff and medical care while the nursing manager/director for the intensive care nursery is
responsible for all of the nurses and nursing care in that unit/ward.
Some hospitals have outpatient departments and some have chronic treatment units such as
behavioural health services, dentistry, dermatology, psychiatric ward, rehabilitation services, and
physical therapy.
Common support units include a dispensary or pharmacy, pathology, and radiology. On the
non-medical side, there often are medical records departments, release of information departments,
information management), clinical engineering, facilities management, plant ops (operations, also
known as maintenance), dining services, and security departments.
Layout of Hospital
Fig. 2Layout of hospital
Introductionof First Aid
First aid is the assistance given to any person suffering a sudden illness or injurywith care provided to
preserve life, prevent the condition from worsening, and promote recovery. 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.
9
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.
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 % 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.
 Wounds and bleeding, including lacerations, incisions and abrasions, Gastrointestinal
bleeding, avulsions and Sucking chest wounds, treated with an occlusive dressing to let
air out but not in.
Fig. 3 First Aid Kit
First Aid Treatment
Poisoning
 Poisons are substances that cause injury, illness or death.
 These events are caused by a chemical activity in the cells.
 Poisons can be injected, inhaled or swallowed.
10
 Poisoning should be suspected if the person is sick for unknown reason.
 Poor ventilation can aggravate inhalation poisoning.
 First aid is critical in saving the life of victims.
Causes medication , Overdose , Occupational exposure ,cleaning detergent/paints , carbon monoxide
gas from furnace , heaters , insecticides , certain cosmetics , certain household plant , animals , food
poisoning
SymptomsBlue lips , skin rashes , difficulty in breathing , diarrhoea , vomiting/nausea, fever ,
headache , giddiness/drowsiness , double vision , abdominal/chest pain , loss of appetite/bladder
control , numbness , muscle twitching , seizures , weakness , loss of consciousness.
Treatment
 Try and identify poison if possible.
 Check for signs like burns around mouth breathing difficult or vomiting.
 Induce vomiting if poison swallowed.
 In case of convulsions, protect the person from self-injury.
 If the vomit falls on the skin, wash it thoroughly.
 Position the on the left till medical help arrives.
For Inhalational Poisoning
 Seek immediate medical help.
 Get help before you attempt to recues others.
 Hold a wet cloth to cover your nose and mouth.
 Open all the doors and windows.
 Take deep breaths before you begin the rescue.
 Avoid lighting a match.
 Check the patient`s and breathing.
 Do a CPR if necessary.
 If the patient vomits, take steps to prevent choking.
11
Steps to Avoid
 Avoid giving an unconscious victim anything orally.
 Do not induce vomiting unless told by medical personnel.
 Do not give any medication to the victim unless directed by a doctor.
 Do not neutralize the poison with lime juice/honey.
Prevention
Store medicines cleaning detergents, mosquito repellents and paints carefully.
 Keep all potentially poisonous substance out of children`s reach.
 Avoid keeping poisonous plants in or around house. Take care while eating products such as
berries, roots or mushrooms
Different Routes of Injection
An injection is an infusion method of putting fluid into the body, usually with a syringe and a hollow
needle which is pierced through the skin to a sufficient depth for the material to be administered into
the body.
 Intramuscular injection
Fig.4Intramuscular Injection
In an intramuscular injection, the medication is delivered directly into a muscle. Many vaccines are
administered intramuscularly. Intramuscular injections are administered by a trained medical
professional; however, prescribed self-administered intramuscular injections are becoming more
common for patients who require these injections routinely.
12
 Intravenous Injection
Fig. 5Intravenous Injection
the forcing of a liquid into a part, as into the subcutaneous tissues, the vascular tree, or an organ, a
substance so forced or administered; in pharmacy, a solution of a medicament suitable for
injection.Immunizing substances, or inoculations, are generally given by injection. Some medicines
cannot be given by mouth because chemical action of the enzymes and digestive fluids would change
or reduce their effectiveness, or because they would be removed from the body too quickly to have any
effect
 Intra-peritoneal injection
Fig. 6 Intra-peritoneal Injection
Intra Peritoneal injection is the injection of a substance into the peritoneum (body cavity). Intra
Peritoneal injection is more often applied to animals than to humans. In general, it is preferred when
large amounts of blood replacement fluids are needed, or when low blood pressure or other problems
prevent the use of a suitable blood vessel for intravenous injection.
13
Artificial Respiration
Fig. 7 Artificial Respiration
Victims of electrical shocks, drowning, gas poisoning or choking have difficulty in breathing and may
stop breathing altogether. Artificial respiration could save their lives. Since most people die within 6
minutes after they stop breathing, artificial respiration should begin as soon as possible after the
breathing difficulty is noticed.
Methods of Artificial Respiration
There are three methods of artificial respiration:
1. Mouth-to-mouth/ Mouth-to-nose
2. Chest pressure arm lift (Sylvester)
3. Back pressure arm lift (Holder-Nielsen)
The most practical method is the mouth-to-mouth/nose method.
Fig. 8 Mouth to Mouth respiration
14
Fig.9 Mouth to Nose
1. Remove your mouth; turn your head to side and listen for the return rush of the air that indicate air
exchange. Repeat the blowing effort.
For the adult blow vigorously at a rate of about 12 breaths per minute. For a child, take relatively
shallow breaths appropriate for the child's size, at a rate of about 20 per minute.
2. If the victim is not breathing out the air that you blew in, recheck the head and jaw position. If you
still do not get air exchange, quickly turn the victim on his side and hit him sharply between the
shoulder blades several times in hope of dislodging foreign matter. Again sweep you finger
through the victim's mouth to remove foreign matter.
If you do not wish to come in direct contact with person, you may hold a cloth over the victim's
mouth or nose and breathe through it. Cloth does not greatly affect the exchange of air.
3. After giving two breaths which cause the chest to rise, attempt to locate a pulse on the casualty. Feel
for a pulse on the side of the casualty's neck closest to you by placing the first two fingers (index
and middle fingers) of your hand on the groove beside the casualty's Adam's apple (carotid pulse).
(Your thumb should not be used for pulse taking because you may confuse your pulse beat with
that of the casualty.) Maintain the airway by keeping your other hand on the casualty's forehead.
Allow 5 to 10 seconds to determine if there is a pulse (See Figure).
Fig. 10 Checking nerve Impulse
1. If a pulse is found and the casualty is breathing -Stop; allow the casualty to breathe on his own.
If possible, keep him warm and comfortable.
2. If a pulse is found and the casualty is not breathing, continue rescue breathing.
3. If a pulse is not found, begin chest compression.
 Expose chest and find breast bone. Put the heal of one hand on breast bone and other
hand on top.
15
 Compress the chest 15 times.
Fig.11 Chest Compression
If a pulse is not found, seek medically trained personnel for help.
For infants and small children
If there is any foreign matter visible in the victim's mouth, wipe it quickly with your fingers or cloth
wrapped around your fingers.
 Place the child on his back and use the fingers of both hands to lift the lower jaw from beneath
and behind, so that it juts out.
 Place your mouth over the child mouth and nose, making a relatively leak proof seal and
breathe into the child, using shallow puffs of air. The breathing rate should be about
20/minute.
If you meet resistance in your blowing efforts, recheck the position of the jaw. If the air
passages are still blocked, the child should be suspended momentarily by the ankles, or
inverted over the arm and given two or three sharp pats between the shoulder blades, in the
hope of dislodging obstructing matter.
16
Dressing of Wounds
Fig.12 dressing the wound
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
Background
There are a number of different dressings and techniques available for managing wounds. The majority
of wounds in children are acute trauma or surgical wounds.
Objectives of wound dressing
 To reduce pain.
 To apply compression for haemorrhage or venous stasis.
 To immobilise an injured body part.
 To protect the wound and surrounding tissue.
 To promote moist wound healing.
Assessment
Elicit a careful history of injury
 mechanism of injury; associated blood loss; risk of contamination; deeper structure damage;
 tetanus status;
 consider Non accidental Injury;
 Underlying chronic illness or disability.
17
Fully examine the injured part in particular checking for
 Underlying nerve, vessel and tendon damage. This requires assessment of movement while
exploring the wound (especially in palmer or hand wounds).
 Assess tissue damage or loss
Investigation
Request special investigations where appropriate
 x-ray for radiopaque foreign body or underlying fracture
 Ultrasound is useful for puncture wounds with a radiolucent foreign body such as thorn or
splinter.
Consider referral for plastic or general surgical opinion either in ED or as outpatient
Management
 Anaesthesia - see Analgesia and sedation guideline
 Cleansing - see Laceration guideline
 Wound closure - see Laceration guideline
 Dressing: in general keep dressings as simple as possible
18
Study of Patient Observation Chart
Fig. 13Patient Observation Chart
Observation and Response Charts
Monitoring and documenting physiological observations is a key component of recognition and
response systems. An observation and response chart is a document that allows the recording of patient
observations, and specifies the actions to be taken in response to deterioration from the norm. The
purpose of these charts is to support accurate and timely recognition of clinical deterioration, and
prompt action when deterioration is observed. The way in which observation charts are designed and
used can contribute to both the poor recording of observations and failure to interpret them correctly.
19
Prescription
Fig. 14 Prescription Letter
A prescription is a health-care program implemented by a physician or other qualified practitioner in
the form of instructions that govern the plan of care for an individual patient. A qualified practitioner
might be a physician, physician assistant, dentist, nurse practitioner, pharmacist, psychologist, or other
health care provider. Prescriptions may include orders to be performed by a patient, caretaker, nurse,
pharmacist, physician, other therapist, or by automated equipment, such as an intravenous infusion
pump. Formerly, prescriptions often included detailed instructions regarding compounding of
medications but as medications have increasingly become pre-packaged manufactured products, the
term "prescription" now usually refers to an order that a pharmacist dispense and that a patient take
certain medications. Prescriptions have legal implications, as they may indicate that the prescriber
takes responsibility for the clinical care of the patient and in particular for monitoring efficacy and
safety.
20
Dispensing
Fig. 15 Dispensing Area
Dispensing includes the preparation and transfer of a medication for a client, taking steps to ensure the
pharmaceutical and therapeutic suitability of the medication for its intended use, and taking steps to
ensure its proper use.
It may also include accepting payment for a medication on behalf of a nurse's employer.
Dispensing occurs when the nurse gives medication to a client or their delegate for administration at a
later time. Examples of dispensing include when
The client is leaving the facility on a day pass and needs their medication while away;
The client is being discharged from the emergency department and needs medication started.
When taking steps to ensure proper use, nurses
Label the medication legibly with
Client’s name
Medication name, dosage, route, and (where appropriate) strength
Directions for use
Quantity dispensed
Date dispensed
Initials of the nurse dispensing the medication and the name, address, and telephone number of the
agency from which the medication is dispensed.
Dosage regime, expected benefits, potential side effects, storage requirements and instructions required
to achieve a therapeutic response in recent times, the scope of pharmacy practice has extended beyond
the supply of medicines to include a range of professional health services such as medicine reviews,
21
chronic disease management and wound management support. Many pharmacies also provide
preventive health services including smoking cessation and weight management support. However, the
traditional dispensing of prescribed medicines still remains the important priority for most
pharmacists. As a complete process, dispensing requires the professional and clinical review by a
pharmacist. Some steps in the dispensing process can be completed by appropriately trained pharmacy
assistants under direct pharmacist supervision. Counselling is an essential element of the dispensing
process, ensuring patients or their careers have sufficient information to enable an understanding of
their medicines and the intended therapeutic effect, and to minimise the risk of adverse effects. As a
result of dispensing, patients or their carers should: receive clearly and correctly labelled medicine
understand how and when to use the prescribed medicines understand how to store the medicines have
access to a pharmacist for professional counselling or advice The flow-chart on the following page
demonstrates that there is more to the dispensing process than stick.
SimpleDiagnostics Reports
`A diagnostic report is the set of information that is typically provided by a diagnostic service when
investigations are complete. The information includes a mix of atomic results, text reports, images, and
codes.
•Laboratory (Clinical Chemistry, Haematology, Microbiology, etc.)
•Pathology / Histopathology / related disciplines
•Imaging Investigations (x-ray, CT, MRI etc.)
Fig. 16 (Blood Test Report)
22
Fig.17 Pathology Report
Fig. 18 (X-Ray)
23
Fig. 19 MRI Scan
Fig. 20 CT scan
24
CONCLUSION
I would like to add the people those who helped me in my report my teachers and other
peoples.
I would like to conclude as I came to know about various kinds of measures on how we can
treat them and various machines which are used to treat our various internal problems.
I gather knowledge on how to study various diagnostic reports and then how to proceed the
upcoming treatment through the reports.
I came to know about various dispensing methods and how to dispense medicines from
pharmacy store present in the hospital.

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Ajay Singh Tomar.docx

  • 1. 1 A Report on HOSPITAL TRAINING-I By AJAY SINGH TOMAR (Roll. No: -1500450004) Faculty of Pharmacy RAJA BALWANT SINGH ENGINEERING TECHNICAL CAMPUS, BICHPURI, AGRA to the DR. A.P.J ABDUL KALAM TECHNICAL UNIVERSITY, LUCKNOW December 2017
  • 2. 2 ACKNOWLEDGMENT I wish to express my heartfull gratitude to my institution faculty of pharmacy Raja Balwant Singh Engineering Technical Campus, Bichpuri,Agra. I praise god,thealmighty,merciful and passionate, for providing me this opportunity and granting me the capability to proceed successfully. The appear in its current form due to the assistance and Guidance of several people. I would like to offer my sincere thanks to all. First and for most I would like to thanks to Dr. Akhand Pratap Singh, Director, Dr. N. K. Yadav, Dean (Faculty of Pharmacy). Dr.Pratima singh(Head of Department), Dr.V. K. Srivastava(Incharge - Faculty of Pharmacy). They gave me an excellence opportunity to learn the subjects. I express my sincere gratitude to all those who have directly or indirectly helped me in the completion of project. I am highly Indebted to Mr Sumit Kaushik, Dr. Shyamveer Singh and my other teaching staff which includes respected Mr Krishna Kumar Agrawal,Mr. Tripanshu Gupta, Mr. Amit Yadav, Ms. Jyoti Verma and other respected faculty members. Above all I am Thankful to my parents who are the foundation stone of the Platform on which I am standing on. My work is the result of their blessings and hardship. AJAY SINGH TOMAR
  • 4. 4
  • 5. 5 Table of Contents Sr.no Topic PAGE NO. 1. Introduction 6 – 7 2. Introduction of First Aid 7 - 10 6. Different Route of Injection 10 – 11 8. Artificial Respiration 12 – 14 9. Dressing of Wounds 15 – 16 10. Study of Patient Observation Chart 17 11. Prescription 18 12. Dispensing 19 – 20 13. Simple Diagnostic Report 20 – 22 14. Conclusion 23
  • 6. 6 List of Figures Sr.no Legends PAGE NO. 1. Overview of Hospital 6 2. Layout of hospital 7 3. First Aid Kit 8 4. Intramuscular Injection 10 5. Intravenous Injection 11 6. Intra-peritoneal Injection 11 7. Artificial Respiration 12 8. Mouth to Mouth respiration 12 9. Mouth to Nose 13 10. Checking nerve Impulse 13 11. Chest Compression 14 12. Dressing The Wound 15 13. Patient Observation Chart 17 14. Prescription Letter 18 15. Dispensing Area 19 16. Blood Test Report 20 17. Pathology Report 21 18. X-Ray 21 19. MRI Scan 22 20 CT Scan 22
  • 7. 7 Introduction Fig. 1 Overview of Hospital Hospital -A hospital is a health care institution providing patient treatment with specialized staff and equipment. The best known type of hospital is the general hospital which has an emergency department .a district hospital typically is the major health care facility in its region, with large number of beds for intensive care and long –term care. Specialised hospitals include trauma centres, rehabilitation hospitals include trauma centres, rehabilitation hospitals, children`s hospitals, seniors hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems and certain disease categories. Specialized hospital can help reduce health care costs compared to general hospitals. The medical 0facility similar than a hospital is generally cared a clinic. Hospitals have a range of department e.g., surgery, and urgent care, specialist units such as cardiology .some hospitals have outpatientdepartments and some chronic treatment units .common support units include a pharmacy, pathology, and radiology. Hospitals consist of departments, traditionally called wards, especially when they have beds for inpatients, when they are sometimes also called inpatient wards. Hospitals may have acute services such as anemergency department or specialist trauma centre, burn unit, surgery, or urgent care. These may then be backed up by more specialist units such as the following:  Emergency department  Free Ambulance service (24*7)  Paediatric intensive care unit  Isolated Tuberculosis check-up centre
  • 8. 8 In addition, there is the department of nursing, often headed by a chief nursing officer or director of nursing. This department is responsible for the administration of professional nursing practice, research, and policy for the hospital. Nursing permit every part of a hospital. Many units or wards have both a nursing and a medical director that serve as administrators for their respective disciplines within that specialty. For example, in an intensive care nursery, the director of neonatology is responsible for the medical staff and medical care while the nursing manager/director for the intensive care nursery is responsible for all of the nurses and nursing care in that unit/ward. Some hospitals have outpatient departments and some have chronic treatment units such as behavioural health services, dentistry, dermatology, psychiatric ward, rehabilitation services, and physical therapy. Common support units include a dispensary or pharmacy, pathology, and radiology. On the non-medical side, there often are medical records departments, release of information departments, information management), clinical engineering, facilities management, plant ops (operations, also known as maintenance), dining services, and security departments. Layout of Hospital Fig. 2Layout of hospital Introductionof First Aid First aid is the assistance given to any person suffering a sudden illness or injurywith care provided to preserve life, prevent the condition from worsening, and promote recovery. 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.
  • 9. 9 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. 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 % 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.  Wounds and bleeding, including lacerations, incisions and abrasions, Gastrointestinal bleeding, avulsions and Sucking chest wounds, treated with an occlusive dressing to let air out but not in. Fig. 3 First Aid Kit First Aid Treatment Poisoning  Poisons are substances that cause injury, illness or death.  These events are caused by a chemical activity in the cells.  Poisons can be injected, inhaled or swallowed.
  • 10. 10  Poisoning should be suspected if the person is sick for unknown reason.  Poor ventilation can aggravate inhalation poisoning.  First aid is critical in saving the life of victims. Causes medication , Overdose , Occupational exposure ,cleaning detergent/paints , carbon monoxide gas from furnace , heaters , insecticides , certain cosmetics , certain household plant , animals , food poisoning SymptomsBlue lips , skin rashes , difficulty in breathing , diarrhoea , vomiting/nausea, fever , headache , giddiness/drowsiness , double vision , abdominal/chest pain , loss of appetite/bladder control , numbness , muscle twitching , seizures , weakness , loss of consciousness. Treatment  Try and identify poison if possible.  Check for signs like burns around mouth breathing difficult or vomiting.  Induce vomiting if poison swallowed.  In case of convulsions, protect the person from self-injury.  If the vomit falls on the skin, wash it thoroughly.  Position the on the left till medical help arrives. For Inhalational Poisoning  Seek immediate medical help.  Get help before you attempt to recues others.  Hold a wet cloth to cover your nose and mouth.  Open all the doors and windows.  Take deep breaths before you begin the rescue.  Avoid lighting a match.  Check the patient`s and breathing.  Do a CPR if necessary.  If the patient vomits, take steps to prevent choking.
  • 11. 11 Steps to Avoid  Avoid giving an unconscious victim anything orally.  Do not induce vomiting unless told by medical personnel.  Do not give any medication to the victim unless directed by a doctor.  Do not neutralize the poison with lime juice/honey. Prevention Store medicines cleaning detergents, mosquito repellents and paints carefully.  Keep all potentially poisonous substance out of children`s reach.  Avoid keeping poisonous plants in or around house. Take care while eating products such as berries, roots or mushrooms Different Routes of Injection An injection is an infusion method of putting fluid into the body, usually with a syringe and a hollow needle which is pierced through the skin to a sufficient depth for the material to be administered into the body.  Intramuscular injection Fig.4Intramuscular Injection In an intramuscular injection, the medication is delivered directly into a muscle. Many vaccines are administered intramuscularly. Intramuscular injections are administered by a trained medical professional; however, prescribed self-administered intramuscular injections are becoming more common for patients who require these injections routinely.
  • 12. 12  Intravenous Injection Fig. 5Intravenous Injection the forcing of a liquid into a part, as into the subcutaneous tissues, the vascular tree, or an organ, a substance so forced or administered; in pharmacy, a solution of a medicament suitable for injection.Immunizing substances, or inoculations, are generally given by injection. Some medicines cannot be given by mouth because chemical action of the enzymes and digestive fluids would change or reduce their effectiveness, or because they would be removed from the body too quickly to have any effect  Intra-peritoneal injection Fig. 6 Intra-peritoneal Injection Intra Peritoneal injection is the injection of a substance into the peritoneum (body cavity). Intra Peritoneal injection is more often applied to animals than to humans. In general, it is preferred when large amounts of blood replacement fluids are needed, or when low blood pressure or other problems prevent the use of a suitable blood vessel for intravenous injection.
  • 13. 13 Artificial Respiration Fig. 7 Artificial Respiration Victims of electrical shocks, drowning, gas poisoning or choking have difficulty in breathing and may stop breathing altogether. Artificial respiration could save their lives. Since most people die within 6 minutes after they stop breathing, artificial respiration should begin as soon as possible after the breathing difficulty is noticed. Methods of Artificial Respiration There are three methods of artificial respiration: 1. Mouth-to-mouth/ Mouth-to-nose 2. Chest pressure arm lift (Sylvester) 3. Back pressure arm lift (Holder-Nielsen) The most practical method is the mouth-to-mouth/nose method. Fig. 8 Mouth to Mouth respiration
  • 14. 14 Fig.9 Mouth to Nose 1. Remove your mouth; turn your head to side and listen for the return rush of the air that indicate air exchange. Repeat the blowing effort. For the adult blow vigorously at a rate of about 12 breaths per minute. For a child, take relatively shallow breaths appropriate for the child's size, at a rate of about 20 per minute. 2. If the victim is not breathing out the air that you blew in, recheck the head and jaw position. If you still do not get air exchange, quickly turn the victim on his side and hit him sharply between the shoulder blades several times in hope of dislodging foreign matter. Again sweep you finger through the victim's mouth to remove foreign matter. If you do not wish to come in direct contact with person, you may hold a cloth over the victim's mouth or nose and breathe through it. Cloth does not greatly affect the exchange of air. 3. After giving two breaths which cause the chest to rise, attempt to locate a pulse on the casualty. Feel for a pulse on the side of the casualty's neck closest to you by placing the first two fingers (index and middle fingers) of your hand on the groove beside the casualty's Adam's apple (carotid pulse). (Your thumb should not be used for pulse taking because you may confuse your pulse beat with that of the casualty.) Maintain the airway by keeping your other hand on the casualty's forehead. Allow 5 to 10 seconds to determine if there is a pulse (See Figure). Fig. 10 Checking nerve Impulse 1. If a pulse is found and the casualty is breathing -Stop; allow the casualty to breathe on his own. If possible, keep him warm and comfortable. 2. If a pulse is found and the casualty is not breathing, continue rescue breathing. 3. If a pulse is not found, begin chest compression.  Expose chest and find breast bone. Put the heal of one hand on breast bone and other hand on top.
  • 15. 15  Compress the chest 15 times. Fig.11 Chest Compression If a pulse is not found, seek medically trained personnel for help. For infants and small children If there is any foreign matter visible in the victim's mouth, wipe it quickly with your fingers or cloth wrapped around your fingers.  Place the child on his back and use the fingers of both hands to lift the lower jaw from beneath and behind, so that it juts out.  Place your mouth over the child mouth and nose, making a relatively leak proof seal and breathe into the child, using shallow puffs of air. The breathing rate should be about 20/minute. If you meet resistance in your blowing efforts, recheck the position of the jaw. If the air passages are still blocked, the child should be suspended momentarily by the ankles, or inverted over the arm and given two or three sharp pats between the shoulder blades, in the hope of dislodging obstructing matter.
  • 16. 16 Dressing of Wounds Fig.12 dressing the wound 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 Background There are a number of different dressings and techniques available for managing wounds. The majority of wounds in children are acute trauma or surgical wounds. Objectives of wound dressing  To reduce pain.  To apply compression for haemorrhage or venous stasis.  To immobilise an injured body part.  To protect the wound and surrounding tissue.  To promote moist wound healing. Assessment Elicit a careful history of injury  mechanism of injury; associated blood loss; risk of contamination; deeper structure damage;  tetanus status;  consider Non accidental Injury;  Underlying chronic illness or disability.
  • 17. 17 Fully examine the injured part in particular checking for  Underlying nerve, vessel and tendon damage. This requires assessment of movement while exploring the wound (especially in palmer or hand wounds).  Assess tissue damage or loss Investigation Request special investigations where appropriate  x-ray for radiopaque foreign body or underlying fracture  Ultrasound is useful for puncture wounds with a radiolucent foreign body such as thorn or splinter. Consider referral for plastic or general surgical opinion either in ED or as outpatient Management  Anaesthesia - see Analgesia and sedation guideline  Cleansing - see Laceration guideline  Wound closure - see Laceration guideline  Dressing: in general keep dressings as simple as possible
  • 18. 18 Study of Patient Observation Chart Fig. 13Patient Observation Chart Observation and Response Charts Monitoring and documenting physiological observations is a key component of recognition and response systems. An observation and response chart is a document that allows the recording of patient observations, and specifies the actions to be taken in response to deterioration from the norm. The purpose of these charts is to support accurate and timely recognition of clinical deterioration, and prompt action when deterioration is observed. The way in which observation charts are designed and used can contribute to both the poor recording of observations and failure to interpret them correctly.
  • 19. 19 Prescription Fig. 14 Prescription Letter A prescription is a health-care program implemented by a physician or other qualified practitioner in the form of instructions that govern the plan of care for an individual patient. A qualified practitioner might be a physician, physician assistant, dentist, nurse practitioner, pharmacist, psychologist, or other health care provider. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist, physician, other therapist, or by automated equipment, such as an intravenous infusion pump. Formerly, prescriptions often included detailed instructions regarding compounding of medications but as medications have increasingly become pre-packaged manufactured products, the term "prescription" now usually refers to an order that a pharmacist dispense and that a patient take certain medications. Prescriptions have legal implications, as they may indicate that the prescriber takes responsibility for the clinical care of the patient and in particular for monitoring efficacy and safety.
  • 20. 20 Dispensing Fig. 15 Dispensing Area Dispensing includes the preparation and transfer of a medication for a client, taking steps to ensure the pharmaceutical and therapeutic suitability of the medication for its intended use, and taking steps to ensure its proper use. It may also include accepting payment for a medication on behalf of a nurse's employer. Dispensing occurs when the nurse gives medication to a client or their delegate for administration at a later time. Examples of dispensing include when The client is leaving the facility on a day pass and needs their medication while away; The client is being discharged from the emergency department and needs medication started. When taking steps to ensure proper use, nurses Label the medication legibly with Client’s name Medication name, dosage, route, and (where appropriate) strength Directions for use Quantity dispensed Date dispensed Initials of the nurse dispensing the medication and the name, address, and telephone number of the agency from which the medication is dispensed. Dosage regime, expected benefits, potential side effects, storage requirements and instructions required to achieve a therapeutic response in recent times, the scope of pharmacy practice has extended beyond the supply of medicines to include a range of professional health services such as medicine reviews,
  • 21. 21 chronic disease management and wound management support. Many pharmacies also provide preventive health services including smoking cessation and weight management support. However, the traditional dispensing of prescribed medicines still remains the important priority for most pharmacists. As a complete process, dispensing requires the professional and clinical review by a pharmacist. Some steps in the dispensing process can be completed by appropriately trained pharmacy assistants under direct pharmacist supervision. Counselling is an essential element of the dispensing process, ensuring patients or their careers have sufficient information to enable an understanding of their medicines and the intended therapeutic effect, and to minimise the risk of adverse effects. As a result of dispensing, patients or their carers should: receive clearly and correctly labelled medicine understand how and when to use the prescribed medicines understand how to store the medicines have access to a pharmacist for professional counselling or advice The flow-chart on the following page demonstrates that there is more to the dispensing process than stick. SimpleDiagnostics Reports `A diagnostic report is the set of information that is typically provided by a diagnostic service when investigations are complete. The information includes a mix of atomic results, text reports, images, and codes. •Laboratory (Clinical Chemistry, Haematology, Microbiology, etc.) •Pathology / Histopathology / related disciplines •Imaging Investigations (x-ray, CT, MRI etc.) Fig. 16 (Blood Test Report)
  • 23. 23 Fig. 19 MRI Scan Fig. 20 CT scan
  • 24. 24 CONCLUSION I would like to add the people those who helped me in my report my teachers and other peoples. I would like to conclude as I came to know about various kinds of measures on how we can treat them and various machines which are used to treat our various internal problems. I gather knowledge on how to study various diagnostic reports and then how to proceed the upcoming treatment through the reports. I came to know about various dispensing methods and how to dispense medicines from pharmacy store present in the hospital.