Village Panchayat Hospital Health Chapters

Contentsof section9: Health.
Chapter2-Health.
2.1-Healthand society –some scenarios.
2.2-Betterto openthe centreswhichcaresinsteadof tellinggotohighercentre.
2.3-Competitionbetweenthe diseaseandthe treatment,whowins?
2.4-VPH,to begin with.
2.5-VPHadministration.
2.6-VPH– Creationof Infrastructure.
2.7-Beginningstaff of the VPH.
2.8-Cateringpopulationof the VPH.
2.9-Introductiontothe emergencytrolley.
2.10-Advantagesof EmergencyTrolley.
2.11-Dimensionsof emergencytrolley.
2.12-Emergencytrolleyrackdescription.
2.13-Commonfeatures
2.14-Emergencydrugsto be keptinEmergencytrolley,Systemwiseclassification(A prototype).
2.15-Emergencydrugsto be keptinE – trolley,Rack/ Compartmentwise classification.
2.16-‘Medicines’inmedical practice.
2.17-Let us decrease ourconfusionondrugswithpresentbrandnames,still retainingthe brand.
2.18-Let us have clarityinthe name of the drug from the time of studyto practice.
2.19-Solutionstodecrease the mistakeswith differentbrandsbydifferentcompanies.
2.20-Reducingthe numberof hospital (PHCtoVPH) will addqualitytothe healthservicesandthe
doctorscan spendtime forperiodical updates.
2.21-Periodical inspectionisthe needtomaintainthe qualityinservice.
2.22-Quantitydecidesthe qualityinsome areas.
2.23-Strict waste disposal protocolsare the needtopreventmanylife threateninginfections.
2.24-National healthprogrammesandthe private medical practise.
2.25-National healthservicesandVillagePanchayathHospital.
2.26-VPH – NHS– CellarandGroundfloor.
2.27-VPH - Departmentof OBG.
2.28-VPH - Central sterilizationstation.
2.29-VPH - Departmentof Physiotherapy.
2.30-VPH - Departmentof Paediatrics.
2.31-VPH - Departmentof Medicine.
2.32-VPH - Departmentof Ophthalmology.
2.33-VPH – Hospital Stores.
2.34-VPH - Departmentof ENT.
2.35-VPH - Departmentof Surgery.
2.36-VPH - Departmentof Orthopaedics.
2.37-VPH - Departmentof Radiology.
2.38-VPH - Laboratory.
2.39-VPH - Departmentof Microbiology.
2.40-VPH - Departmentof Biochemistry.
2.41-VPH - Departmentof Pathology.
2.42-VPH - Departmentof Bloodbank.
2.43-VPH - Departmentof Pharmacy.
2.44-VPH - OPDregistration.
2.45-VPH - MinorOT.
2.46-VPH - IPregistration.
2.47-VPH - Trauma care centre.
2.48-VPH - Reception.

2.49-VPH - RMO – CMO.
2.50-VPH - Casualty.
2.51-VPH - Ambulance.
2.52-VPH - Police.
2.53-VPH - Canteen.
2.54-VPH - Departmentof Dental science.
2.55-VPH - Departmentof Ayurvedha.
2.56-VPH - Departmentof Siddha,Homeopathy,Unani.
2.57-VPH - Departmentof Forensicmedicine.
2.58-VPH - Stores– Furniture’s.
2.59-VPH - Departmentof Anaesthesia.
2.60-VPH - Nursingandhousekeepingstaff section.
2.61-VPH - General andspecial wards:
2.62-VPH - Medical superintendent:
2.63-VPH - Meetingrooms.
2.64-VPH - Hospital administration.
2.65-NHS – VPH- VPPreventivemedicine.
2.66-NHS – VPH- VPPollutioncontrol office.
2.67-NHS – VPH- Publichealthengineering.
2.68-NHS – VPH- Coordinator– National healthprogramme.
2.69-NHS – VPH- CoordinatorNHP1– HIV / AIDS.
2.70-NHS – VPH- CoordinatorNHP2– Malaria.
2.71-NHS – VPH- CoordinatorNHP3 – Tuberculosis.
2.72-NHS – VPH- CoordinatorNHP4– Blindnesscontrol programme.
2.73-NHS – VPH- CoordinatorNHP – Nutritional disease control programme.
2.74-NHS – VPH- CoordinatorNHP6– NRHM.
2.75-NHS – VPH- PIN registrationrecordmaintenanceofficer.
2.76-NHS – VPH- PIN registrationoffice.
2.77-NHS – VPH- PIN healthupdate recordmaintenance office.
2.78-NHS – VPH- PIN healthupdatingofficer.
2.79-NHS – VPH- Birthrecord maintenance officer.
2.80-NHS – VPH- Birthregistrationofficer.
2.81-NHS – VPH- Deathrecord maintenance officer.
2.82-NHS – VPH- Deathregistrationofficer.
2.83-NHS – VPH- Libraryand readingrooms.
2.84-NHS – VPH- Hospital networking.
Views to make this ‘World’ developed and this
‘Earth’ as the lovely place for every ‘Human’.
SECTION 9
HEALTH

Targeting for long life:
Why we need to target only for 100 to 150 years of
life, why not 200 to 300 years of healthy, active,
productive life as we read in our ancient epics.
Try to achieve the state where there is health for
everyone, everywhere, all the time.
Chapter 2: Health.
2.1. Health and society – some scenarios.
Health scenarios:
1. Obstetriciandidanemergency LSCS,whichwasreferredfromthe PHC/Village TBA / Urban slum
whichisan un booked/un registeredcase.Obstetriciandecidedtodocesareansection,because the
fetal heart rate was very slow and there is not much dilatation of the cervix and she did the LSCS
immediately without waiting for the report to save the baby. Both the mother and the baby were
saved and later the report comes from the lab as the lady is positive for HIV / HBsAg.
Solution:WithVPA –VPH - MV – MN, all the caseswill be booked casesandadequate ANCcheckups
can be done.
2. Sometimes we receive the patient in respiratory failure and we refer the patient in the same
respiratory failure due to the non availability of the ventilators. Leave about the PHC, even at the
taluk levels hospital, the same procedure is followed. The patient reaching the higher centre with
the respiratory failure will be decided by the god. Sometimes the ambulance that we send the
patient to the higher centre may not have the Oxygen cylinder in working condition in it.
Solution:WithVPA –VPH - MV – MN, all the VPHwill have adequate facilitiestotreatsuch casesand
the availability of life line ambulances.
3. A family from Chikmagalur migrated to USA on some job with their child who is seven year old.
US governmentisaskingforimmunization certificate. Parents lost the immunization card. BCG was
givenatthe governmenthospital, asitisnotroutinelygiveninthe private setup.The baby received
few vaccines in the Holy cross hospital Chikmagalur, few vaccines were taken in Bangalore, and
differentcardswere given in different places. And the government card did not have the space for
all the vaccines other than UIP (Universal Immunization Programme).
Solution: With VPA – VPH - MV – MN, the entire event can be computerized for better
documentation and for follow-up.

4. A person had head injury, taken to government hospital, was then referred to other private
hospital,where surgeonwasnotpresentonthatday, thenhe was referred to CT scan centre to rule
out intracranial injury, on the way the patient developed convulsions.
Solution: With VPA – VPH - MV – MN, such types of cases can be well managed.
5. Pregnant women with IUD (Intrauterine death) was made to deliver the child, went for DIC
(Disseminated Intravascular Coagulation), had PPH (Post partum hemorrhage – excessive bleeding
afterdelivery),plateletcount dropped – requires immediate platelet concentrate to stop bleeding
and /or freshblood,butthe bloodisnot available in that hospital, the doctor shifted the patient to
higher centre taking risk, reaching the higher centre is left to the god.
Solution:WithVPA –VPH - MV – MN, all the neededspecialiststohandle suchcases, all the needed
instruments and the laboratory to diagnose and to prognosticate the event, and all the needed
things including the blood components can be made available and accessible to all the people.
6. Newborn – birth asphyxia – HIE – Neonatal seizures: Pediatrician thinks 100 times to give Inj.
Phenobarbitone, because he does not have the ventilator backup if the child goes for respiratory
failure with the drug. Attendees are not affordable to go to the higher center where the neonatal
ventilators are available. It was the case referred from the government taluk hospital, and the
districtgovernmenthospital maynothave the pediatricventilatororall the ventilatorsare occupied.
Solution: With VPA – VPH - MV – MN, such types of cases can be well managed in the VPH.
7. A old man who is having seizures due to low sodium in blood (Hypo nitremia), which was
diagnosedafterthe hospital admission,wasmade tomove from the hospital to hospital due to non
availability of the physician, in that Sunday with holidays in the previous two days. Different
physician have gone for different work to different place without knowing that everyone is out of
the stationon the same day,because theywere working at the different hospitals in the same city,
thus there is a possibility that all of them may leave the station in one day for their work or all of
them may stay back in one day, it is possible different Physician can go on different days of the
month so the services for the needy people will not suffer.
Solution:WithVPA –VPH - MV – MN, it possible tocoordinate amongthe doctors and they can take
leaves on different days to get their work done.
8. G2, P1, L1, routine scan were done but some congenital heart disease was not picked up in that
scan. LSCS was done for PROM and oligo hydromnia (less fluid). Baby looked well at birth, so
tubectomy was done. Later it was found to be having some murmur on day two and the baby died
after few days and they were arranging some money to go to higher centre for getting the
echocardiography to be done.
Solution:WithVPA –VPH - MV – MN, betterdiagnostictestscanbe made available even at the VPH
level.
9. Most of the patientwithheadinjuryneedstomove manykilometerstorule outthe possibility of
intracranial injury.

10.Most of the ambulances are just ordinary vehicles except for the siren on their head. The
situation may be better with the present 108 ambulance and some private ambulance service.
Solution: With VPA – VPH - MV – MN, all the ambulances can be made in to life line ambulance,
since an ordinary thinking emergency can turn in to mortality at any time.
11.An emergency call was made to the 108 ambulance, telling that a lady is in labor pain. Lady
deliveredafemale child in the ambulance itself, and the blood was spilled all over the floor of the
ambulance, later the mother and the child were shifted to the hospital and it was found that both
the motherand the babyare retroviral positive.Ambulance bythattime hasalreadyshiftedanother
patient to some other hospital.
Solution:WithVPA –VPH - MV – MN, all the patientswillhave regularcheckupsandthusthe people
workinginhealthservicesandthe peoplecominginthe waywill notgetsuchinfectionsaccidentally.
12.OPD: Regularstaff forinjectionroomespecially in the immunization room. Otherwise there is a
possibilityof administeringthe injectiontothe wrongsite /route/soonorchildmay land up in some
of the complications of wrong technique of injection.
Solution:WithVPA –VPH - MV – MN, it is possible togive goodtrainingsin the fields they work and
thus we can minimize the unexpected complications due to wrong techniques.
13.Husband,wife anda childof 2 montholdhad come to one of their relative's house for a festival.
Child was having some cough, which the parents noticed during their journey to their relative's
house. They had the plan to show the child to their family doctor when they go back to their place
next day. From the late evening the child was not sucking well at the breast, but the parents tried
some Palladafeedsandthought'whytogive trouble totheirrelatives,letusgo to our place and will
show to our family doctor'. But the child became worse by night, started having noisy breathing,
refusedtotake Palladafeeds,becamelethargic, cry and activity became poor. Now the parents are
worried and wanted to show to some doctor and they told their wish to their relatives and their
relatives arranged some vehicle and took to one of the nearby hospital where no pediatrician was
available atthattime.Latertheyhave takento anotherhospital where nooxygen was available and
theydidnot have the facilitytomonitorthe oxygensaturation,so the baby was referred to another
hospital. In the third hospital they recorded the vitals and systemic examination was done. The
doctor recorded the heart rate of 180/min, respiratory rate of 80/min, oxygen saturation as it is
recorded by the pulse oxymeter was 60% in room air and 75% with 10 liters per minute of flowing
oxygen, baby had nasal flaring, chest retractions, cyanosis, grunting. Diagnosis of pneumonia in
respiratoryfailure wasmade,oxygenwascontinued,andthe doctorexplainedtothe attendees that
this baby requires ventilator support and that hospital did not had the ventilator to support that
baby(no neonatal andpediatricmode,the machine can support only the children above 12kg's), so
the doctor inthat hospital toldtotake childto the hospital where the ventilator support to support
that childisavailable andalsotoldthatit isideal toshiftthe childto thatcentre withoxygensupport
at least.Thenthe baby'sattendee askedthe doctor 'how much is the ambulance charge' (since free
ambulance serviceslike 108ambulanceswill not shift the patient from hospital to hospital). Doctor
saidit maycost 3000 to 5000 rupees.Thenthe attendeestold'we do not have so much money', but

theirrelativestold'we will arrange the money'andthe doctortold'I will informthe administrator to
arrange the ambulance'. But the administrator told that the ambulance driver is on leave. So the
attendees planned to take the child in some private vehicle without the support of the oxygen.
What are the possibilities after this event?
a. The baby may die in another half an hour or so on the way to another hospital.
b. It mayreach the hospital where ventilator facility is available but the ventilators are not free. In
this case they may have to take the baby another hospital or to another city to put the baby on
ventilator if at all if it is alive by the time it reaches another hospital.
c. The babymay die afterfewdaysof ventilator support because of delay in initiation of treatment
and by this time the baby had injury to the brain, kidney, heart, and so on because of hypoxia. But
the family has already sold some property to save the child to pay few lakhs of hospital bill.
d. The baby is saved but the baby is not normal, now the baby is diagnosed as cerebral palsy with
mental retardationandthe familyhasto suffer throughout their life and the problems increases as
the parents becomes old, when they are not earning and when they are not in a position to look
after themselves.
e. The baby may die because of drowning during an attack of seizures and tubectomy was already
done during cesarean section and the parents will not have any one to look after them at their old
age.
Solution: creation of MV - MN - VPH - NHS will reduce the number of hospitals thus it reduces the
people runningfromhospitaltohospital withmanyadviseswhichtheycannotunderstandeasilyand
it createslotof confusionintheirmind.VPHwill have all the facilitiestohandle all type of cases and
thusno caseswill be referredtoanotherhospital unnecessarilythus the ambulance services will be
reducedtothe maximum.If the patientsare gettingthe treatmentintheirownvillagethentheywill
have more comfortand lesspersonnel expense,thusthe publictransportation will be reduced, fuel
consumption will be reduced, pollution will be reduced to the maximum extent.
Since the treatments are initiated early with better round the clock monitoring there is better
recovery with less morbidity and mortality.
14.Chronicdiseases: One daya60 year oldladywas goingout from the casualty on the wheel chair,
as I was entering at 1AM. I enquired the doctor on duty, he said it is a case of CRF (Chronic Renal
failure),physicianexplainedthe needfordialysis,theyare tellingitisnotpossible to go to any other
place, if you give 100% guarantee, then we will try and spend the money, thus they are taking the
lady home.
Solution:All the terminally ill and chronic patients can be kept in the hospital till their death or till
theybecome betterandtheycan be triedwithall possible modalities of treatment possible, so that
it will helpthe next generate doctors in following the protocols formulated by their senior doctor.

The familywill alsofeelfree in managing the situation and they can visit the sick person whenever
theywant.Thisis possible withthe establishmentof model village - model nation - villagepanchayat
hospital.
15.Babies delivered at house or at PHC, if they are term babies, will do well at house, if they are
pretermthentheyare recognizedwellandwill be takentothe hospital for preterm care, but if they
are borderline term or IUGR then they will be taken to the hospital only if they stop feeding
completely,andafterdoingall the exerciseslike feedingthe childwith bottle, spoon, Pallada. Many
a times they may suffer from border line hypoglycemia and may recover with subclinical injury to
CNS, later they are the ones who are going to be the children with ADHD, poor school performer.
This type of injury can happen even at the hospitals, where round the clock monitoring and the
facilities to identify such type of problems are absent. Late admissions of such babies with many
problemslike sepsis,hyperbilirubinaemia,hypocalcaemia,hypoglycemia,hyperglycemia, and so on,
will make the child to survive with morbidity or may lead to mortality.
Solution: creation of MV - MN - VPH - NHS will reduce the number of hospitals and make all the
deliveries as hospital deliveries. All the neonates will get better neonatal care and later they will
become the healthy citizens with sound mind and sound body.
2.2. Better to open the centers which cares instead of telling go to
higher centre.
The primary and higher primary health care should be available VPH in the MV.
It is better to have only few thousands of VPH which gives all the necessary services to the needy
people insteadof lakhsof centerswhichsay‘we don’thave the facilitytohandle thisproblem, so go
to highercenterat critical timeswhenthe alreadythe patient had spend lot of time in reaching the
hospital and waited for the doctor to listen this sentence. That is what the situation exists in the
rural health care setup that can be solved with VPA - VPH – MV – MN.
2.3. Competition between the disease and the treatment, who
wins?
The beginningof the disease islikethe beginningof the marathon. No one will recognize that there
is one unwanted participant (Disease) in the marathon in the beginning of the run. When we
recognize the thing like the disease is progressing in the marathon and it is reaching its target of
death, it may too late that the athlete - treatment has not started its run in the marathon. The
question is who is going to win the race the athlete of disease or the athlete of treatment.

2.4. VPH, to begin with.
To beginwith,the VPHshould have adequate beds with facilities to handle emergencies including
the facilitiesforintubationandIPPV,bloodtransfusionetc.Itshouldhave adequate doctors,nursing
staff, lab & x-ray technicians with ambulance facility.
TalukHospital shouldactlike secondaryhealthcare center. Districthospitalsshouldbe incorporated
with Medical college hospital.
The studentstudyinginthatcollege should be given seats as per the population distribution of the
nation.The entrance system is explained in the education section under the university education.
The principal/Directorandthe districthealthofficer of the Medical College should post Interns and
postgraduates to various VP Hospitals.
Any accidents/emergencies happening in the VPA Area should be handled immediately by the VP
Hospital. If necessary help can be taken from the nearby VP Hospitals; Cases can be referred to
appropriate higher center according to the needs.
Regular health talks, screening camps for the people for hypertension, diabetes etc., awareness
aboutagricultural injuries,firstaidforbites,stings, injuries etc.for the people shouldbe provided
by the VPH.
It should have a regular contact with Medical collage hospitals; inform the higher center about
agricultural methods and its health impact, usage of fertilizers, insecticides, assessment of toxin
levelsinthe foodgrainsetc.The help for all the activities is taken from the District medical college
hospital and from its university.
The medical university(Allopathic) of the state posts the graduates for the hospital. The Allopathic
medicine universitywill announce the jobopportunitiesinitsnational magazine (see job counseling
section of the university education), and the candidates are selected through interview at the
university campus and posted in the VP Hospital and other hospitals.
2.5. VPH administration.
The Controlling System for the Hospital (Allopathic) is as follows:
↓1 The President of India.
↓2 Prime minister of India.
↓3 Central Health minister
↓4 Central Health Commissioner
↓5 Vice chancellor / Governor of national

Allopathic University.
↓6 Chief Minister at state.
↓7 Health minister at state.
↓8 State Health commissioner.
↓9 Vice chancellor of state allopathic
university.
↓10 Principal and district health officer.
↓11 Taluk Health officer.
↓12 VP Medical officer.
The transfer of the hospital staff and appointing other required staff is done by the allopathic
university.Interuniversitycommunicationwith otheruniversities like university of Nursing service,
University of Nursing faculty, University of Pharmacy is also taken in appointing necessary staff.
Those staffsare appointedthroughtheiruniversitiesonly. Alliedspecialtiescanhave same university
campus for better administration and sharing the teachers.
The materialsandequipmentsupplyisdone bythe Allopathic University, the drugs are supplied by
the University of Pharmacy.
The doctors and the other staff of the hospital are given regular orientation by the District Medical
College Hospitalandbythe University.The doctorshave toattendthe conferencesconductedby his
Allopathic University to upgrade their knowledge in a rapidly changing field of medicine.
2.6. VPH – Creation of Infrastructure.
National Health services: Department of health and medical science: Creation of Infrastructure.
The hospital buildingwill be constructed as per the design planned by the MV – MN creating team.
The working team of the VPA will work in the construction work under the supervision of the
architects of MV – MN team. The materials will be supplied by the central team directly from the
factory,will be transportedandstockwill be maintained under the security of the army. The health
of the people of the MV will be maintained by the VPH under NHS.
2.7. Beginning staff of the VPH.
The staff pattern of the VPH to begin, with will be as follows:
Designation: No. Degree
1. Physician. 4 PGD in Medicine.

2. Surgeon. 4 PGD in surgery.
3. Obstetrician 4 PGD in OBG.
4. Ophthalmologist. 3 PGD in Ophthalmology
5. ENT surgeon. 3 PGD in ENT.
6. Biochemist. 2 PGD in Biochemistry.
7. Pathologist. 2 PGD in Pathology.
8. Microbiologist. 2 PGD in Microbiology.
9. Forensic specialist. 2 PGD in Forensic
medicine.
10. Community
medicine.
2 PGD in Community
medicine.
11. Anesthetist. 4 PGD in Anastasia.
12. Intensivist. 4 PGD in Intensive
medicine.
13. Pediatricians 4 PGD in Pediatrics
14. Radiologist. 3 PGD in Radiology.
15. Orthopedic
surgeon.
2 PGD in Orthopedics
Supporting staff:
16. Lab technician 6 Degree in lab
technology.
17. X ray and radio
imaging technician.
4 Degree in X ray
technology and radio
imaging.
18. OT technician. 6 Degree in OT
technology.
19. Physiotherapist. 6 Degree in
physiotherapy.
20. Nursing staff 300 Degree in nursing
services.

21. Housekeeping
staff
150 SSLC pass / PUC not
completed.
2.8. Catering population of the VPH.
Each VPH will be catering the people of 50000 to one lakh. No health camps, no home delivery by
TBA, no mobile vaccination, no field visits by the health worker are done with the complete
establishment of VPA – VPH – NHS – MV – MN.
The life line ambulance services are done inside the village from the home to the hospital by
designatedelectricalvans.The referralsare done onlyrarely when the treatment is not available at
the VPH for that disease with the staff of the VPH.
All the healtheventsof the individualsare recordedinthe patientsPIN underthe healthfile withthe
details of the doctor treated at each visit both in outpatient and inpatient visits. So if we open the
health file we will get the details of the individual health from his birth to till date / death.
VPH focuses on curative / preventive / promotive health services. No clinic set up is allowed
anywhere. Individual practice can be done at the VPH itself if the person has appropriate degree
withoutanyrentfor the room and the doctor need to update the health details of the patient with
PIN.The doctors PIN will be attachedwith special codes for opening the health files of the patient.
PIN for every new born is issued on the day of discharge from the hospital by the obstetrician and
the pediatrician with their PIN and it will be added in the family tree of the newborn. Automatic
updates of the PIN is done at various places like at the entry of school / primary education /
secondary education / pre university education / university education / post graduation / job /
change of job / marriage / transfer / child birth / children marriage / death. The PIN will be
automatically will be added in the list of Voters at the entry of 18 years of age.
2.9. Introduction to the emergency trolley.
Introduction: Emergency Trolley is the common idea which already exists in the field of medicine.
Here we repeatthe same withlittle modificationmake thisavailable inall the hospital atall the time
to give betteremergencyservice,toall the needypeople,because the life is precious for the family
and sometimesforthe nation.Thisprojectistoincrease the quality of Emergency services. It is one
stem among the several steps of NHS.
It is created to get the emergency drugs and other materials required during emergency handling
without wasting the time.
Delay in each second in initiating the treatment due to any reason related to communication,
transport,roads, traffic, vehicle, vehicle fuel, shifting methods, splinting, doctor, supporting staff,
drugs,perenteral routes,equipments,tubes,connectors,lovingmindfromthe people who delivers
the relatedservicescansignificantlyaffectthe mortalityand morbidity of the person and will make
the dependent family and the nation to suffer for the rest of the period.

In Indiainthe presenteconomicstatus,itmaynot be practical to establishthe emergencyservicesin
public places and to train the public in the events related to emergency handling by giving related
educationlike insome of the developed countries, but at least in the hospitals which provides the
healthservicesshouldbe readywithall the necessary items in hand to decrease the time between
the onset of emergency and initiation of the treatment to decrease the mortality and morbidity.
Where we can keep these emergency trolleys?
These E trolleys can be maintained in the places like 1.ICU, 2. ICCU, 3.SICU, 4.OT, 5.LABOUR ROOM,
6.PICU, 7.NICU, 8.Emergency ward, 9. Casualty,10. Ambulance.
2.10. Advantages of Emergency Trolley.
What are the advantages of emergency trolley?
The advantages are,
Availability of all the necessary drugs, tubes, monitor, oxygen, defibrillator in one portable small
table measuring 24(Breadth), 42(length), 31(Height) inches;
The table can be shifted near the patient and thus it decreases the walking and searching time.
The emptycompartmentwithdesignatedname withoutanymaterial inside will tell the staff to refill
the itemwhichwasutilizedforthe previouspatientandthuswe neednotspendlongtime tolook in
to all the items/ drugs to know what is absent and what is present.
When the administering staff (Doctor/Staff nurse) requests the assisting staff (Staff
nurse/Pharmacist) to load some drug and give, it is easy to search because, we will know which
row/box/compartment has that item and thus it decreases the searching time.
The moneythat we invest to maintain the trolley (towards used items) will decrease the mortality
and the morbidity as it is used in a needy time without writing the prescription to the hospital or
outside pharmacy through the patient attendee. [There may be a delay due to money (some body
may be bringingthe moneyfrom home which may be a far place) or non availability (the pharmacy
might have closed/ stock might have got over)].
At presentall the itemsmaybe presentinthe hospital/drugstore inascatteredway and may not be
available at the needy time due to many reasons like pharmacy time got over, needs permission
fromthe higherofficerforgivingthe stock,the personin charge may be on leave or the key may be
with him and he might have gone for food and thus it leads to the delay. The aim is to get all the
needy items in a composite way at all the time in one table in the places where we handle the
emergencies. If needed, the used items can be replaced by the patient attendee itself at a
convenient time.
Some time we maynot be maintainingall the itemsatall the places,routinely,like Inj.Streptokinase
inNICU- E – Trolley,where we canputa label like nostockismaintained,butall the necessary drugs
should be replaced immediately.

Autoclavedsurgical setcanbe kepton the table top,whichcontainsneedles,threads,arteryforceps,
mosquitoarteryforceps,thumbforceps(toothedandsmooth),needle holder,holetowel,glovesect
for doingemergencybedsidesimple procedures like ICD insertion, tracheotomy, vene section and
others.A separate surgical trolleyshouldalsobe maintained apart from the E trolley as it is running
today for the purpose of wound dressing and for minor suturing.
2.11. Dimensions of emergency trolley.
Dimensions of Emergency Trolley:
S
N
Dimension, Measurements,
1 Height( Excludingthe table
top andthe electrical panel
on the table)
31 inches
2 Length 42 inches
3 Breadth 24 inches
Height division,
S
N
Division, Measurements,
1 Row1 2 inches
2 Row2 2 inches
3 Row3 3 inches
4 Row4 3 inches
5 Row5 3 inches
6 Row6 3 inches
7 Row7 6 inches
8 Row8 6 inches
9 Wheel space height 3 inches
Total height excluding the
table top and the electrical
panel
31inches
Length division,

S
N
Division, Measurements,
1 Right wall space 0.5 inches
2 Right row length 20 inches
3 Central separator space 1 inches
4 Left row space 20 inches
5 Left wall space 0.5 inches
Total length 42 inches
Electrical panel measurement,
S
N
Dimension, Measurements,
1 Height 6 inches
2 Length 42 inches
3 Breadth at the base 6 inches
4 Breadth at the top 2 inches

1. Side walls – wooden/plywood/plasticlaminated –Screwed:- The top, rightand left side walls and
the back walls are made of wooden or play wood sheets (Non conductors) which are screwed and
fitted to the body.
2. Electrical panel:- Are createdat the topof the trolleytofitthe electrical sockets.Andthispanel is
dividedintotwocompartments,one forwiringpurpose andanotherforplacingthe rolledwire. The
size of the panel is – height 6 inches, width at the base is 6 inches and at the top is 2 inches.
3. Electrical sockets: - are fitted at the electrical panel with the provision for four connections.
4. Wire holder: - the folded wires are kept in the wire socket in the electrical panel.
5. Side Para path wallsforthe trolleytop:one inchheightside wallsare createdtopreventfall of the
vials when it is kept at the top.
6. Handles can be fixed on either the sides of the table to push and pull the table.
7. Slid able and foldable drip stand and light source can be incorporated.
8. Oxygencylinder:Provisioncanbe made to fix the conventional size oxygen cylinder on either the
sides of the E – Trolley.
9. Pad holder can be created on either the sides of the trolley to keep the necessary files.
10. Openvial holder: - Usedvial holderisfittedatthe top to keep the used/opened vials on the top
withdifferentdiameters.The lengthof the openvial holderisfittedalongthe breadthof the trolley.
The floor plate of the holder has got depressions for holding the ampoule base at place
correspondingtothe topplacingholes.The firsthole plate isfittedatone inch above the floor plate
and extends throughout the length of the floor plate and has all the seven rows of holes with 0.5
inch gradient with the biggest hole diameter being the 3.5 inches and the smallest being the 0.5
inches in diameter as shown in the picture. The second hole plate is fixed one inch above the first

plate and which extends only for the 10 inches of length and has got only three rows of holes with
the diameter of 3.5inches, 3.0inches, 2.5inches in diameter, two each in number.
Dimensions of the open vial holder:
S
N
Dimension Measuremen
t
1 Length 16 inches
2 Breadth 8 inches
3 Height- Back 10 inches 2 inches
4 Height – Front 6 inches 1 inches
Holes plate places,
S
N
Diameter of
the hole
Number
of rows
Numberof the
holesplaces in
the row.
1 3.5inches one Two
2 3.0 inches one Two
3 2.5 inches one Two
4 2.0 inches one Three
5 1.5 inches one Four
6 1.0 inches one Six

7 0.5 inches one Eight
Total
number
of holes
27 (Twenty
seven)
2.12. Emergency trolley rack description.
Rack descriptions:
Rack 1, 2 & 3.
Measurement description of rack 1, 2 & 3.
S
N
t
1 Length 20 inches
2 Breadth 24 inches
3 Height including the
separation plate
2 inches
Box description of rack 1, 2 & 3.
S
N
t
1 Number of boxes along the
Length
5

2 Number of boxes along the
Breadth
8
3 Total number of boxes 40
4 Length of each box 4 inches
5 Breadth of each box 3 inches
Rack4.
Measurement description of rack 4.
S
N
Dimension Measurement
1 Length 20 inches
2 Breadth 24 inches
separation plate
2 inches
Box description of rack 4.
S
N
1 Numberof boxesalong the
Length
5
Breadth
4

Rack 5 & 6.
Measurement description of rack 5 & 6.
S
N
1 Length 20 inches
2 Breadth 24 inches
separation plate
3 inches
Box description of rack 5 & 6.
S
N
Length
5
Breadth
4
Rack 7,8,9,10,11 & 12.

Measurement description of rack 7,8,9,10,11& 12.
S
N
1 Length 20 inches
2 Breadth 24 inches
separation plate
3 inches
Box description of rack 7,8,9,10,11& 12.
S
N
Length
7
Breadth
1
4 Length of each box 2.75 inches
Rack 13 & 14.

S
N
1 Length 20 inches
2 Breadth 24 inches
separation plate
6 inches
Box description of rack13 & 14.
S
N
Length
3
Breadth
2
4 Length of each box 6.6 inches
5 Breadth of front row of
boxes
16 inches
Breadth of back row of
boxes
8 inches
Rack 15 & 16.

S
N
1 Length 20 inches
2 Breadth 24 inches
separation plate
6 inches
Box description of rack 15 & 16.
S
N
Length
5
Breadth
2

2.13. Common Features
Descriptions.
The height of the rack mentioned in the picture includes the separation plate/ bar also.
One centimeter obdurate plate is fixed on either the sides of the rack to prevent the rack falling
when it is excessively pulled.
Sliding bar is fixed at the floor of the rack to prevent the damage to the floor and formation of the
holes and others by repeated use (Pull and push).
Number and name bar is inserted at the front part of the box row at a little depth to write the
numberandname.It isfixedata depthof 0.5 centimeters to prevent the erosion of letters written
over the bar while pulling and pushing.
A 0.25 centimeter back fold is made or a plate is bordered so that the area for writing the number
and names are placed 0.25 centimeters inside to prevent the erosion by body touch.
2.14. Emergency drugs to be kept in Emergency trolley, System wise
classification (A prototype).
Com
part
num
ber.
Name of the drug. Strength / Dose
CVS

1-1 1. Amiodarone 50mg / ml
1-2 2. Adenosine. 3mg / ml
1-3 3. Digoxin 250mcg / ml
(0.5mg / 2ml)
1-4 4. Dopamine 200mg / 5ml
1-5 5. Dobutamine 250mg / 5ml
1-6 6. Dilteazem 25mg / 5ml
1-7 7. Verapamil 5mg / 2ml
1-8 8. Nitroglycerine 25mg / 5ml
1-9 9. Streptokinase 15LU / vial
1-10 10. Xylocard2% 21.3mg /
ml,50ml vial
RS
4-1 1. Aminophylline 250mg / 10ml
1-11 2. Deriphylline 110mg / ml, 2ml
vial
1-12 3. Salbutamol respirator 5mg / ml, 15ml
vial
1-13 4. Ipratropium
respirator
20mg / ml, 15ml
vial
4-2 5. Budesonide
respirator
0.5mg / 2ml
PA
1-14 1. Buscopan. 20mg / ml
1-15 2. Dicyclomine
hydrochloride.
10mg / ml
1-16 3. Metoclopramide. 10mg / 2ml
1-17 4. Ondensetron. 4mg / 2ml
1-18 5. Omeprazole. 40mg / vial

1-19 6. Pantaprazole 40mg / vial
1-20 7. Ranitidine 50mg / 2ml
RENAL
1-21 1. Frusemide. 20mg / 2ml
CNS
1-22 1.Diazepam 10mg / 2ml
1-23 2.Pentazosin lactate 30mg / ml
1-24 3. Paracetamol 300mg / 2ml
1-25 4. Atropine 0.6mg / ml
1-26 5.Neostigmine 0.5mg / ml
1-27 6.Haloperidol 5mg / ml
1-28 7.Midazolam 5mg / 5ml
1-29 8.Ketamine 50mg / ml,
2mlamp
1-30 9.Nalaxone 0.4mg / ml
1-31 10.Pethidine 50mg / ml
1-32 11.Morphine 4mg / ml
1-33 12.Phenytoin sodium 50mg / ml, 2ml
amp
1-34 13.Phenobarbitone 200mg / ml
1-35 14.Prochlorperazine 12.5mg / ml
1-36 15.Promethazine. 25mg / ml, 2ml
amp
1-37 16.Thiopentone. 1gram / vial
15-1 17.Mannitol 20grams /
100ml
MUSCULOSKELITAL
1-38 1.Diclofenac sodium 25mg / ml, 3ml

amp
1-39 2.Tramadol
hydrochloride
50mg / ml, 2ml
amp
1-40 3.Piroxicam 20mg / ml, 2ml
amp
2-1 4.Ketoralac sodium 30mg / ml
2-2 5.Valethamate(Epidosin
)
8mg / ml
2-3 6.Drotaverine 40mg / 2ml
2-4 7.Syntocinon 5units / ml
2-5 8.Methargin 0.5mg / ml
2-6 9.Isoxsuprin hcl 5mg / ml, 2ml
amp
IONS
4-3 1.Sodium
bicarbonate0.75%
0.9meq / ml,
10ml amp
4-4 2.Calciumgluconate10% 0.1gram / ml,
10ml amp
4-5 3.Potassium chloride 2meq / ml,
10ml amp
2-7 4.Magnesium sulfate 25% / ml
2-7 5.Magnesium sulfate 50% / ml
ENDOCRINES
2-8 1.Hydrocortisone 100mg / vial
2-9 2.Dexamethasone 4mg / ml, 2ml
amp
2-10 3.Betamethasone 4mg / ml
2-11 4.Methyl prednisolone 1gram / vial
4-6 5.50% Dextrose 25ml,
15-2 6.50% Dextrose 100ml

4-7 7.25% Dextrose 25ml,
15-3 8.25% Dextrose 100ml
2-12 9.Insulin – Plain 40units / ml,
10ml vial
2-13 10.Adrenaline1:1000 0.001gram / ml
HEMATOLOGY
2-14 1.Heparin 5000units / ml
2-15 2.Aminocaproic acid 250mg / ml,
20ml vial
2-16 3.Vitamine K 10mg / ml
2-17 4.Ethamsulate 125mg / ml, 2ml
amp
2-18 5.Butropase 1cu / ml
2-19 6.Protamine sulphate 10mg / ml
ANTIBIOTICS
2-20 1.CP 10L / vial
2-21 2.Ampiclox 1g / vial
2-22 3.Amoxicilline+Clavaluni
c
1.2g / vial
2-23 4.Ampicilline 500mg / vial
2-24 5.Gentamycine 80mg / 2ml
2-25 6.Amikacin 100mg / vial
2-26 7.Amikacin 500mg / ml
2-27 8.Cefotaxim 250mg / vial
2-28 9.Cefotaxim 500mg / vial
2-29 10.Cefotaxim 1gram / vial
2-30 11.Ceftriaxone 250mg / vial
2-31 12.Ceftriaxone 500mg / vial

2-32 13.Ceftriaxone 1gram / vial
2-33 14.Ceftazidime 250mg / vial
2-34 15.Ceftazidime 500mg / vial
2-35 16.Ceftazidime 1gram / vial
2-36 17.Cefaperazone+Sulba
ct
1gram / vial
2-37 18.Cefipime 250mg / vial
2-38 19.Cefipime 500mg / vial
2-39 20.Cefipime 1gram / vial
15-4 21.Ciprofloxacin 200mg / 100ml
15-5 22.Metronidazole 500mg / 100ml
3-1 23.Quinine 300mg / ml
3-2 24.Arteether(Emol) 150mg / 2ml
3-3 25.Artemether 80mg / ml
3-4 26.Artesunate 60mg / amp
LOCAL ANAESTETIC
2-40 1.Lignocaine2%(Local)
EMERGENCY TABLETS
3-5 1.Depin 5mg
3-6 2.Aspirin 75mg
3-7 3.Aspirin 300mg
3-8 4.Sorbitrate 5mg
3-9 5.Digoxin 0.25mg
3-10 6.Digoxin solution 50mcg / ml
3-11 7.Propranolol 10mg, 40mg
3-12 8.Eltroxin 0.1mg
3-13 9.Amlodepine 2.5mg

3-14 10.Amlodepine 5mg
3-15 11.Amlodepine 10mg
3-16 12.Enalaprilmaleate 2.5mg
3-17 13.Enalaprilmaleate 5mg
3-18 14.Enalaprilmaleate 10mg
3-19 15.Methyldopa 250mg
3-20 16.Clonidine 0.1mg
3-21 17.Verapamil 40mg
3-22 18.Diltiazem 30mg
3-23 19.Dilteazem 60mg
3-24 20.Clopedogrel 75mg
3-25 21.Diclofenac
suppository
30mg
3-26 22.Paracetamol
suppository
80mg
3-27 23.Diazepam
suppository
5mg, 10mg
3-28 24.Domperidone
suppository
30mg
5-1 25.Xylocaine gel
INTRAVENOUS FLUIDS
15-6 1.Hamaccele 500ml
15-7 2.Ralidase 500ml
15-8 3.5%Dextrose 500ml
15-9 4.10%Dextrose 500ml
15-
10
5.RL 500ml
16-1 6.IsolyteP 500ml

16-2 7.IsolyteM 500ml
16-3 8.DNS 500ml
16-4 9.0.45%DNS 500ml
16-5 10.NS 500ml
16-6 11.NS 100ml
16-7 12.3%Saline 100ml
16-8 13.0.45%NS 500ml
AMBUBAG & TUBINGS
13-2 1.Ambubag-Preterm
size
13-3 2.Ambubag-Term size
14-1 3.Ambubag-Pediatric-
Small 250ml
14-2 4.Ambubag- Pediatric-
500ml
14-3 5.Ambubag-Adult size
AMBUBAG MASK &
LARYNGOSCOPE.
13-2 1.Ambubag mask-
Preterm size
13-2 Laryngoscope handle +
Straight blade no0,1.
13-3 2.Ambubag mask-Term
size
Pediatric-Small
Curved blade no1,2.
Pediatric-medium

Pediatric-large
Curved blade no2,3.
14-3 6.Ambubag mask-Adult
size
OXYGEN MASK
13-2 1.Oxygenmask-Preterm
size
13-3 2. Oxygen mask-Term
size
14-1 3. Oxygen mask-
Pediatric-Small
Pediatric-medium
Pediatric-large
14-3 6. Oxygen mask-Adult
size
ENDOTRACHEAL TUBES
13-4 1.Endo tracheal tube
No2
No2.5
13-4 3.Stallate
No3
No3.5
No4

No4.5
13-5 8.Stallate
No5
No5.5
No6
No6.5
13-6 13.Stallate
No7
No7.5
No8
No8.5
No9
No9.5
14-6 20.Stallate
AIRWAYS
5-2 1.AirwayNo.00
5-2 2.AirwayNo.0
5-3 3.AirwayNo1
5-3 4.AirwayNo2
5-4 5.AirwayNo3

5-5 6.AirwayNo4
5-6 7.AirwayNo5
TRACHEOSTOMY TUBE
5-7 1.Tracheostomy tube
NO.5
NO.5.5
NO.6
NO.6.5
NO.7
NO.7.5
NO.8
NO.8.5
CENTRAL LINE
CATHETER
7-1 1.Central line catheter-
Femoral- one each
7-2 2.Central line catheter –
Jugular – one each
Basilic/cephalic– one
each
7-4 DRIP SET – MACRO
7-5 DRIP SET – MICRO
7-6 DRIP SET – PEDIATRIC
WITH MEASURING

CHAMBER
RYLES TUBES
8-1 1.Ryles tube No5
SUCTION TUBES
9-2 1.Suction tube No.6

7-7 ORAL SUCTION TRAP
ICD TUBES
10-1 1.ICD tube No8
10-1 2.ICD tube No10
FOLEY’S CATHETER
11-1 1.Foley’s catheter No.6
11-2 3.Foley’scatheterNo.10
RED RUBBER CATHER
11-5 1.Red Rubber Catheter
No.10

No.12
No.14
No.16
No.18
No.20
SCALP VEIN SET
5-15 1.Scalp vein set No.18
IV CANNULA – VASOFIX
6-4 1.Vasofix No.18
6-5 2.Vasofix No.20
6-6 3.Vasofix No.22
6-7 4.Vasofix No.24
6-8 5.Vasofix No.26
LP NEEDLES
6-9 1.LP Needles No.20

6-10 .LP Needles No.21
SYRINGES
6-14 1.1ml (Insulin)Syringe
6-15 2.2ml Syringe
6-16 3.5 ml Syringe
6-17 4.10ml Syringe
6-18 5.20ml Syringe
6-19 6.50ml Syringe
NEEDLES
4-7 1.Needle(1.5”)No.16
4-8 2.Needle(1.5”)No.18
4-9 3.Needle(1.5”)No.20
4-10 4.Needle(1.5”)No.22
4-11 5.Needle(1.5”)No.24
4-12 6.Needle(1.5”)No.26
4-13 ENDOTRACHEAL TUBE
CONNECTORS
4-14 ICD TUBE CONNECTORS
4-15 TRIWAY CONNECTOR
4-16 GLUCOMETER WITH
STRIPS
4-18 CHEST LEAD PLASTERS
4-19 ELECTRICAL JELLY
4-20 SCALPEL BLADES

6-20 PULSE OXYMETER
SENSOR PROBES-
PEDIATRIC AND ADULT
13-1 CARDIAC MONITOR
WIRES
13-1 PULSE OXYMETER
WIRES
13-1 SPANNER, HAMMER,
AMPULE CUTTER,CELLS
FOR LARYNGOSCOPE.
TOP & SIDES
TOP PULSE OXYMETER
TOP CARDIAC MONITOR
WITH DEFIBRILLATOR
TOP OPEN VIAL HOLDER
TOP PLUG POINTS
SIDE OXYGEN CYLINDER
SIDE PAD HOLDER
SIDE LIGHT SOURCE
SIDE DRIP STAND
2.15. Emergency drugs to be kept in E – trolley, Rack /
Compartment wise classification.
RACK1:
Compartment measurements.
Length Breadth Height No. compartments
10 cms 7.5 cms 5 cms 40
Drugs-Injections.
Com
part
num
Name of the drug. Sto
ck.
Length
in cms/

ber. Strength/Dose Diamete
r in cms
1-1 1. Amiodarone. 50mg /
ml
2 7.5/1.5
1-2 2. Adenosine. 3mg / ml 2
1-3 3. Digoxin. 250mcg / ml
(0.5mg / 2ml)
4 6/1
1-4 4. Dopamine. 200mg /
5ml
4 7.5/1.5
1-5 5. Dobutamine . 250mg /
5ml
4 7/1.5
1-6 6. Dilteazem. 25mg / 5ml 2
1-7 7. Verapamil. 5mg / 2ml 2
1-8 8. Nitroglycerine. 25mg /
5ml
4 7.5/1.5
1-9 9. Streptokinase. 15LU /
vial
2 5.5/2
1-10 10. Xylocard2%. 21.3mg /
ml, 50ml vial
2
1-11 2. Deriphylline. 110mg /
ml, 2ml vial
5 5.5/1
1-12 3.Salbutamol respirator.
5mg / ml, 15ml vial
2 7.5/3.5
1-13 4.Ipratropium respirator .
20mg / ml, 15ml vial
2 7.5/3.5
1-14 1. Buscopan. 20mg / ml 5 4.5/1
1-15 2.Dicyclomine
hydrochloride. 10mg / ml
5 5.5/1
1-16 3. Metoclo pramide.
10mg / 2ml
5 6/1

1-17 4. Ondensetron. 4mg /
2ml
5 6/1
1-18 5. Omeprazole. 40mg /
vial
4 6.5/2
1-19 6. Pantaprazole. 40mg /
vial
4 5.5/2
1-20 7. Ranitidine. 50mg / 2ml 10 6/1
1-21 1. Frusemide. 20mg / 2ml 20 5.5/1
1-22 1.Diazepam. 10mg / 2ml 10 6/1
1-23 2.Pentazosin lactate.
30mg / ml
5 5/1
1-24 3. Paracetamol. 300mg /
2ml
10 6/1
1-25 4. Atropine. 0.6mg / ml 20 5/1
1-26 5.Neostigmine. 0.5mg /
ml
10 5/1
1-27 6.Haloperidol. 5mg / ml 5 5/1
1-28 7.Midazolam. 5mg / 5ml 2 5/2.5
1-29 8.Ketamine. 50mg / ml,
2ml amp
2 5.5/2.5
1-30 9.Nalaxone. 0.4mg / ml 2
1-31 10.Pethidine. 50mg / ml 2 5.5/1
1-32 11.Morphine. 4mg / ml 2
1-33 12.Phenytoin sodium.
50mg / ml, 2ml amp
10 6/1
1-34 13.Phenobarbitone.
200mg / ml
10 5/1
1-35 14.Prochlorperazine.
12.5mg / ml
5 5/1
1-36 15.Promethazine. 25mg / 10 6/1

ml, 2ml amp
1-37 16.Thiopentone. 1gram /
vial
2 6/3
1-38 1.Diclofenac sodium.
25mg / ml, 3ml amp
10 7/1
1-39 2.Tramadol
hydrochloride.50mg/ ml,
2ml amp
5 6/1
1-40 3.Piroxicam. 20mg / ml,
2ml amp
5 6/1
RACK2:
Length Breadth Height No.
compartmentss
10 cms 7.5 cms 5 cms 40
Drugs-Injections.
Com
part
num
ber.
Name of the
drug.
Strength
/Dose
Sto
ck.
Length in
cms/
Diameter
in cms
2-1 4.Ketoralac sodium.
30mg / ml
5
2-2 5.Valethamate
(Epidosin). 8mg / ml
10 5/1
2-3 6.Drotaverine.
40mg / 2ml
10
2-4 7.Syntocinon.
5units / ml
10 5/1
2-5 8.Methargin. 10 5/1

0.5mg / ml
2-6 9.Isoxsuprin hcl.
5mg / ml, 2ml amp
10 6/1
2-7 4.Magnesium sulfate.
25% & 50% / ml
10 6.5/1
2-8 1.Hydrocortisone.
100 mg / vial
10 5/2.5
2-9 2.Dexamethasone.
4 mg / ml, 2ml amp
10 3.5/1.5
2-10 3.Betamethasone.
4 mg / ml
10 5/1
2-11 4.Methyl prednisolone.
1 gram / vial
4 7.5/3.5
2-12 9.Insulin – Plain.
40 units / ml, 10ml vial
Frid
ge2
2-13 10.Adrenaline1:1000.
0.001 gram / ml
10 5/1
2-14 1.Heparin.
5000 units / ml
2 7/3
2-15 2.Aminocaproic acid.
250 mg / ml, 20ml vial
2
2-16 3.Vitamine K.
10 mg / ml
5 5/1
2-17 4.Ethamsulate.
125 mg / ml, 2mlamp
5 6/1
2-18 5.Butropase.
1cu / ml
5 5/1

2-19 6.Protamine sulphate.
10 mg / ml
5
2-20 1.CP.10 L / vial 4 4/3.5
2-21 2.Ampiclox. 1 g / vial 4 4/3.5
2-22 3.Amoxicilline+Clavaluni
c. 1.2 g / vial
2 6.5/3
2-23 4.Ampicilline. 500 mg /
vial
4 4/3.5
2-24 5.Gentamycine.
80 mg / 2ml
4 4/1.5
2-25 6.Amikacin.
100 mg / vial
4 4.5/2.5
2-26 7.Amikacin.
500 mg / ml
4 5/2.5
2-27 8.Cefotaxim.
250 mg / vial
4 5/3
2-28 9.Cefotaxim.
500 mg / vial
4 5/3
2-29 10.Cefotaxim.
1 gram / vial
4 6/3
2-30 11.Ceftriaxone.
250 mg / vial
4 6/3
500 mg / vial
4 7.5/3
1 gram / vial
4 8/3
2-33 14.Ceftazidime. 4

250 mg / vial
2-34 15.Ceftazidime.
500 mg / vial
4
2-35 16.Ceftazidime.
1 gram / vial
4
2-36 17.Cefaperazone+Sulba
ct . 1 gram / vial
4
2-37 18.Cefipime.
250 mg / vial
4
2-38 19.Cefipime.
500 mg / vial
4
2-39 20.Cefipime.
1 gram / vial
4
2-40 1.Lignocaine2%(Local). 2
RACK3:
10 cms 7.5 cms 5 cms 40
Drugs-Injections.
Com
part
num
ber.
Name of the drug.
Strength/Dose
Stock
3-1 23.Quinine. 300mg / ml 4
3-2 24.Arteether (Emol). 150mg / 2ml 6
3-3 25.Artemether. 80mg / ml 6
3-4 26.Artesunate. 60mg / amp 6

3-5 1.Depin. 5mg 10
3-6 2.Aspirin. 75mg 20
3-7 3.Aspirin. 300mg 20
3-8 4.Sorbitrate. 5mg 20
3-9 5.Digoxin. 0.25mg 20
3-10 6.Digoxin solution. 50mcg / ml 2
3-11 7.Propranolol. 10mg, 40mg 10
3-12 8.Eltroxin. 0.1mg 100
3-13 9.Amlodepine. 2.5mg 20
3-14 10.Amlodepine. 5mg 20
3-15 11.Amlodepine. 10mg 20
3-16 12.Enalaprilmaleate. 2.5mg 20
3-17 13.Enalaprilmaleate. 5mg 20
3-18 14.Enalaprilmaleate. 10mg 20
3-19 15.Methyldopa. 250mg 20
3-20 16.Clonidine. 0.1mg 20
3-21 17.Verapamil. 40mg 20
3-22 18.Diltiazem. 30mg 20
3-23 19.Dilteazem. 60mg 20
3-24 20.Clopedogrel. 75mg 20
3-25 21.Diclofenac suppository. 30mg 20
3-26 22.Paracetamol suppository. 80mg 20
3-27 23.Diazepam suppository. 5mg,
10mg
20
3-28 24.Domperidone suppository.
30mg
20
3-29

3-30
3-31
3-32
3-33
3-34
3-35
3-36
3-37
3-38
3-39
3-40
RACK4:
10 cms 15 cms 5 cms 20
Drugs-Injections.
Com
part
num
ber.
Name of the drug.
Strength/Dose
Sto
ck
Length in
cms/
Diameter
in cms
4-1 1. Aminophylline
250mg / 10ml
8 10/2
4-2 5. Budesonide
respirator
0.5mg / 2ml
8 9/1.5
4-3 1.Sodium
bicarbonate0.75%
0.9meq / ml, 10ml
8 13/2

amp
4-4 2.Calcium
gluconate10%
0.1gram / ml, 10ml
amp
8 9.5/1.5
4-5 3.Potassium chloride
2meq / ml, 10ml amp
8 9.5/1.5
4-6 5.50% Dextrose
25ml,
8 13/2
4-7 7.25% Dextrose
25ml,
8 13/2
4-8 1.Needle(1.5”)No.16 50
4-9 2.Needle(1.5”)No.18 50
4-10 3.Needle(1.5”)No.20 50
4-11 4.Needle(1.5”)No.22 50
4-12 5.Needle(1.5”)No.24 50
4-13 6.Needle(1.5”)No.26 50
4-14 ENDOTRACHEAL TUBE
CONNECTORS
2sets,from2
to9.5
4-15 ICD TUBE
CONNECTORS
2sets,from8
to32
4-16 TRIWAY CONNECTOR 4
4-17 GLUCOMETER WITH
STRIPS
50 strips (same
code)
4-18 CHEST LEAD PLASTERS 30
4-19 ELECTRICAL JELLY 2tubes
4-20 SCALPEL BLADES 2each no.
RACK5:

compartmentss
10 cms 15 cms 7.5 cms 20
Drugs-Injections.
Compart
number.
Name of the drug. Stock
.
5-1 24.Xylocaine gel 2tub
es
5-2 1.AirwayNo.00
2.AirwayNo.0
2
2
5-3 3.AirwayNo1
4.AirwayNo2
2
2
5-4 5.AirwayNo3 2
5-5 6.AirwayNo4 2
5-6 7.AirwayNo5 2
5-7 1.Tracheostomy tube NO.5 2
5-8 2.Tracheostomy tube NO.5.5 2
5-15 1.Scalp vein set No.18 4

RACK6:
compartments
10 cms 15 cms 7.5 cms 20
Drugs-Injections.
Compart
number.
Name of the drug. Stock.
6-4 1.Vasofix No.18 6
6-9 1.LP Needles No.20 4
6-14 1.1ml (Insulin)Syringe 10
6-15 2.2ml Syringe 20
6-16 3.5 ml Syringe 20

6-20 PULSE OXYMETER
SENSOR PROBES-
PEDIATRIC AND ADULT
2sets
RACK7:
compartments
7.5 cms 60 cms 7.5 cms 7
Drugs-Injections.
Compart
number.
7-1 1.Central line catheter-
Femoral- one each
1each
no
Jugular – one each
1each
no
Basilic/cephalic– one each
1each
no
7-4 DRIP SET – MACRO 20
7-5 DRIP SET – MICRO 20
7-6 DRIP SET – PEDIATRIC
WITH MEASURING
CHAMBER
10
7-7 ORAL SUCTION TRAP 10
RACK8:

compartments
7.5 cms 60 cms 7.5 cms 7
Drugs-Injections.
Compart
number.
2.Ryles tube No6
10
10
4.Ryles tube No8
10
10
6.Ryles tube No10
10
10
8.Ryles tube No12
20
20
10.Ryles tube No14
20
20
12.Ryles tube No16
20
20
14.Ryles tube No18
20
20
RACK9:
compartments
7.5 cms 60 cms 7.5 cms 7
Drugs-Injections.
Compart Name of the drug. Stock.

number.
16.Ryles tube No20
10
10
2.Suction tube No.8
20
20
4.Suction tube No.12
20
20
6.Suction tube No.16
10
10
9-5 7.Suction tube No.18 10
9-6
9-7
RACK10:
compartments
7.5 cms 60 cms 7.5 cms 7
Drugs-Injections.
Compart
number.
10-1 1.ICD tube No8
2.ICD tube No10
2
2
4.ICD tube No14
2
2
6.ICD tube No18
2
2

8.ICD tube No22
2
2
10.ICD tube No26
2
2
12.ICD tube No30
2
2
10-7 13.ICD tube No32 2
RACK11:
compartmen
ts
7.5 cms 60 cms 7.5 cms 7
Drugs-Injections.
Compart
number.
Name of the drug. Sto
ck.
2.Foley’s catheter No.8
4
4
4
4
4
4
4
4
11-5 1.Red Rubber Catheter No.10
2.Red Rubber Catheter No.12
4
4
11-6 3.Red Rubber Catheter No.14 4

4.Red Rubber Catheter No.16 4
11-7 5.Red Rubber Catheter No.18
6.Red Rubber Catheter No.20
4
4
RACK12:
compartments
7.5 cms 60 cms 7.5 cms 7
Drugs-Injections.
Compart
number.
12-1
12-2
12-3
12-4
12-5
12-6
12-7
RACK13:
compartments
Drugs-Injections.

Compart
number.
Name of the drug. Stock
.
13-1 CARDIAC MONITOR WIRES,
PULSE OXYMETER WIRES,
SPANNER, HAMMER,
AMPULE CUTTER. CELLS FOR
LARYNGOSCOPE.
2sets
each
13-2 1.Ambubag-Preterm size
1.Ambubag mask-Preterm
size
1.Oxygenmask-Preterm size
Laryngoscope handle +
straight blade no.0,1
1set
1set
4sets
1set
13-3 2.Ambubag-Term size
2.Ambubag mask-Term size
2. Oxygen mask-Term size
1set
1set
4sets
13-4 1.Endo tracheal tube No2
2.Endo tracheal tube No2.5
3.Stallate
10
10
2
6.Endo tracheal tube No4
8.Stallate
10
10
10
10
2
11.Endo tracheal tube No6
13.Stallate
10
10
10
10
2

RACK14:
compartments
Drugs-Injections.
Compart
number.
14-1 3.Ambubag-Pediatric-Small
250ml
3.Ambubagmask-Pediatric-
Small
3. Oxygen mask-Pediatric-
Small
Curved blade no.1,2.
1set
1set
4sets
1set
14-2 4.Ambubag- Pediatric-
500ml
4.Ambubag mask-
Pediatric-medium
5.Ambubag mask-
Pediatric-large
4. Oxygen mask- Pediatric-
medium
5. Oxygen mask- Pediatric-
large
Curved blade no.2,3.
1set
1set
1set
4sets
4sets
1set

14-3 5.Ambubag-Adult size
6.Ambubagmask-Adultsize
6.Oxygen mask-Adult size
1set
1set
4sets
15.Endo tracheal tube
No7.5
10
10
No8.5
10
10
No9.5
20.Stallate
10
10
2
RACK15:
compartments
10 cms 30 cms 15 cms 10
Drugs-Injections.
Comp
art
numb
er.
Name of the drug.
Strength/Dose
St
o
ck
.
Length
in cms/
Diamete
r in cms
15-1 17.Mannitol.
20grams / 100ml
4 13.5/5
15-2 6.50% Dextrose.100ml 4
15-3 8.25% Dextrose.100ml 4
15-4 21.Ciprofloxacin.200mg 4 11.5/5

/ 100ml
15-5 22.Metronidazole.
500mg / 100ml
4 13.5/3.5
15-6 1.Hamaccele.500ml 1 21/8
15-7 2.Ralidase.500ml 1
15-8 3.5%Dextrose.500ml 2 20.5/7
15-9 4.10%Dextrose.500ml 2 20.5/7
15-10 5.RL.500ml 2 20.5/7
RACK16:
compartments
10 cms 30 cms 15 cms 10
Drugs-Injections.
Comp
art
numb
er.
Name of the drug.
Strength/Dose
Sto
ck.
Length in
cms/
Diameter
in cms
16-1 6.IsolyteP.500ml 2 20.5/7
16-2 7.IsolyteM.500ml 2 20.5/7
16-3 8.DNS.500ml 2 20.5/7
16-4 9.0.45%DNS.500ml 2 19/7
16-5 10.NS.500ml 2 20.5/7
16-6 11.NS.100ml 4 10.5/4.5
16-7 12.3%Saline.100ml 2 10.5/4.5
16-8 13.0.45%NS.500ml 2 20.5/7
16-9

16-10
TOP & SIDE
TOP PULSE OXYMETER 1
TOP CARDIAC MONITOR WITH
DEFIBRILLATOR
1
TOP OPEN VIAL HOLDER 1
TOP PLUG POINTS 4
SIDE OXYGEN CYLINDER 2
SIDE PAD HOLDER 2
SIDE LIGHT SOURCE 2
SIDE DRIP STAND 2
2.16. ‘Medicines’ in medical practice.
The hand writingof the persondependsonhow muchhe write inthe copy writingbookinhisschool
days, the pen he uses, the paper he uses, and the support underneath the paper and so on. It also
dependsonthe grip,holdandthe pressure we use with the pen on the paper. Most of the peoples
hand writing may be good in their school days and it may not be good after few years of intensive
practice in their profession.
Some of the professionalsmayhave betterhandwritingasthe day advances in their profession like
those who do clerical job. Those professions who use less pen for their work, but they use their
finger skills more for other works, may develop poor hand writing with ‘pen on the paper’. Those
professionalswhofrequentchange the ‘gripandhold’onpenandthe pressure onthe paperwill not
have goodhand writing.People like type writer,those whoworkwiththe computermayhave better
typing skills with the type writer and the artist may have better drawing skills, but may not have
good hand writing. The doctors with busy practice may be examining the patients, will be doing
some procedure,andthusleavesandholdsthe penfrequently,writesfast on the paper, because of
this they lose ‘grip and hold’ on the pen frequently and thus the pressure on the paper, thus their
hand writing may go bad with passage of time. This may not hold good for those who are not too
busyin theirprofessionandthose whoinvolve inwringforlong hours for some reasons in between
their regular profession. Many times we hear from the common people telling like ‘the doctors
language will be knownonlybythe people of the medical stores’. That means the common people
will notbe able to understandthe spellingsof the medicines the doctor write (this will not apply to
all the doctors).The people of the medical shop know the routine drugs written by the doctor or in
case of doubtstheymay call the doctor and clarifythe doubt. Mistakes can happen while giving the
medicine with this type of confusing hand writing.

One medical shop may be running by one pharmacist. The drug controller is there to control the
standardsof the medical shop, and ‘he ensuring the presence of the pharmacist all the time in the
medical shop’ is of more theoretical. Pharmacist is also a human being, he may have to have food,
go for natural calls, may require some rest some days, and to go for other place for shopping and
otherworks.Because of thisreasonmostof the medical shopswill appoint some assistant, who are
educated enough to read the names of the drugs. And they will be working more than the real
pharmacist.Appointinganotherpharmacistinthe place of the regularpharmacistinthe times when
the regularpharmacistgoesfor buying medicines may not be feasible by the owner of the medical
shopor theymay not be gettingthattype of replacingpharmacist.Soatthese times the assistant of
the pharmacist may be managing the medical shop and with the bad hand writing of the doctor he
may give the ‘wrong but similar looking drug’ which may lead to the problem.
The medical studentswill read the pharmacology in detail. All the words in the text book may look
new for them, even though they might have used some of them at home in their early life. For a
medical studentthe name ‘paracetamol’maylooklike anew word,butif he seesthe name ‘dolo’ he
may tell ‘I have used it when I was suffering from the fever in my younger days’. One drug and
thousandsof brandnamesmakeseveryone confused,andnosingle doctoronthisearth will be able
to rememberall the brandsanditscontents.But,all the medical professionals will know the entire
drug moleculesthatare presentintheirpharmacologybook;otherwise theywill not be able to pass
the examination.If a patient bring some prescription written by some other doctor to other doctor
tellingthat‘twomonthsback we have used this medicines and the patient was better in between,
againhe ishavingfever’.Theymaybringonlythe prescriptionbutnotthe medicine.The doctor may
not have sufficienttime tosee the contentof the brandby lookingat the ‘drug books’, enquire how
much of drug ispresentinthat bottle,thinkwhetheritissufficient for that illness - for that patient,
and advise ‘thatissufficient,youcanuse the same,if it is not expired’.Thismay not happen and the
doctor will write new prescription for that illness and will start seeing another patient. Thus every
house will have miniature medical stores with half empty drug bottle and few tables with them.
After some days they will be thrown in to the dust bins with the general waste, thus it will add
burdenonwaste management,possibilityof poisoning,apartfromthe economicburdenbythistype
of wastage over the family and on the nation.
The differentbrandsforsingle molecule bydifferentcompaniesmighthave originatedin the market
inorder to give ‘competitiontosimilarmoleculeswithdifferentbrand’and ‘to sustain in the market
withbetterqualitywithcompetitive price’.It is the science and it is the business through which we
needtoleadthe life.But,itshouldnotbe at the cost of the life of the patient. Mistakes can happen
at any stage, like giving different molecule with different trade name which looks similar, or
administration of different drugs with confusing brands, or the marketing people keeping similar
looking words to give competition for good running brand.
The doctors may be prescribing some brand because he feels that brand is good – gives better
resultsthatmeanthat companywhichmanufacturesthat drug is good, they might have done many
studies to see that the brand is working well.
So, let the doctors write which ever company they prefer, let the manufactures prepare the
medicinesinthe goodstandardpossible bythem, letthe people who marketthe drugdotheir job in

the processof providingthe medicinestoall the nook and corner of the nation. All the people have
to lead the life, so let all of them take their share of income.
The onlyrequestbyme in the presentsystemof pharmacy isto decrease the confusionwhilewriting
the prescription,while dispensingthe medicine,while administering the medicine among the lacks
of brands,whichwe have withusin the present market. It is better to have a system where no one
is going to have confusion with the brand they use including the patient and thus prevent the
possible accidents by wrong administration.
2.17. Let us decrease our confusion on drugs with present brand
names, still retaining the brand.
We can see lotof brands with very minimal change in the letters but will have different molecules
withthem,same brandname but differentmolecules,same brand name and the same molecule by
different pharmaceutical company and sometimes different cost and so on.
The examples are as follows: The following tables (e.g. 1to 20) are based on the references taken
from the ‘DRUG TODAY – 79, VOLUME 1 & 2, January to March 2013.’
Brands
which
look
similar
with
very
minimal
change
in
letter.
The different
molecules
that the
brand
contains.
Preparati
on
Pharmace
utical
company
name
e.g.1
Atorno Atorvastatin Tablet Gnova
biotech
Atorlo Losartan Tablet Olcard
e.g.2
ATS Artesunate Injection Vee
remedies
ATV Atorvastatin Tablet Zee lab
e.g.3
Axon Methyl
cobalamine,
ALA,
Tablet Bajaj
pharmace

thiamine
mono
nitrate,
pyridoxine,
folic acid
uticals
Axone Ceftriaxone
sodium
Injection Newgen
e.g.4
B - com B complex syrup Prism
pharma.
B - con Flucanazole Tablet Bio max
lab.
e.g. 5
Lenova Levofloxacin Tablet Genova
life care
Lenova Levofloxacin Tablet Gnova
biotech
Lenovo Levocetirizin
e
Tablet Innova
e.g. 6
Axytee Hydroxyl
progesterone
Injection Axygen
Axytef Clarithromyci
n
Tablet Axygen
Axytex Acetazolamid
e
Tablet Bionext
e.g.7
Azicare Azithromycin
e
Tablet Bindlysh
biotec
Azi-care
-200
Micronized
progesterone
Tablet Azillian H
- care
Same
trade
Different
molecule
Preparati
on
Different
pharmace
utical

name company
e.g. 8
Beta Atenolol Tablet Stad med
Beta Betamethaso
ne
Tablet Mefro
pharma
Beta Beclomethas
one
diproprionat
e
cream Micro
labs
e.g. 9
Levot Levofloxacin Tablet Genasia
Levo-t Levoceterizin
e
Tablet Genx
health
care
e. g. 10
Zanin Azithromycin
e
Tablet Glencare
life
sciences
Zanin Hydroxy
progesterone
caproate
Injection Zenlabs
India
e.g. 11
LCD Levodopa +
Carbidopa
Tablet Intas
LCD Levoceterizin
e
Tablet Mac
organics
e.g. 12
Azin Asenapine Tablet Intas
Azin Azithromycin
e
Tablet Oyster
labs
Azin azithromycin
e
Tablet sanshis

Same
trade
name
Same
molecule
Same
preparati
on?
Different
cost.
Different
pharmace
utical
company
e.g.13
Axicef Ceftrioxone Injection Numera
life
sciences.
Axicef Ceftrioxine Injection Axis
pharma.
e.g 14
Azicin Azithromycin Tablet Shalman
pharma
Azicin Azithromycin Tablet Nutron
e.g.15
Azinik Azithromycin Tablet Nick
pharma
Azinik Azithromycin Tablet Orange
biotech
Azinik Azithromycin Tablet Unik
health
care
e.g. 16
Azipro Azithromycin Tablet Cipla
Azipro Azithromycin Tablet Mepro
pharma
e.g.17
Azisil Azithromycin Tablet Basil
Azisil Azithromycin Tablet Silicon
pharma
e.g. 18

Balamin Methyl
cobalamine
Injection
(Rs 30)
Kapeetus
medicorp
Balamin Methyl
cobalamine
Injection
(Rs 250)
Avni H
care
e.g.1: Brands with minimal change in letters with different molecules:
Brand Molecules. Preparati
on
Company
e.g.1
Atorno Atorvastatin Tablet Gnova
biotech
Atorlo Losartan Tablet Olcard
Here the trade names Tab. Atorno and Tab. Atorlo may look similar if the doctor is not writing
prominatly looking ‘L’, and thus the pharmacist may give the molecule Atorvastatin instead of
Losartan potassium and the patient may land up in complications related to hypertension.
e.g.2
ATS Artesunate Injection Vee
remedies
ATV Atorvastatin Tablet Zee lab
The possibility of making errors may be less if the doctor write all the letters in capital, thus the ‘s’
and ‘v’will be differentiatedwell betweenInjection.ATS and Tablet. ATV. An intelligent pharmacist
can make the differentiation by looking at the preparation since Injection is written before ATS
(artesunate).Thiswill alsobe differentiatedinthe hospital before givingthe injection.The attendees
of the patient may have to come to the pharmacy may be once more for the same reason if the
pharmacist makes the mistake or the nursing staff writes only the trade name but not the
preparation in the prescription, thus the pharmacist may give Tablet. Atorvastatin.
e.g.3: Similar looking brand with one extra letter with different molecules:
Axon Methyl
cobalamine,
ALA,
thiamine
mono
Tablet Bajaj
pharmace
uticals

nitrate,
pyridoxine,
folic acid
Axone Ceftriaxone
sodium
Injection Newgen
There isone letter‘e’isextrabetweenTab.AxonandInj.Axone.If the pharmacistisintelligentthen,
he will get the clue from the preparation even if the letter ‘e’ is not prominent.
e.g.4
B - com B complex syrup Prism
pharma.
B - con Flucanazole Tablet Bio max
lab.
The possibilityof the pharmacistgivingsyrupBcomplex (B – com) insteadof Tablet.Flucanazole (B –
con) telling that they do have the same brand tablet of B complex or they may replace with other
brand of B complex tablet.Thus the patient may land up in extensive fungal infection for which he
was not given the correct tablet in the pharmacy. If the patient goes to the same doctor and if the
doctor remembershimashisoldpatientorif the patienttakes the old prescription with him telling
that he is not better, then this mistake may be corrected at the second visit. If the patient goes to
another doctor thinking that the doctor is not good because he is not better or if he loses the
prescription, and if another doctor writes the same brand then this cycle of mistake may repeat.
e.g.5:Brands withsimilarname andmolecule andalsosimilarlookingbrandswithminimal change in
letters with different molecule.
e.g. 5
Lenova Levofloxacin Tablet Genova
life care
Lenova Levofloxacin Tablet Gnova
biotech
Lenovo Levocetirizin
e
Tablet Innova
In this example we can see the similar two brand names with the same molecule inside and by
differentcompanies.The doctormaybe aware of one companyand its quality,butwhenitcomes to
the pharmacy the pharmacistmay give the drugwhichisavailable inhispharmacy.If the pharmacist

giveswrongdruglike ‘tabletLenovo’inthe place of ‘tabletLenova’thenthe infection in the patient
may progressandbecomes fatal. The patient will also have the faith in the doctor and will wait for
the drug to act, thinkingthatitwill take some time to have the cure without knowing the thing like
he is not consuming the same medicine as it is meant by the doctor.
e.g.6: Brands with minimal change in letters with different molecule:
e.g. 6
Axytee Hydroxyl
progesterone
Injection Axygen
Axytef Clarithromyci
n
Tablet Axygen
Axytex Acetazolamid
e
Tablet Bionext
The possibility of replacing, the medicine by the other brand names is present with such types of
brand names.
e.g.7: Brands which look similar with very minimal change in it with different molecule.
e.g.7
Azicare Azithromycin
e
Tablet Bindlysh
biotec
Azi-care
-200
Micronized
progesterone
Tablet Azillian H
- care
Possibilityof dispensing ‘Tablet.Azithromycine’inthe place of ‘Tablet.Micronizedprogestrerone’ as
the secondone may notbe available withall the pharmacistand the cost of it may not be known by
the pharmacist. If the pharmacist reads the ‘doctors name and qualification’ and the ‘patient’s age
and sex’, then he may get the clue that it is some different drug. Most of the time the pharmacist
may notcommitsuch type of mistakes,buthisassistantinthe absence of the pharmacist may make
such mistakes.
e.g.8: Brands with similar names but entirely different drugs.
e.g. 8
Beta Atenolol Tablet Stad med

Beta Betamethaso
ne
Tablet Mefro
pharma
Beta Beclomethas
one
diproprionat
e
cream Micro
labs
Differentmoleculeslike ‘Atenolol’ and ‘Betamethasone’ and both are in tablet form will lead to lot
of problemforthe patient.If the pharmacistisintelligent,thenhe mayidentifyitdifference withthe
dosage written along with the drug.
e.g.9: brands with similarity with different molecules:
e.g. 9
Levot Levofloxacin Tablet Genasia
Levo-t Levoceterizin
e
Tablet Genx
health
care
If the doctor writesitinsmall letter,thenthe small ‘-’will be merged when the ‘o and t’ combines.
e.g.10: brands with same name with different molecule.
e. g. 10
Zanin Azithromycin
e
Tablet Glencare
life
sciences
Zanin Hydroxy
progesterone
caproate
Injection Zenlabs
India
These brandsmay looksimilarbutthe molecules are different and the pharmacist has to identify it
by its preparation.
e.g.11 & 12: Same brands with different molecules.
e.g. 11
LCD Levodopa + Tablet Intas

Carbidopa
LCD Levoceterizin
e
Tablet Mac
organics
e.g. 12
Azin Asenapine Tablet Intas
Azin Azithromycin
e
Tablet Oyster
labs
Azin azithromycin
e
Tablet sanshis
When many brands with same name and preparation are present in one pharmacy, then the
possibility of giving different molecules is the possibility like replacing ‘talbet levoceterizine’ for
‘tablet levodopa+carbidopa’, and replacing ‘tablet Azitromycine’ for ‘tablet Asenapine’.
e.g.13,14, 15, 16, & 17: Brands withsimilarname andsimilarmoleculesbutbydifferent companies.
e.g.13
Axicef Ceftrioxone Injection Numera
life
sciences.
Axicef Ceftrioxine Injection Axis
pharma.
e.g 14
Azicin Azithromycin Tablet Shalman
pharma
Azicin Azithromycin Tablet Nutron
e.g.15
Azinik Azithromycin Tablet Nick
pharma
Azinik Azithromycin Tablet Orange
biotech
Azinik Azithromycin Tablet Unik
health
care

e.g. 16
Azipro Azithromycin Tablet Cipla
Azipro Azithromycin Tablet Mepro
pharma
e.g.17
Azisil Azithromycin Tablet Basil
Azisil Azithromycin Tablet Silicon
pharma
In such cases the patient may not get the same brand he wants as it is intended by his doctor. The
doctor may mean one company and the pharmacist may give different company’s drug with same
brand andmolecules.The doctormay not be sure whether that company is producing quality drug,
whetherhasdone lotof studiestoprove the molecule of itscompanyaspotent drug on the patient.
One companymay be spendingcroresof rupeestodo lotof studiestomake its productssuperior,to
bring objective evidences, where as the other company be spending lot of money on advisement,
gives good margin to the pharmacist and offers to the doctors, makes lot of difference in giving
bettercure for the patient.Itisverymuch essential tounderstand the efficacy of the drug, because
the same molecule withdifferenceinpreparation and the adjuvant they use as preservative makes
lot of difference in pharmaco kinetics and pharmaco dynamics of the drugs in the body of the
humans and thus on its targeted action.
Everybrand will gounderseriesof peopleand the drug controllers before it steps in to the market,
but still the same molecules with same brand is coming may be difference in the price is little
surprising.The possibilitiesare the drugcontrollermighthave forgottenthatsimilarbrandisexisting
in the market, or that brand might be away from the market for some time in that new company
might have introduced the same brand and same molecule in to the market, or the same brand
name may be given in the period of different drug controller and so on.
e.g.18: Same brand name and same molecule but difference in price:
e.g. 18
Balamin Methyl
cobalamine
Injection
(Rs 30)
Kapeetus
medicorp
Balamin Methyl
cobalamine
Injection
(Rs 250)
Avni H
care
The companiesmaygive many reasons for this type of difference in the cost of the medicines. The
company with the high cost will tell ‘we ensure quality in manufacturing at every step; the
bioavailability is more, good action on the targeted tissue with good tissue penetration’ with the
supportive clinical data for the same. On the other hand the company with low price may tell ‘we
also ensure quality in manufacturing at every step, the bioavailability is good even with our
molecule, we also have studies to prove the good action on the targeted tissue with good tissue

penetration,we are givingthisforlowercostbecause ourbrand ismovingwell inthe marketinlarge
quantity, because of which we are able to give it for low cost’.
We cannotrule out the possibilityof makingmoneybyany one of the company, they may be giving
good margins for the pharmacists, the quality may not be good even with high cost, if the mind of
the company concentrates only on money making.
e.g.19: Brands with different name but the molecule is the same.
Brands
with
different
name (It
isdifficult
to
remembe
r all the
brands)
All the
brands
containing
the same
molecule.
Name of
the
pharmace
utical
company.
Suggeste
d brand
name for
the same
company
(it is easy
to
remembe
r all the
brands)
Acetamin
ophen
Paracetam
ol
Agrawal Paraceta
mol -
agrawal
Aceto Paracetam
ol
Ormed H
care
Paraceta
mol -
ormed
Achmol Paracetam
ol
meriodin Paraceta
mol -
meriodin
ACN500 Paracetam
ol
MLS
health
care
Paraceta
mol -mls
Activate Paracetam
ol
Divine
pharma
Paraceta
mol -
divine
Alpamol Paracetam
ol
Allpa Paraceta
mol -
allpa
Anamol Paracetam
ol
Elder Paraceta
mol -
elder

Arimol Paracetam
ol
Aries
drugs
Paraceta
mol-aries
Askapyrin Paracetam
ol
Asklepios
remedies
Paraceta
mol -
asklepios
Bacine Paracetam
ol
Baxil
pharma
Paraceta
mol-baxil
Bambiti Paracetam
ol
Deys Paraceta
mol -
dyes
Bepamol Paracetam
ol
Biological
E
Paraceta
mol -
biological
Calpol Paracetam
ol
Glaxo
smithklin
e
Paraceta
mol - gsk
Cemol Paracetam
ol
Inga
laboratori
al
Paraceta
mol - igna
Cincro Paracetam
ol
Welkind
pharma
Paraceta
mol-
welkind
Cofamol Paracetam
ol
CFL
pharma
Paraceta
mol - cfl
Crocin Paracetam
ol
Glaxo
smithklin
e
Paraceta
mol -
glaxo
Decetol Paracetam
ol
Deltoid
pharma
Paraceta
mol-
deltoid
Dispar Paracetam
ol
Rekvina Paraceta
mol -
rekvina
doliprane Paracetam
ol
Nicholas Paraceta
mol -
nicholas

Empar Paracetam
ol
Materkin
formulati
on
Paraceta
mol -
materkin
Ezee para Paracetam
ol
Nicholas
actis div.
Paraceta
mol –
Nicholas
actis
Fastpara Paracetam
ol
Santiago Paraceta
mol –
santiago
Febrex Paracetam
ol
Indoco Paraceta
mol-
indoco
Fee Paracetam
ol
Safetech Paraceta
mol-
safetech
Fepanil Paracetam
ol
Citadel Paraceta
mol-
citadel
Fe - stop Paracetam
ol
Hamax Paraceta
mol-
hamax
Fevago Paracetam
ol
Cipla Paraceta
mol-cipla
Zepara Paracetam
ol
Zee lab Paraceta
mol-zee
e.g.20: Brands with different name but the molecule is the same.
Brands
with
different
name (Itis
difficultto
remember
all the
brands)
All the
brands
containing
the same
molecule.
Name of
the
pharmace
utical
company.
Suggested
brand
name for
the same
company
(it is easy
to
remember
all the

brands)
Ab - cef Cefixime Bestoche
m
Cefixime-
bestochem
Ab – fax Cefixime Ameriacan
biocare
Cefixime-
american
Abirec
200
Cefixime Gulsun
overseas
Cefixime-
gulsun
Abixim Cefixime Abia
pharma
Cefixime-
abia
Aelxim Cefixime Allenge
india
Cefixime-
allenge
Aknicef Cefixime Aknil
biotech
Cefixime-
aknil
Arcefim Cefixime Aryan
biological
Cefixime-
aryan
Askacef Cefixime Asklepios
remedies
Cefixime-
asklepios
Astecef Cefixime Aster
mediphar
ma
Cefixime -
aster
Audixim Cefixime Diya H
care
Cefixime-
diya
Bezofix Cefixime Zeal lab Cefixime-
zeal
Brexime Cefixime Brit health
care
Cefixime-
brit
CE Cefixime Care
pharma
Cefixime-
care
Delocef Cefixime Deltoid
pharma
Cefixime-
deltoid
Deltacef Cefixime Mecado H
care
Cefixime-
mecade
Ecefibard Cefixime B.M. Cefixime-

Medico bbm
Fexburg Cefixime Ginsburg
drugs
Cefixime-
ginsburg
Frix Cefixime Unichem Cefixime-
unichem
Rezix Cefixime Rezicure
pharma
Cefixime-
rezicure
Taxim - o Cefixime alkem Cefixime-
alkem
Zifi Cefixime FDC Cefixime-
fdc
With thiswe will addthe companyname withthe molecular name to make the brand name. it may
look long at the beginning, but it will be like putting signature on the paper as the days passes, by
reflex we can write the drug fast and all the people can understand the medicine and also the
company. There will be less confusion with all the brand names.
The presentprescriptionlike ‘Tab. Bambiti, 500mg, one tid’ will be replaced by ‘Tab. Paracetamol -
dyes, 500mg, one tid’.
Similartypesof brandscan be made evenfordrugs havingmore thanone molecule withit.Butneed
to consider some uniform protocols for making such nomenclature. The national university of
allopathicmedicine initspharmacy division can do all such things after discussing with the experts
and the drug inspectors working in this field.
2.18. Let us have clarity in the name of the drug from the time of
study to practice.
It isnot goodto practice short hand while prescribing the drug, because this short hand will not be
able to understandbyall,evenwithinthe groupof people whoare writing this short hand (doctors)
and whoare readingthisshorthand(pharmacist),we should be able to prevent even a single error
coming with such type of practice.
It is better to make all the marketing companies to sell the product under the banner of the
manufacturingcompany,sothatthe doctorand the people will easilyrecognizewhether it is a good
companyor not. If the manufacturingcompany is not possible to manage the marketing, then let it
give to the marketing company which the manufacturing company prefers and let them market it,
but the name shouldcome to the manufacturingcompany,because itisthe one which prepares the
molecule andthe molecule ismostimportantforthe doctorand the patient,butnotthe people who
putsthe label andsells.Puttinglabel andsellingisalsoimportantformakingthe drugavailable to all
the nooks and corners, but it is necessary to see that only quality brands with quality molecules

should reach the people and the doctor and the people should be able to recognize the same by
looking at the company by which that product is prepares as it is with the name of the molecules.
It ispossible toremember all the names of the molecules that we use in our practice by the doctor
and by the pharmacist, which is very much essential. But it is not possible to remember all the
brandsof the single moleculeswhichare notessential,if we are not going to see the prescription of
the otherdoctors inour practice,but itis not possible because as medical practitioners we need to
take the ‘drug history’of the patient. Let us make it possible to remember all the brands by simple
changesinthe nomenclature of the brands,sothere islessconfusion by all the people. The doctors
and the pharmacist will be able to recognize all the products easily, without looking in to the drug
books.The medical andthe pharmacy studentswill rememberthe nameswithease.There are fewer
errorswiththe namesof the brandsas we see intoday’spractice withlakhsof brandsexistingin the
marketfor one molecule.Iam nottellinganydoctorto change the brand whichtheybelieve itasthe
superior among all the brands available in the market. The medicine which is present inside the
bottle or the packing will not change; the person who is supplying the drug will not change, the
stockiest will not change, the people who are marketing the brand will not change and the
companies will not change and the only change I request is to make the names of brands by
combiningthe namesof the molecule andthe name of the pharmaceutical companyasshowninthe
example 19 and 20 of this section, so that there is less confusion at all the stages, like the children
and the commonpeople will be seeingthe same molecule intheirroutinelife as and when they use
the medicines, thus they are familiar with the commonly used drugs, the students can easily
rememberthe moleculesastheyhave alreadyfamiliar with most of the common drugs used by the
people in the society, doctors will have less confusion in selecting the brand if they know that the
companythey are writing is a good company, the people in the pharmacy can arrange all the drugs
withsimilarnames(same molecules) at one rack in their pharmacy and they will never go wrong as
the molecule name ispresentwiththe brandthe doctorwants,the commonpeople canidentify the
mistake,if theydonotsee the molecule onthe drugstheybuy,as it is present in the prescription of
the doctor and the corrections can be made at the pharmacy itself, because it is very clear and
transparent.
The one side of the coveror the packingwhichis enclosingeachtabletshould contain the minimum
information like brand name (molecule with company), dosage, the expiry date, and the batch
number. So that even with single tablet we will be able read the necessary things like what is that
drug and whenisthe expiry. The other side of the packing may contain the same information as of
today. With this we can avoid many tablets going waste, if it remains one or two in number.

I was listeningtoone of the lecture,inthat,the speakerwastellingthatwe donot know the potency
and side effectsof the drugsproducedbydifferentcompanies,asone companyproductmaycontain
100% drugs, another company drug may contain 60% of the drugs, he was also telling ‘we do not
know, from where they import the molecules and what are base used to stabilize the primary
molecule’ and so on. He was also telling about the development of the drug resistance due to
inadequate dosage and duration, thus countries like India leading the top, in producing microbes,
resistanttomost of the drugs. He was stressingthatthe doctorsare the sole responsible people for
such cause.
Withthe presenthealthsystemitisnotpossible toidentify,which doctor is using which brand, why
he is using,what‘dose’he isusing,how long he is using, why he is changing the drug, why patients
change the doctor - thusall the treatmentregimen changes with the change in the doctor. Patients
simplygoto the hospital withsome complaintwhichtheyare sufferingfrom, the doctorwill listento
the complaintandno recordwill be maintainedforthe same.The doctormaywrite the medicine for
three daysand will askthe patienttocome after two or three days to see the response, the patient
will lose the prescription once he gets the medicines in hand and most of the time, he will not get
the bill or he will not preserve the bill or the prescription. The patient may go to another doctor, if
he is notimprovedwithin, one or two days without having any records in his hand. Another doctor
will start,anotherantibioticandthispatientmaydevelopresistance for the drug started by the first
doctor, thus this patient may spread the microbe to many people in his community, which is
resistant to many drugs and this is an endless problem in countries like India.
2.19. Solutions to decrease the mistakes with different brands by
different companies.
Let us think about the practically of issues related to the drugs – manufacturing company – drug
prescribingdoctor – the patient who takes the medicine for his illness. There are many companies
whichproducesthe same drugwithdifferenttrade names.Theywill dosome clinical study, will use
some method and will prove that their drug acts better both in vitro and in vivo. They may use the

betterdrugand theymay maintainbetterqualitytill theygetthe approval from the drug controller,
but what is the guarantee, that they maintain the same quality as they market publicly. It is the
patient and the treating doctor who has to give feedback for using various drugs, after using the
same as per the recommended dose and duration. The clinician has to comment on why he used
that drug, why he chosen that brand, what is the clinical status of the patient before starting the
medicine,whatwasthe diagnosismade,whatwasthe course of the illness and the prognosis, what
are the side effectsnoticedandwithwhatdose anddurationthe side effectsappeared,whether the
drug or the brand stopped or changed and the reasons for the same. The doctor need not do, all
these exercisesseparately,if the doctorentershisdaytoday notesdigitallythenthe drug controller
will come to know how many doctors are using that particular brand in that day and in that hour,
whythe doctors preferthatbrand,what are the side effectsseenwiththatparticularbrand(fromall
the placessimultaneously sitting at one place) where it was used, the reasons for discontinuation,
whether the different brand with the same of molecules acted well as seen by the clinical
improvement and if that is the case which brand is not acted well and which brand acted well and
whatare the reasonsfor the same.All these compilation inferences have to be worked by the drug
controller.We can generate the dedicatedsoftware forthe same purpose andthissoft will grasp all
the detailsandwill give the statisticslike the molecule name,thenthe brandname,the name of the
doctor,the hospital whichusesthatbrandandthe clinical statusof the patient like improved, same
status, died. Thus the drug controller can do vertical, horizontal and random analysis of the drugs
which comes under same status or died by collecting the drugs in the open market at different
places and can subject for analysis.
The patients can also enter their comments like, what was the medicine taken, for how long, and
howtheyfeel aftertakingthatmedicine.We cancreate the software with biometrics like, when he
comes to the hospital he swipe his finger at the counters dedicated for these comments - the PIN
basedpersonsfile opens - healthfile hastobe opened - visitfilecanbe openedandthenthe patient
can enterhisfeelingslike, whetherhe isfeeling better or no improvement in the box dedicated for
the same.Both the doctor at the time of follow upandthe drugcontroller can assess the comments
and the effectiveness of that brand. Those drugs which are not working well can be removed from
the market.Thus the qualityassessmentcanbe done foreverydrug,usedat all the nookand corner,
on dayto day basisand thusthe qualityassessmentwill notendsoonaftergivingthe licence forthat
brand bythe drugcontroller.Thisispossible with the establishment of the MV - MN - VPH with the
establishment of inter VPA communication soft ware’s through net by the NHS. We can easily
compare all the brands, their efficacy, side effects, where all it is used and so on, by sitting at one
place, thus we can continue with better ones.
2.20. Reducing the number of hospital (PHC to VPH) will add quality
to the health services and the doctors can spend time for
periodical updates.
The doctors and the other professionals who work in small towns and in rural areas may not get
much time toupdate themselvesintheirfield,because theyare busyintheirroutine work,so,these
people may stick to their old concept. The newer technology and its advantage will not reach the
common people. For example a 150 bedded hospital in a rural area or in a taluk head quarter with

one physician,one gynecologist,one surgeon,one pediatricianandtwoduty doctors will work most
of the time in the hospital. They may have blood bank with a blood bank officer who is trained in
bloodbankingundersome pathologistand will be running the blood bank. The physician, surgeon,
pediatrician, obstetrician will use the blood when there is an indication. Sometimes they will use
A1+ve donor blood for a A2+ve recipient patient. In the next transfusion the same patient will
developtransfusionrelatedreaction because he has developed the antibodies for A1 and will land
up in complications, like this many problems like O negative (Bombay blood group) blood group
person developing reaction to O negative blood with H antigen, developing reactions with other
blood group antigens like kell, duffy and so on are all common. Many of the doctors will not be
aware of identifyingsuchtype of problems with the conventional old methods used in their lab for
manyyears,evenif theycome to knowaboutthe new technology,all the doctorsinthe hospital will
thinkhavingsuch type of technology is going to give financial burden to the patients because they
are not doing transfusions regularly. In the same way doctors present in the 100 small hospitals,
nursinghomesandclinicspresentinthatdistrictdistributed in 4 to 5 taluk head quarters and in 8 to
10 small townswill think and they will use their own ideas and will try to help the patients in their
own way to minimize the cost of treatment and in long term they will be creating harm to the
patients without their knowledge. Many units of blood may be transfused every day in different
hospitalsatdifferenttimes,butnoone becomesresponsible for complications that can occur at the
nexttransfusion.Inthe same waybecause of this type of haphazard services we will not be able to
adopt the newer techniques and thus it will never reach the common people.
Solution: creation of MV - MN with VPH under national health services will reduce the number of
hospitals and will make all the hospitals to have such type of facility when once the efficacy and
effectivenessisproved,since the turnoverbecomeslarge one place, managing the demand and the
stock according to the expiry becomes easy and if the turnover is better than the technology
becomescosteffectiveandall the segmentsof the peoplewill be able to afford the services and we
can have less complications related to the treatment.
2.21. Periodical inspection is the need to maintain the quality in
service.
It isnecessarytocreate the teamwhichinspectsall the emergencydrugs, equipments, instruments
and the staff periodically,sothatall the hospitalswillupdate themselves and delay in initiating the
treatmentdue tono availabilityof drugs,equipments,staff will be corrected and many lives will be
saved due to timely initiation of treatment.
Solution: with the establishment of MV - MN - VPH, the number of villages are going to reduce,
number of hospitals are going to reduce, people come closer to the better services and all will be
aware of the available best treatment modalities and the inspection group for monitoring the
emergency drugs, equipments and the dedicated staff for this service can be maintained well and
will be monitored well by the team. The monitoring team with dedicated physician, pediatrician,
obstetrician,pharmacist, equipment engineer can do the rounds in all the hospital once in 15 days
and the physician will inspect the register of emergency patients treated, their case sheets, the
medicinesusedin the treatment of emergency cases, their correlation with the stock register, will

call for the mortality meeting and will assess the deficiency and will correct mistakes. Pediatrician
and the obstetricianswill dothe similarexerciseintheirdepartment.The pharmacistwill inspectthe
drugs,stock,expiryandwill write hisremarksforthe same.The equipment engineer will inspect all
the equipmentsusedinthe emergencytreatmentandif some are notworkingthenhe will write his
remarks then it is the duty of the concerned department of get it corrected as early as possible by
the hospital maintenanceteam.If the same remarksrepeatatthe nextinspectionat15 daythen the
actionswill be takentothe concernedstaff,technician or on the hospital by the inspection team. If
thingsstill notcorrectedthenthe inspection team will raise the issue to VP member for health, VP
secretary for health, village panchayat president, DHO, MLA, DC, MP for needed action.
It iscommon toreplace the drugs in the pharmacy like the pharmacist may give cough suppressant
in the place of expectorant/bronchodilator and the staff nurse will also not know about this
difference and will open the seal and may administer the dose. When the doctor comes for the
rounds and examines the chest he will hear rhonchus, fall in the oxygen saturations, increased
oxygenrequirement by the patient, and increase in the respiratory rate. The doctor is worried and
he will checkall the medicine andhe will see the cough suppressant ABCD-D instead of ABCD-X, by
this time the patient might have already had an injury to his brain due to low oxygen.
2.22. Quantity decides the quality in some areas;
One of the lab in charge of one authorised blood bank was telling that, they get, only 4 to
5 bags of blood in a week for that they have to do Elisa test for HIV, HCV, HBsAg, and
sometimes, they have to do these tests once in 2 to 3 days, and its works out costly for
the hospital. The conventional Elisa try contains 96 wells, and at a time they can do
Elisa test for 92 patients with 2 positive controls and 2 negative controls. If the lab gets
more samples then it work out cheaper per investigation, the man power will be utilized
well, and the cost for the patient is going to decrease.
2.23. Strict waste disposal protocols are the need to prevent many
life threatening infections.
Is the ear buds selling at the roadside people are prepared with hospital waste cotton
used to clean blood and pus? May be possible, some of the microbiologists in pollution
control board may say yes for this statement.
Microbiologist tells, father dies in the family with HBsAg infection and the son also dies
with the same disease after one year. Later it was found that both died because of prick
by the HBsAg infected needle in the slipper used for walking, which was thrown out of a
clinic with the common waste and the dog displaced the needle to the walking path
which got pieced in to the slipper.

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