Hospital Report -I: First Aid Training

A
Project Report on “Hospital Report -I”
For partial fulfillment of B.Pharm 3th
Year 5th Semester
Session2022-23
ALIGARH COLLEGE OF PHARMACY ALIGARH
(U.P.)
APPROVED BY AICTE, PCI & AFFILIATED
TO
Dr. A.P.J Abdul Kalam Technical University Lucknow
Submitted By: Submitted To:
Name: Rovin Sharma Mr. Shobhit Singh
Roll no: 2002340500076 [ M.Pharma, M.Ba]

ALIGARH COLLEGE OF PHARMACY
Declaration by the Candidate
I hereby declare that the project work entitled “Hospital Report -I”
submitted to Dr. A.P.J Abdul Kalam Technical University,
Lucknow, is a bonafide and genuine work carried out by me
under the guidance of “Mr. Shobhit Singh”. I also declare that
the material embodied in it is original and the same has not
previously formed the basis for the award of any diploma
degree, fellowship of other university or institution .
Date : Submitted by
Rovin Sharma
2002340500076

ENDORSEMENT BY THE GUIDE
This is to be certified that the project entitled “Hospital Report - I”
is a bonafide work done by “Rovin Sharma” in partial
fulfillment of the requirement for degree of “ Bachelor of
Pharmacy” of Dr. A.P.J Abdul Kalam Technical University
,Lucknow .This work was carried out by him under my guidance
and supervision .
DATE: Mr. Shobhit Singh
PLACE: ALIGARH [M.Pharma , M.Ba]

ENDORSEMENT BY THE PRINCIPAL
This is to be certified that the project entitled “Hospital Report -
I” is a bonafide work done by "Rovin Sharma” in partial
Fulfillment of the requirement for degree of "Bachelor of Pharmacy"
of Dr. APJ Abdul Kalam Technical University, Lucknow.
DATE: Dr. Raghvendra Sharma
( M.Pharm Ph.D. )
PLACE: ALIGARH (Principal A.C.P Aligarh)

ACKNOWLEDGEMENT
The training opportunity I had with was a great chance for learning and professional
development .Therefore, I consider myself a very lucky individual as I was provided with
an opportunity to be a part of it. I am also grateful for having a chance to meet so many
wonderful people and professional who led me through this training period.
I express my deepest thanks to Mr. Shobhit Singh
for giving me necessary advices and guidance and arranged all facilities to make my
training successful.
It is my radiant sentiment to place on record my best regards deepest sense of gratitude
to Mr. Shobhit Singh
for their careful and precious guidance which were extremely valuable for my study both
theoretically and practically.
I perceive as this opportunity as a big milestone in my career development. I will strive
to use gained skills and knowledge in my best possible way.
The successful completion of this would be incomplete unless we mention the people
who made it possible and whose constant guidance and encouragement served as a beam
of light and give me energy to enjoy and complete this work .
Date:
Submitted by
Rovin Sharma
2002340500076

CONTENTS
Introduction
Different departments of hospital
First aid
Surgical and
Parenteral routes of administration
Dispensary
Waste management
Emergency
Summary
Observation
Conclusion

Hospital Training Report Part-I
Rovin Sharma 2002340500076 B.harma 3th Year 1
About College
Aligarh College of pharmacy is located three km from Sasni Gate on Mathura Road,
Aligarh. Jawahar Vidyalay Society formed Aligarh College of pharmacy. It has been
approved by Al India Pharmacy council and affiliated with U.P. AKTU, Lucknow.
Major facilities are library, lab etc. The Trust was formed in the year 2000 and the
Institute was established in the year 2001.
which providing enriching education in various disciplines and train with a positive
outlook to grow. To ensure job placements for students and to establish the name of
the college amongst one of the best engineering colleges in the country.
To prepare students for higher level of education in pharmacy line so that they
become
competent, creative and imaginative professionals. To develop ACP into an institute of
excellence for imparting education in Pharmacy with special emphasis an personality
development

About Hospital
Hospitals are centres of treatment. People from all comers of the society and
all walks of life converge here to cure themselves of their diseases.
I did my training in Pt. Deen Dayal Upadhyay Joint Hospital, Aligarh
This is also known as "IN Combind District hospital" Aligarh
It is a centre for all types of medical facilities especially for the poor people.
This training also made me realize the importance of hospital for people and
how it affects even the day-to-day lives of them
Not only the patients but also the people working in the hospital are truly
dependent on it.
This training report comprises of the whole summary of my training in this
hospital

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/or
promote recovery. It includes initial intervention in a serious condition prior to
professional medical help being available, such as performing CPR while awaiting an
ambulance, as well as the complete treatment of minor conditions, such as applying
a plaster to a cut. First aid is generally performed by the layperson, with many people
trained in providing basic levels of first aid, and others willing to do so from acquired
knowledge. Mental health first aid is an extension of the concept of first aid to cover
mental health
Aim
The primary goal of first aid is to prevent death or serious injury from worsening. The
key aims of first aid can be summarized with the acronym of 'the three Ps
• Preserve life: The overriding aim of all medical care which includes first aid, is to
save lives and minimize the threat of death. First aid done correctly should help
reduce the patient's level of pain and calm them down during the evaluation and
treatment process.
• Prevent further harm: Prevention of further harm includes addressing both external
factors, such as moving a patient away from any cause of harm, and applying first
aid techniques to prevent worsening of the condition, such as applying pressure to
stop a bleed from becoming dangerous.
• Promote recovery: First aid also involves trying to start the recovery process from
the illness or injury, and in some cases might involve completing a treatment, such
as in the case of applying a plaster to a small wound.
It is important to note that first aid is not medical treatment and cannot be compared
with what a trained medical professional provides. First aid involves making common
sense decisions in the best interest of an injured person.
Training Principal
Basic principles, such as knowing the use of adhesive bandage or applying direct
pressure on a bleed, are often acquired passively through life experiences. However,

to provide effective, life-saving first aid interventions requires instruction and practical
training. This is especially true where it relates to potentially fatal illnesses and
injuries, such as those that require CPR; these procedures may be invasive, and carry
a risk of further injury to the patient and the provider. As with any training, it is more
useful if it occurs before an actual emergency, and in many countries, emergency
ambulance dispatchers may give basic first aid instructions over the phone while the
ambulance is on the way.
Training is generally provided by attending a course, typically leading to certification.
Due to regular changes in procedures and protocols, based on updated clinical
knowledge, and to maintain skill, attendance at regular refresher courses or re-
certification is often necessary. First aid training is often available through community
organizations such as the Red Cross and St. John Ambulance, or through commercial
providers, who will train people for a fee. This commercial training is most common
for training of employees to perform first aid in their workplace. Many community
organizations also provide a commercial service, which complements their community
programmes.
1. Junior level certificate Basic Life Support
2. Senior level certificate
3. Special certificate
Types of first aid which require training
There are several types of first aid (and first aider) that require specific additional
training. These are usually undertaken to fulfill the demands of the work or activity
undertaken.
• Aquatic/Marine first aid is usually practiced by professionals such as lifeguards,
professional mariners or in diver rescue, and covers the specific problems which
may be faced after water-based rescue or delayed MedEvac.
• Battlefield first aid takes into account the specific needs of treating
wounded combatants and non-combatants during armed conflict.
• Conflict First Aid focuses on support for stability and recovery of personal, social,
group or system well-being and to address circumstantial safety needs.
• Hyperbaric first aid may be practiced by underwater diving professionals, who
need to treat conditions such as decompression sickness.

• Oxygen first aid is the providing of oxygen to casualties with conditions resulting
in hypoxia. It is also a standard first aid procedure for underwater diving incidents
where gas bubble formation in the tissues is possible.
• Wilderness first aid is the provision of first aid under conditions where the arrival
of emergency responders or the evacuation of an injured person may be delayed
due to constraints of terrain, weather, and available persons or equipment. It may
be necessary to care for an injured person for several hours or days.
• Mental health first aid is taught independently of physical first aid. How to support
someone experiencing a mental health problem or in a crisis situation. Also how to
identify the first signs of someone developing mental ill health and guide people
towards appropriate help.
Types of First Aid Kits
Having a good first aid kit is essential for any office or restaurant. First aid can
help people treat minor injuries or buy you valuable time in an emergency when
you're waiting for professional medical care. Additionally, having a first aid kit and
staff trained in first aid is an OSHA requirement for most industries. Read on to learn
more about how to pick the best first aid kit for your business.
First Aid Kit Purchasing Considerations
There are four important factors to consider when purchasing a first aid kit: the
intended use of the first aid kit, the quantity and type of supplies within the first aid
kit, type of first aid kit container, and the necessary information in each first aid kit.
By taking these into consideration you will know what should be in a first aid kit for
your business. Having the incorrect supplies in a first aid kit may mean that you don't
have the necessary supplies to properly treat an injury.
First Aid Kit Size and Intended Use

The size of the first aid kit you need will depend upon the number of people working
in a facility and the types of injuries that are expected to arise. Having a kit that is
too simple or small for your operation may mean you don't have the necessary
supplies to treat an employee's injury or illness. A first aid kit that is too large and
complex may mean that supplies expire before they are used, thus wasting money.
For example, an office that has a few employees may only need a small and simple
first aid kit to treat minor injuries such as headaches, nausea, and paper cuts. Large
commercial kitchens or manufacturing facilities will require larger, more complex first
aid kits that have supplies to treat more serious injuries such as burns, cuts from
blades, and mild to moderate pain. If a cardiac emergency arises, having an AED
(automated external defibrillator) can save lives, so we recommend investing in one
even though they aren't a required first aid kit item.
Regardless of the size of the kit or number of people who may use it, all general first
aid kits should include the following types of supplies:
Antiseptics: used to clean wounds and destroy disease-causing microorganisms
Bandages: used to cover wounds and control bleeding
Medicines: used to treat common ailments such as stomach aches, allergies, and
pain
Basic Medical Tools: include simple tools such as tweezers to remove splinters,
trauma shears to cut gauze and bandages, and a thermometer to check patient
temperature
Injury Treatment Supplies: include supplies such as an instant hot or cold pack to
reduce swelling, antibiotic ointment to inhibit infection, bandages to control bleeding
and cover cuts, and burn creams and sprays to treat and minimize the damage from
burns.
2. First Aid Kit Classifications
The classification of a first aid kit will depend on the quantity of first aid supplies, the
variety of supplies in the kit, and the kit's intended use. These standards are
maintained by the American National Standards Institute (ANSI) and the International
Safety Equipment Association.
There are two first aid kit classifications: Class A and Class B. Additionally, there are
many first aid kits that do not fall within these classifications because the quantity of
supplies or their intended use.
Class A First Aid Kits Definition:

Class A first aid kits provide a basic range of products to deal with very common
injuries such as small cuts, abrasions, and minor burns. Therefore, Class A first aid
kits are good choices for low population and low-risk workplaces such as offices.
Class B First Aid Kits Definition:
Class B first aid kits provide a broader range and greater number of supplies to
handle workplace injuries. Because of this, Class B first aid kits are the best choice
for highly populated, complex, or high-risk workplaces.
First Aid Kit Information
Because of the varying degrees of first aid training among staff, including an
information card on how to treat basic injuries and illnesses should be included with
first aid kits. These instructions should be easy to read and understand, include
diagrams or pictures to help visualize first aid treatment skills, and cover usage
instructions for all the supplies contained within the first aid kit.
Most pre-assembled first aid kits include this information in a booklet or pamphlet. If
you add supplemental information to your first aid kits, make sure that it is from a
credible source such as ANSI or ISEA. Regularly checking information contained in
the first aid kits is necessary to make sure that it up to date with the latest medical
best practices.
The following information is great to include inside a first aid kit or as a poster near
the first aid station:
• How to perform the Heimlich maneuver

• Instructions on how to perform CPR
• Directions for controlling bleeding
• How to immobilize a broken limb
• Ways to treat stings and bites
• First aid kit list of supplies
Other Types of First Aid Kits
First Aid Burn Relief Kits
Burn relief kits contain all the supplies necessary to treat burn injuries. Proper use
of burn supplies help reduce patient pain as well as minimize scarring. Most burn
kits contain ointment to sterilize the burned area and reduce pain, burn dressings
and gauze to cover burns, and burn gel to cool the burned area and promote
healing.
First Aid Emergency Kits
Emergency kits contain the necessary first aid supplies to handle most common first
aid injuries and illnesses as well as some additional supplies which can be helpful in
survival, search and rescue, or disaster events.
In addition to medical supplies, these kits may include rescue supplies such as
whistles, flashlights, food and water ration packets, and emergency blankets.
Emergency kits generally come in large duffel bag style containers with carrying
straps, secure closure buckles, and reflective emblems for visibility.
First Aid Travel Kits
First aid travel kits generally come in a small container size making them perfect for
placing in vehicles or luggage. These kits have fewer first aid supplies than other
types of first aid kits as their main purpose is to be a compact first aid kit used to
treat minor injuries or illnesses.
Travel kits come in a variety of containers too. Some come in plastic or metal cases
that can be mounted inside cars. Others are small, zippered cases that are perfect for
sliding in a glove compartment or suitcase.
Wound Dressing

A wound dressing is anything that is used in direct contact with a wound to help it
heal and prevent further issues or complications1
. Different wound dressings are used
based on the type of the wound, but they all aim to help reduce infection. Wound
dressings also help with the following.
• Stop bleeding and start clotting
• Absorb excess blood, plasma, or other fluid
• Wound debridement
Different Types of Wound Dressings
There are tons of different types of wound dressings used in the medical field today.
In this article, we’ll discuss the most common ones. They include the following.
Cloth
This type of wound dressing is the most commonly used dressing and for good
reason. It’s versatile and is used to protect open wounds from a number of minor
injuries. Whether it’s a scraped knee, an uncomfortable cut, or an injury in a sensitive
area. Cloth wound dressings are also commonly used for small patches of broken
skin or in delicate areas.
Most often, medical practitioners use cloth dressings as a first layer of protection. In
other circumstances, they’re used as a second layer to further secure an area1. Since
cloth conforms to your body, it’s a great option for wounds that are awkward or
difficult to dress.
You’ve likely used cloth dressings before, as they are the most well known type of
dressing used in homes—other than simple Band-Aids. Cloth dressings come in both

pre-cut packaged dressings and roll options. They’re available in a variety of shapes
and sizes and are easily altered to fit any wound.
Foam
Another common type of wound dressings is foam dressings. They’re extremely soft
and usually very absorbent, depending on the brand. Foam dressings help to protect
the wound while it’s healing and maintains a healthy moisture balance1
. This makes
foam dressings good for wounds that may exhibit foul smelling odors.
The absorbency of foam dressing helps to promote faster healing times as the
dressing efficiently absorbs excess fluids from the wounds surface while still keeping it
moist2
. The moisture kept inside the wound from foam dressings promotes faster
healing times while protecting the area from infection. Due to the unique permeability
of the foam dressing, water vapor enters but bacteria can’t.
Foam wound dressings come in a variety of shapes and sizes. There are both
adhesive and non-adhesive options available.
Transparent
Transparent dressings are most commonly used when a doctor wants to closely
monitor healing of a specific wound. Since transparent dressings are made using a
clear film, it’s much easier to monitor wounds using this type of dressing in compared
to a cloth or foam bandage. For this reason, transparent dressings are often used on
larger, more complicated wounds.
Most frequently, transparent dressings are used on surgical incision sites, burns and
ulcers, and IV sites2
. Since the film is so thin, these dressings are considered more
comfortable than others and are far more flexible.
When used correctly, transparent dressings will keep your wound clean, speed up
healing, and allow you to monitor for complications.
Hydrocolloid
Hydrocolloid dressings are a non-breathable, self-adhesive dressing2
. They work by
creating moist conditions to help speed up healing time and are made out of a
flexible material for increased comfort. The surface of hydrocolloid dressings is coated
with a substance containing polysaccharides and other polymers that work to absorb
water and form a gel2
. This gel is in direct contact with your wound and helps it heal
faster.

These types of dressings are most commonly used on burns, light to moderately
draining wounds, necrotic wounds, under compression wraps, and on pressure or
venous ulcers3
. They are one of the longest lasting types of dressings and their self-
adhesive qualities make them easy to apply.
Hydrogel
For dry wounds that need a little help healing, hydrogel is a great option. It acts in a
way that adds moisture to your wound so it heals faster and breaks down dry, dead
tissue1. This process helps increase patient comfort levels while simultaneously
reducing pain caused by dead tissue. In some hydrogel products, a cooling gel is
used for extra comfort.
Hydrogel wound dressings are commonly used on a large range of wounds. Wounds
that emit little to no fluid need hydrogel dressings for a strong recovery. They’re also
used on wounds that are unusually painful or necrotic. Due to the excess liquid in
these dressings, which promotes cellular growth, hydrogel is good for second-degree
burns and infected wounds.
Alginate
On the opposite end of the spectrum, we have alginate dressings. Alginate dressings
are extremely absorbent and are used on wounds that have excessive drainage. The
absorbency is up to 20x it’s weight1
, making them perfect for extreme or deep
wounds. Along with absorbency, alginate dressings also create a gel-like substance to
help with the healing process.
They’re best used for burns, venous ulcers, packing wounds, and higher state
pressure ulcers2
. Do not use alginate on wounds that are already dry as they will
hinder the healing process and create an environment that’s even drier. Alginate
should only be used on wounds that are wet with large amounts of liquid drainage2
.
Since alginate dressings are used on wounds with a lot of fluid, they need to be
changed more often—every two days at the very least. Pay attention to your wound
and determine whether or not they should be changed more frequently and if you’re
unsure, talk to your doctor. When these types of dressings are changed too
frequently, there is a bigger chance for excessive dryness and bacterial penetration.
Collagen

Finally, there are collagen wound dressings. These types of dressings are most
commonly used for chronic wounds with a slow or stalled healing time. They are also
be used on pressure sores, transplant sites, surgical wounds, ulcers, burns, or injuries
that cover a large area of your body2
.
The difference between collagen dressings and the others we’ve discussed is that
collagen dressings act as a temporary “second skin” that allows new cells to grow
and flourish. Without it, the healing time would take much longer.
Collagen dressings are a good alternative to traditional bandaging because they help
to promote healing in a number of different ways. Aside from providing a scaffolding
system for new cells to accumulate, collagen dressings help remove dead tissue,
encourage the formation of new blood vessels, and help tighten the wound’s edges2
.
In addition to the common types of wound dressings, there are a number of other
options available. If you’re injured and need a specific type of wound dressings, talk
to your doctor to discuss the best course of action for your situation. Nothing beats a
professional medical opinion.
Conclusion
If you want to protect yourself and your family from the complications of wounds,
regardless of their size or type, it’s important to make sure you’re ready. The best
way to be ready is to have a good supply of wound care supplies and any wound
dressings you may need. Byram Healthcare is a leading wound care supplier with an
outstanding Chronic Wound Program. We aim to help reduce costs to the health care
system, patients, and any facilities that may need supplies. At Byram Healthcare, we
have everything from bandages and gauze to unna boots, hydrogels, and compression
bandages. Check out our wound care selection and request a comprehensive catalog
on our website today!
Artificial respiration,
breathing induced by some manipulative technique when natural respiration has
ceased or is faltering. Such techniques, if applied quickly and properly, can prevent
some deaths from drowning, choking, strangulation, suffocation, carbon monoxide
poisoning, and electric shock.
Resuscitation by inducing artificial respiration consists chiefly of two
actions:

(1) establishing and maintaining an open air passage from the upper respiratory
tract (mouth, throat, and pharynx) to the lungs
(2) exchanging air and carbon dioxide in the terminal air sacs of the lungs while
the heart is still functioning. To be successful such efforts must be started as soon as
possible and continued until the victim is again breathing.
Route of administration of Injection
This is the second commonest route of drug administration. They mainly involve
introducing the drug in form of solution or suspension into the body at various sites
and to varying depths using syringe and needle. Thus administration involves risk of
infection, pain, and local irritation.
Injection routes of drug administration are usually employed where:
1. rapid effect is urgently needed as in emergency situations;
2. the patient is too ill or unconscious for oral route to be employed;
3. the drug is orally ineffective due to its being destroyed or not absorbed from the gut;
4. an injection is the only way for the drug to reach its require site of action;
5. these is need to maintain a steady blood level of a drug.

The most important factors or requirements in all injection routes are the surrounding
tissue or site must be as clean as possible, and all instruments used must be clean
and sterile. There are three commonly used injection routes: subcutaneous (SC),
intramuscular (IM), and intravenous (IV). Other routes such as intra-arterial (IA),
intrathecal (IT), intraperitoneal (IP), intravitreal etc., are used less frequently.
Injection routes Definition
Subcutaneous (SC)
Administration beneath the skin; hypodermic. Synonymous
with the term subdermal or hypodermal.
Intramuscular (IM) Administration within a muscle.
Intradermal (ID) Administration within the dermis.
Intravenous (IV) Administration within or into a vein or veins.
Intra-arterial (IA) Administration within an artery or arteries.
Intrathecal (IT)
Administration within the cerebrospinal fluid at any level of
the cerebrospinal axis, including injection into the cerebral

ventricles
Intraperitoneal (IP) Administration within the peritoneal cavity.
Intravitreal Administration within the vitreous body of the eye.
Subcutaneous (SC) :
A subcutaneous injection is a method of administering medication. Subcutaneous
means under the skin.
In this type of injection, a short needle is used to inject a drug into the tissue layer
between the skin and the muscle. Medication given this way is usually absorbed more
slowly than if injected into a vein, sometimes over a period of 24 hours.
This type of injection is used when other methods of administration might be less
effective. For example, some medications can’t be given by mouth because acid and
enzymes in the stomach would destroy them.
Other methods, like intravenous injection, can be difficult and costly. For small
amounts of delicate drugs, a subcutaneous injection can be a useful, safe, and
convenient method of getting a medication into your body.
Intramuscular (IM):
An intramuscular injection is a technique used to deliver a medication deep into the
muscles. This allows the medication to be absorbed into the bloodstream quickly.

You may have received an intramuscular injection at a doctor’s office the last time
you got a vaccine, like the flu shot.
In some cases, a person may also self
example, certain drugs that treat
self-injection.
Intradermal (ID):
Intradermal injection, often abbreviated
substance into the dermis, which is located between the
hypodermis. For certain substances,
faster systemic uptake compared with
immune response to vaccinations,
drug uptake. Additionally, since administration is closer to the surface of the skin, the
body's reaction to substances is more easily visible.
the procedure compared to sub
administration via ID is relatively rare, and is only used for
tuberculosis and allergy tests,
Hospital Training Report Part
Rovin Sharma 2002340500076 B.harma 3
intramuscular injection at a doctor’s office the last time
you got a vaccine, like the flu shot.
In some cases, a person may also self-administer an intramuscular injection. For
example, certain drugs that treat multiple sclerosis or rheumatoid arthritis
Intradermal injection, often abbreviated ID, is a shallow or superficial
, which is located between the epidermis
. For certain substances, administration via an ID route can result in a
faster systemic uptake compared with subcutaneous injections leading to a stronger
immune response to vaccinations, immunology and novel cancer treatments, and faster
Additionally, since administration is closer to the surface of the skin, the
body's reaction to substances is more easily visible. However, due to complexity of
the procedure compared to subcutaneous injection and intramuscular injection
tests, Monkeypox vaccination, and certain therapies
B.harma 3th Year 16
intramuscular injection at a doctor’s office the last time
administer an intramuscular injection. For
rheumatoid arthritis may require
, is a shallow or superficial injection of a
epidermis and the
via an ID route can result in a
leading to a stronger
and novel cancer treatments, and faster
Additionally, since administration is closer to the surface of the skin, the
However, due to complexity of
intramuscular injection,
n therapies

Intravenous (IV)
An intravenous (IV) injection is an injection of a medication or another substance
into a vein and directly into the bloodstream. It is one of the fastest ways to get a
drug into the body.
IV administration involves a single injection followed by the insertion of a thin tube or
catheter into a vein. This allows a healthcare professional to administer multiple doses
of medication or medicated infusions without having to re-inject needles to deliver
each dose.
This article outlines what healthcare professionals use IV injections for, how IV
injections work, and the equipment they require. It also outlines some of the pros and
cons of IV injections and infusions, as well as some of their possible risks and side
effects.
Intraperitoneal (IP):
Intraperitoneal injection or IP injection is the injection of a substance into
the peritoneum (body cavity). It 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.
In humans, the method is widely used to administer chemotherapy drugs to treat
some cancers, particularly ovarian cancer. Although controversial, intraperitoneal use in
ovarian cancer has been recommended as a standard of care. Fluids are injected
intraperitoneally in infants, also used for peritoneal dialysis
study of patient observation charts,
Introduction
Regular measurement and documentation of physiological observations (i.e. clinical
observations) are essential requirements for patient assessment and the recognition of
clinical deterioration.
The Victorian Children’s Tool for Observation and Response (ViCTOR) charts are age-

specific ‘track and trigger’ paediatric observation charts for use in Victorian hospitals,
and are designed to assist in recognising and responding to clinical deterioration in
children. These charts have been integrated into the Electronic Medical Record (EMR)
and the observations are viewed on the ViCTOR graphs.
These ViCTOR graphs, also known as ‘track and trigger’ charts mandate a response
by the clinician once the patient’s observations reach a designated ‘zone’. Concerning
changes in any one observation, or vital sign, are indicated by two coloured zones
(Orange and Red). If a child’s observation transgresses the Orange or Red zone an
escalation of care response is triggered. The type and urgency of the escalation
response depends on the degree of clinical abnormality.
The ViCTOR graphs are standardised for the following 5 age groups: less than 3
months, 3 to 12 months, 1 to 4 years, 5 to 11 years and 12 to 18 years. At RCH
the 12-18 years graph is used for young people older than 18 years.
Aim
To provide guidance to clinical staff regarding the:
• Measurement of clinical observations;
• Use of the Victorian Children’s Tool for Observation and Response; and
• Role of continuous cardio-respiratory monitoring and pulse oximetry monitoring.
Definition of terms (abbreviations and acronyms)
• AUM- Associate Unit Manager
• CPMS – Children’s Pain Management Service
• ECG - Electrocardiograph
• EMR- Electronic Medical Record
• ICP - Intracranial Pressure
• MET - Medical Emergency Team
• PACU - Post Anaesthetic Care Unit
• PCA - Patient Controlled Analgesia
• PICU - Paediatric Intensive Care Unit

• Rapid Review– review of patient by Bed-card doctor within 30 minutes of request.
Guideline details
Clinical Observations
Clinical observations may include;
• estimation of haemoglobin-oxygen saturation (SpO2, pulse oximetry)
• oxygen delivery
• respiratory rate
• respiratory distress
• heart/pulse rate
• blood pressure (systolic, diastolic and mean)
• temperature
• level of consciousness OR level of sedation
• pain score.
• in certain clinical circumstances further observations (for example, neurological
observations or neurovascular observations)
Clinical observations are recorded by the nurse as part of an admission assessment
(Nursing Assessment), at the commencement of each shift and at a frequency
determined by the child’s clinical status and/or current treatment. For example,
required observations during routine post anaesthetic observations can be found.
The frequency of observations and type of observations is ordered within EMR and
should be should be documented in flowsheets
Observations should be performed at least once per hour if the patient:
• Has previous observations within the shaded orange or red zone (unless
modified)
• Was transferred from PICU/NICU (as clinically indicated)
• Is receiving PCA, Epidural, or Opioid infusion
• Is receiving an Insulin infusion
• has ICP monitoring
• is receiving oxygen therapy
(Note, some children will require continuous monitoring as described later in this
guideline).

A set of observations must be recorded within the hour before transfer from one area
to another, for example from ED to ward, PICU to ward or PACU to ward. If a child's
observations are transgressing the Orange or Red zone, this must be addressed prior
to transfer.
Each set of observations should be documented in flowsheets and then trends should
be viewed on the VICTOR graph, to better enable analysis and interpretation of the
data. Link: flowsheet learning resources. For observations entered via Rover the
trending of observations on the ViCTOR graph should be viewed as soon as
practicable.
In the event of a “down time” of EMR all treating areas at RCH have a supply of the
paper ViCTOR charts for all age groups. This information will later be uploaded to the
EMR. On the paper charts the Red Zone is colored purple.
Coloured zones
Age-specific ViCTOR parameters are automatically set by the child's age in the EMR
and when breached a notification for escalated care is triggered. There are 3 distinct
coloured ‘zones’ within the ViCTOR graph.
The White zone is considered the ‘acceptable zone’. That is, most patients trending in
this area are considered to have acceptable age-related vital signs ( Normal Ranges
for Physiological Variables.) Nevertheless, it is important to be vigilant – for example, a
heart rate that is steadily rising in this White zone should trigger attention before
crossing into the Orange zone.
The Orange zone is the first zone to signal that the patient may be deteriorating. It
triggers the clinician to escalate care to the AUM (at a minimum) to decide if a
medical review or other emergency response is required. The Red zone is the second
and more concerning trigger and signals that the patient may be deteriorating or is
seriously ill. If the patient is in the Red zone, an emergency call must be initiated,
that is, a Rapid Review or MET call. If the child’s observations transgress into the
Orange or Red zone, then further details must be documented, including the
Escalation of Care plan and response.
Appropriate escalation of care must occur as per the Deteriorating Patient: Escalation
of Care flow chart and the Medical Emergency Response Procedure.
Remember, regardless of what zone the patient is in, if a staff member or parent is
very worried about the child’s clinical state, initiate an emergency response.

Modification of the Orange or Red zone
Modification of the Emergency response criteria may be ordered by medical staff, in
accordance with the Medical Emergency Response Procedure
O2 Saturation and oxygen delivery
Haemoglobin-oxygen saturations (SpO2) are entered numerically in the flowsheet.
Oxygen delivery refers to the flow (L/min) or percentage (%) of oxygen that the
patient is receiving. If no oxygen is given, write 'RA' (room air). Oxygen delivery
guidelines.
The device used to deliver oxygen should be noted as follows:
• Nasal prongs (NP)
• Hudson Mask (HM)
• Humidified Nasal Prongs (HNP)
• High Flow Nasal Prongs (HFNP)
• Non-rebreather mask (NRM)
• Tracheostomy (T)
Standing medical orders for nurse initiated oxygen therapy for PICU patients are
linked .
Heart rate
The heart rate is checked by palpation of the pulse or auscultation of the heart at
least once per shift and whenever there is concern about the child’s physiological
condition, a change in heart rhythm or when there is doubt about the accuracy of the
monitoring technology. The pulse volume and regularity of heart rate should also be
assessed at this time.
Respiratory rate
The respiratory rate is checked at least once per shift established by counting the
patient’s breaths over 60 seconds.. Further respiratory assessment including the
pattern and effort of breathing should also be evaluated at this time. Respiratory
distress should be recorded as Nil, Mild, Moderate or Severe based on the
assessment.

Blood Pressure
Blood pressure (BP) must be recorded as systolic, diastolic and mean BP. Only
systolic BP triggers an escalation of care response. A measurement in the Orange
zone reflects hypertension (upper zone) and in the Red zone, hypotension (lower
zone).
BP should be assessed at least once on admission, and thereafter at a frequency
appropriate for the child’s clinical state. If a child's pulse/heart rate falls in the Orange
or Red zone, BP must be measured and documented. The limb used to measure BP
should be documented as should the type of measurement (eg manual, automated).
Temperature
For infants less than 3 months, the temperature section contains an Orange zone to
escalate care for the infant with a low (≤ 36°C) or high temperature (≥38.5°C).
For neonates, the temperature should be > 36.5°C ( Temperature Management
guideline)
For other age groups, an order can be placed when, and if an alteration in
temperature should be reported to medical staff (e.g. febrile neutropenic patient,
temperature rise >1°C and ≥38°C during blood product transfusion).

Level of Consciousness
Level of Consciousness assessment should be made by using the AVPU scale:
A = child is Alert (opens eyes spontaneously when approached).
V = child responds to Voice.
P = child responds to a Painful stimulus.
U = the child is Unresponsive to any stimulus.
The AVPU score may be difficult to determine for infants. Some infants may respond
to the voice of a parent, but not a clinician.
Children should be woken before scoring AVPU. Conversely, in an otherwise clinically
stable patient, it may not be appropriate to wake a sleeping child to assess the level
of consciousness, with every set of observations (e.g an infant with bronchiolitis who
is on hourly observations for ongoing evaluation of respiratory distress and has just
settled to sleep).
A more comprehensive neurological assessment must be performed for any patient
who has, or has the potential, to have an altered neurological state. Neurological
observations should ordered for children with:
• Increasing, or potential for increased, intracranial pressure
• Neurosurgical procedures
• Encephalopathy (e.g. metabolic disorder, liver failure)
• Endocrine disorders (e.g. Diabetic ketoacidosis, Diabetes Insipidus)
• Electrolyte disorders (e.g hyponatraemia)
• Demyelinating neurological conditions (e.g. Guillain - Barre syndrome)
• Seizures –consider underlying diagnosis, or new onset. AVPU scoring may be
appropriate for children with pre-existing seizure conditions.
• Those at an increased risk of stoke or bleeding (eg Ventricular Assist Device,
altered INR’s)
Level of Sedation
Level of Sedation should be assessed ONLY for patients receiving sedation (e.g.
chloral hydrate, midazolam, nitrous oxide, and opiates at higher doses) and the Level
of Sedation score is to be used instead of the AVPU score.
The University of Michigan Sedation Score (UMSS) is used;

0 Awake and alert
1 Minimally sedated: may appear tired/sleepy, responds to verbal conversation +/- sound
2
Moderately sedated: somnolent/sleeping, easily roused with tactile stimulation or verbal
command
3 Deep sedation: deep sleep, rousable only with deep or physical stimulation
4Unrousable
Pain scores
Pain scores should be calculated by using a Pain Assessment tool appropriate for the
age, developmental level and clinical state of the child. Nursing Clinical Guideline Pain
Assessment and Measurement. Suggested pain scales include
• FLACC scale for infants and toddlers and non-verbal children
• Wong-Baker Faces Scale for children 5 -17 years (may be used for some children from
3 years)
• Numeric rating scale for children >8 years.
• (mPAT) (Neonatal Pain Assessment )
• COMFORT- B scale (used in PICU).
Additional Observations
Further patient specific observations may be required and ordered.
• Blood sugar level (POCT)
• Capillary refill time
• Non-invasive ventilation parameters
• Ventilation parameters
• Isolette/radiant heater temperature ( <1 year only)
• Nausea
• Patient whereabouts
Adding a comment
Comments that help interpret the observations and trends (e.g decreased heart rate
observed with administration of procedural sedation, or mother concerned about
increased drowsiness of her child, or commencement or completion of blood product
transfusion) can be made within flowsheets or as a real time progress notes.

Continuous monitoring
Continuous monitoring includes either cardio-respiratory monitoring or pulse oximetry
monitoring.
Continuous monitoring supplements manually performed intermittent clinical
observations. If used appropriately it can assist clinicians to identify rapid changes in
condition. Some monitors enable the review of trends in physiological parameters over
time.
Cardio-respiratory monitoring
Continuous cardio-respiratory monitoring is the technological measurement of heart
rate/pulse rate, respiratory rate and SpO2. Children who are clinically unstable or are
at risk of sudden changes in condition should have cardio-respiratory monitoring.
Some indications include:
• Potential or actual apnoeic or bradycardic episodes
• Recent unexplained sudden collapse
• Abnormalities of heart rate and rhythm or high risk of arrhythmia (e.g. pericardial
effusion, altered electrolytes)
• Temporary pacing
• Prostaglandin infusion, medications that compromise cardiac function including
concentrated electrolyte therapy, administration of pro-arrhythmic drugs with potential to
cause QT prolongation or ventricular dysrhythmias, therapies associated with a high risk
of anaphylaxis, administration of toxic medications)
• High risk of respiratory failure (e.g., infants with severe bronchiolitis)
• Post-operative assessment as ordered by medical staff (e.g. 24-48 hours post spinal
surgery)
Correct electrode placement when utilitsing ECG monitoring is vital. 3 lead ECG
monitoring is most common however 5 lead ECG monitoring can also be used with
the bedside monitors.
The above image shows the correct lead placement for a 5 lead ECG. When only
using 3 leads, place the 3 coloured leads in the appropriate spots as outlined above.
Commonly white (RA) , black (LA) and green (RL) are used for 3 lead ECG
monitoring.
Skin preparation and regular changing of electrodes (usually daily) is vital to ensure
accurate readings. For further information Cardiac Telemetry Guideline.

Pulse oximetry monitoring
Continuous pulse oximetry monitoring measures oxygenation (SpO2) and pulse rate.
Indications for its use include the child who:
• is receiving oxygen therapy and clinically unstable
• is clinically unstable and the need for oxygen therapy is yet to be determined
• has a nasopharyngeal airway or tracheostomy and requiring acute nursing care
• is receiving respiratory support (e.g., invasive or non-invasive ventilation)
• is undergoing a procedure where respiratory depressants are used
• is a high risk patient receiving an opioid infusion
• is in the immediate post-operative period
• has a decreasing conscious status
It is important to neither rely on nor ignore monitors. Whenever continuous monitoring
of heart rate, SpO2 or respiratory rate is in use, clinical observations must be
documented hourly, at a minimum. The heart rate should be cross checked by
palpation of the pulse or auscultation of the heart at least once per shift and
whenever there is concern about the child’s physiological condition, a change in heart
rhythm or when there is doubt about the accuracy of the monitoring technology.
Alarm settings
Alarm limits should be set at the appropriate age related profile selected on the
monitor, where the default settings reflect the ViCTOR escalation of care parameters.
Subsequent adjustment of the alarms may be required as the patient’s clinical status
changes. That is, it may be necessary to set the alarm limits within a narrower range
for some patients. Widening of the alarms limits must only be done in accordance
with the procedure outlining the modification of emergency response criteria (Orange
zone).
The patient profile and alarm settings should be checked at the beginning of each
shift and as otherwise indicated. The key principle is to provide safe alarm settings for
the child and minimise the number of false alarms. A high frequency of false alarms
has the potential to desensitize staff and decrease their responsiveness, thereby
compromising patient safety.
By turning the monitor into stand-by mode when not being used, all settings will be
saved and available for the next set of observations. If the monitor is turned off by

the power button displayed on the front of the monitor, all settings will be lost and
need to be re-programed.
When commencing cardio-respiratory monitoring, make sure that the patient’s name is
correctly entered into the monitor. When new patients are added to the monitor it is
important that the correct Profile (age group) is selected otherwise alarm settings will
default to the 1-4 year age group.
All alarms must be “enabled” (activated) and audible. When an alarm sounds clinicians
should respond immediately, assess the child, determine and apply the appropriate
intervention and rectify problems with monitoring devices if necessary. Parents are not
permitted to disable or alter alarm settings.
Discontinuation of continuous monitoring
As the condition of the child stabilises and the risk of sudden deterioration lessens,
the decision to continuously monitor the child should be reviewed by the nursing and
medical staff (usually at least once per shift). When no longer necessary the patient
can be transitioned to 1-4 hourly observations.
The need for close observation and monitoring should be balanced against
unnecessary dependency on the monitor.
Dispensing the prescription
When a patient arrives at a pharmacy to collect his medication, the pharmacist with or
without MSc (Pharm) (proviisori) identify themselves in the pharmacy system with the
healthcare professional card. The pharmacy system searches for the prescriptions to
be dispensed from the Prescription Centre where the doctor has saved them.
If the buyer of the medicine is not the patient him/herself, the person must be able to
prove in a reliable way that they are entitled to receive the patient's medication. To
do this, they must show either a patient instruction sheet or the patient's Kela card, or
they must be able to prove their right to act on behalf of the patient in some other
way.
Searching prescriptions with a bar code

The patient instruction sheet and the summary printout of the patient's prescriptions
contain a bar code, which can be used by the pharmacy system to search for the
prescription in the Prescription Centre without the pharmacist having to enter any
other information about the patient or the prescription into the system.
Searching prescriptions without a patient instruction sheet
If the patient is collecting the medication without a patient instruction sheet or
summary, the pharmacist will search the information required for specifying the
prescriptions using the patient's personal identity code. The search can be limited by
searching the specific data of all of the patient's prescriptions with some medication
left on the prescription or by limiting the prescription search to apply to undispensed
or partially dispensed prescriptions issued within a specific time period. From the
prescriptions found as a result of the prescription search, the pharmacist will choose
the ones from which the patient wants to purchase medication.
Dispensing
Dispensing is carried out one prescription at a time. When a prescription is selected
to be dispensed, the pharmacy system will show the pharmacists or the pharmacology
student the dispensing event that has been precompleted on the basis of the
prescription data. The pharmacist checks the information of the dispensing event and
completes the information. The pharmacy system verifies that compulsory information
has been completed and the drug to be dispensed is found in the Pharmaceutical
Database unless it is a question of medication to be prepared at the pharmacy or
other preparation outside the Pharmaceutical Database.
If the dispensing person is a pharmacology student, the dispensing event is saved to
be inspected and sent by the supervising pharmacist.
The prescription contains a field where the doctor may have written a message to the
pharmacy. The message may be, for example, information about when the prescription
can be dispensed or when the patient should book a follow-up appointment.

The dispensing information for a prescription dispensed by a pharmacy in another
European country may be incomplete. If a pharmacy discovers an error in such
dispensing information, it must contact the Kanta Services.
Dispensing event is signed electronically
When all of the patient's prescriptions to be dispensed at the same time are ready,
the pharmacist will sign the dispensing events electronically and send them to the
Prescription Centre. The professional card enables not only identification of the
person, but also electronic signing.
With the electronic signature, it will be possible to verify at a later date who has
dispensed the prescription and when. An electronic prescription is safer than a
traditional signature: it cannot be forged and it guarantees that the contents signed for
are unchanged.
Handing over the medication to the patient
When the medication is handed over to the patient, the patient is given a description
of the dispensed medication. The information is printed out onto the sticker to be
attached to the package.
It is also possible to give a summary of the patient's prescriptions at the patient's
request. The summary will show the latest information about the amount of medication
still to be dispensed.
SIMPLE DIAGNOSTIC REPORTS
Abstract
Acute muscle pain and walking difficulty are symptoms compatible with both benign
and severe degenerative diseases. As a consequence, in some cases invasive tests
and hospitalizations are improperly scheduled. We report the case of a 7-year-old
child suffering from acute calf pain and abnormal gait following flu-like symptoms.
A review of the literature will be helpful to better define differential diagnosis in
cases of muscle pain in children. Daily physical examination and urine dipstick are

sufficient to confirm the diagnosis of benign acute childhood myositis (BACM) during
the acute phase, to promptly detect severe complications and to rule out
degenerative diseases. Children with BACM do not require hospitalization, medical
interventions or long-term follow-up.
Medical diagnosis is the process of determining which disease or condition explains a
person's symptoms and signs. It is most often referred to as diagnosis with the
medical context being implicit. The information required for diagnosis is typically
collected from a history and physical examination of the person seeking medical care.
Often, one or more diagnostic procedures, such as diagnostic tests, are also done
during the process. Sometimes posthumous diagnosis is considered a kind of medical
diagnosis.
Diagnosis is often challenging, because many signs and symptoms are nonspecific.
For example, redness of the skin (erythema), by itself, is a sign of many disorders
and thus does not tell the healthcare professional what is wrong. Thus differential
diagnosis, in which several possible explanations are compared and contrasted, must
be performed.
This involves the correlation of various pieces of information followed by the
recognition and differentiation of patterns. Occasionally the process is made easy by
a sign or symptom (or a group of several) that is pathognomonic.
Diagnosis is a major component of the procedure of a doctor's visit. From the point of
view of statistics, the diagnostic procedure involves classification tests.
A diagnosis, in the sense of diagnostic procedure, can be regarded as an attempt at
classification of an individual's condition into separate and distinct categories that
allow medical decisions about treatment and prognosis to be made. Subsequently, a
diagnostic opinion is often described in terms of a disease or other condition, but in
the case of a wrong diagnosis, the individual's actual disease or condition is not the
same as the individual's diagnosis.
A diagnostic procedure may be performed by various health care professionals such
as a physician, physical therapist, optometrist, healthcare scientist, chiropractor,

dentist, podiatrist, nurse practitioner, or physician assistant. This article uses
diagnostician as any of these person categories.
A diagnostic procedure (as well as the opinion reached thereby) does not necessarily
involve elucidation of the etiology of the diseases or conditions of interest, that is,
what caused the disease or condition. Such elucidation can be useful to optimize
treatment, further specify the prognosis or prevent recurrence of the disease or
condition in the future.
The initial task is to detect a medical indication to perform a diagnostic procedure.
Indications include:
• Detection of any deviation from what is known to be normal, such as can be
described in terms of, for example, anatomy (the structure of the human body),
physiology (how the body works), pathology (what can go wrong with the
anatomy and physiology), psychology (thought and behavior) and human
homeostasis (regarding mechanisms to keep body systems in balance).
Knowledge of what is
• Normal and measuring of the patient's current condition against those norms
can assist in determining the patient's particular departure from homeostasis and
the degree of departure, which in turn can assist in quantifying the indication
for further diagnostic processing.
• A complaint expressed by a patient
• The fact that a patient has sought a diagnostician can itself be an indication to
perform a diagnostic procedure. For example, in a doctor's visit, the physician
may already start performing a diagnostic procedure by watching the gait of the
patient from the waiting room to the doctor's office even before she or he has
started to present any complaints.
• Even during an already ongoing diagnostic procedure, there can be an
indication to perform another, separate, diagnostic procedure for another,
potentially concomitant, disease or condition. This may occur as a result of an
incidental finding of a sign unrelated to the parameter of interest, such as can

occur in comprehensive tests such as radiological studies like magnetic
resonance imaging or blood test panels that also include blood tests that are
not relevant for the ongoing diagnosis.

REPORT SUMMARY
The summary of the report is perhaps the most important section, not only because it
is where all the pieces get tied up into one final portrait of the child, but also
because it is sometimes the only part of the report that is read. So it must be well
done.
CONCLUSION
• ∙ During training procedures I have got lot of knowledge about flowing- Stated
project a training regarding each and every first aid procedures, It includes
checking the symptoms and treating at small scale in first aids and later
transferring for surgical procedures. I got known regarding artificial respiration
process and wound dressing.
• ∙ In Prescription reading, its parts and the abbreviations used are studied by
me in this project it’s truly a scandalous matter for pharmacists study. Later
the dispensing procedure is stated therefore which was practiced by me all
around the training at regular intervals.
• ∙ In Simple diagnostic reports those are easy to study in case of pathological
reports but a bit of difficulty arises in reading radiological reports .
• ∙ Sites of injection which includes knowledge of syringes, routes of injections.
Routes of injections such as I.V., I.M., I.D., Subcutaneous etc.
• ∙ Therefore I have got
• The project Hospital Training is the working in a hospital. The process takes
care of all the requirements of an average hospital and is capable to provide
easy and effective storage of information related to patients that come up to the
hospital.
• It generates test reports; provide prescription details including various tests, diet
advice, and medicines prescribed to patient and doctor. It also provides injection
detail and billing facility on the basis of patient’s status whether it is an indoor
or outdoor patient.
The system also provides the facility of backup as per the requirement. Patients who
are non-local language speakers or come from migrant populations or ethnic minority
groups often are not able to communicate effectively with their clinicians to receive
complete information about their care.

REFERENCE
• https://en.wikipedia.org/wiki/First_aid
• https://www.rehabmart.com/category/wound_dressings.htm
• https://en.wikipedia.org/wiki/Route_of_administration
• https://en.wikipedia.org/wiki/Dispensing
• https://en.wikipedia.org/wiki/Medical_prescription
• https://www.safetyandquality.gov.au/our-work/recognising-and-responding-to-clinical-
deterioration/observation-and-response-charts/
• https://www.healthline.com/health/stroke/stroke-first-aid
• https://en.wikipedia.org/wiki/Artificial_ventilation
• https://www.webmd.com/first-aid/tc/emergency-first-aid-for-heatstroke-topic-overview
• http://ecprcertification.com/index.php/page/course/63
• https://en.wikipedia.org/wiki/Dressing
• https://www.advancedtissue.com/different-types-wound-care-dressings/
• https://en.wikipedia.org/wiki/Medical_ventilator
• "Decisions about cardiopulmonary resuscitation model information leafler" .
British Medical Association. July
• "Artificial Respiration" . Microsoft Encarta Online Encyclopedia 2007. Archived
from the original on 20091031
• "Artificial Respiration" .Encyclopædia Britannica. Archived from the original on 14
June 2007.
• Jull AB, Cullum N, Dumville JC, Westby MJ, Deshpande S, Walker N (6 March
2015). "Honey as a topicaltreatment for wounds". Cochrane Database of
Systematic Reviews. 3:
• "First Aid Equipment, Supplies, Rescue, and Transportation". Hospital Corpsman.
Naval Education and Training
• http://medicaldictionary.thefreedictionary.com/pressure+dressing
• Lees P, Cunningham FM, Elliott J (2004). "Principles of pharmacodynamics and
their applications in veterinary
• a b c Fernandez R., Griffiths R. (15 February 2012). "Water for wound
cleansing". Cochrane Database of systemic review
• Simple wound management , patient.info (website), accessed 8 January 2012
• "Duct tape for the win! Using household items for first aid needs." . CPR
Seattle. Archived from the original on20141104.

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