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ACKNOWLEDGMENT
I wish to express my heart full gratitude to my institution faculty of pharmacy Raja Balwant
Singh Engineering Technical Campus, Bichpuri, Agra.
I praise god, the almighty, 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. AkhandPratap Singh, Director, Dr. N. K.
Yadav, Dean (Faculty of Pharmacy). Dr.V. K. Srivastava, Incharge (Faculty of Pharmacy), Dr.
Pratima, head of department (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.
DEEPCHANDRA
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TABLE OF CONTENTS
SR. NO. TOPIC PAGE NO.
1. Introduction 6 – 7
2. Introduction Of First Aid 7 - 10
3. Different Route Of Injection 10 – 11
4. Artificial Respiration 12 – 14
5. Dressing Of Wounds 15 – 16
6. Study Of Patient Observation Chart 17
7. Prescription 18
8. Dispensing 19 – 20
9. Simple Diagnostic Report 20 – 22
10. Conclusion 23
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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
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Introduction
Fig. 1 Overview of S.N. Medical College and Hospital, Agra
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 outpatient departments 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 an emergency 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
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
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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. 2 Layout of hospital
Introduction of First Aid
First aid is the assistance given to any person suffering a sudden illness or injury with care provided to
preserve life, prevent the condition from worsening, and 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.
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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.
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These events are caused by a chemical activity in the cells.
Poisons can be injected, inhaled or swallowed.
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
Symptoms Blue 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.
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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.4 Intramuscular Injection
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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.
Intravenous Injection
Fig. 5 Intravenous 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
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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.
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.
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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.
Compress the chest 15 times.
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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.
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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
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mechanism of injury; associated blood loss; risk of contamination; deeper structure damage;
tetanus status;
consider Non accidental Injury;
Underlying chronic illness or disability.
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
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Study of Patient Observation Chart
Fig. 13 Patient 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.
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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.
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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
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the supply of medicines to include a range of professional health services such as medicine reviews,
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.
Simple Diagnostics 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.)
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Fig. 20 (CT scan)
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.
