Summer Induction Training-II

Hospital Training

CHC, Itaunja, Lucknow

A Report Submitted
In Partial Fulfillment of the Requirements
for the Degree of

Bachelor of pharmacy
by

VIVEK YADAV
2110014335069

Under the Supervision of

Dr. Namrata Singh Dr. Pushpendra Kumar Tripathi

(Assistant Professor, LUIPS, UoL) (Director, Institute of Pharmaceutical

Sciences, UoL)

to the

INSTITUTE OF PHARMACEUTICAL SCIENCES

UNIVERSITY OF LUCKNOW,
LUCKNOW

10 January, 2025

1
 DECLARATION

I hereby declare that the work presented in this report entitled “Hospital Training Summer
Induction Training- II", was carried out by me. I have not submitted the matter embodied in
this report for the award of any other degree or diploma of any other University or Institute.
I have given due credit to the original authors/sources for all the words, ideas, diagrams,
graphics, computer programs, experiments, results, that are not my original contribution. I have
used quotation marks to identify verbatim sentences and given credit to the original
authors/sources.
I affirm that no portion of my work is plagiarized or manipulated. In the event of a complaint
of plagiarism and manipulation, I shall be fully responsible and answerable.

Name : Vivek Yadav

Roll. No. : 210014335069
Course & Year: B.Pharm. IV Year VII Semester

(Candidate Signature)

2
Certificate of training

3
Certificate of Training

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 ACKNOWLEDGEMENT

It has been a privilege to be associated with Community Health Centre, Itaunja. I am deeply
grateful to the hospital for providing an exceptional training experience. The dedication of the
hospital staff and the expertise of the medical professionals have greatly contributed to my
learning and growth in understanding healthcare practices. I am especially appreciative of the
hospital’s commitment to creating a supportive and educational environment. During my 45-
day training period (3rd June 2024 to 20th July 2024), I gained invaluable knowledge and
experience, making this opportunity truly rewarding.

I would like to extend my heartfelt gratitude to the staff and management of Community Health
Centre, Itaunja for their constant support and guidance throughout my training. I am especially
thankful to Qazi Zafar Husain for his mentorship, encouragement, and invaluable insights,
which have been instrumental in shaping my understanding of the healthcare field.

I also wish to express my sincere appreciation to my fellow trainees and the hospital staff,
whose support and cooperation made it possible for me to successfully complete this project.

Finally, I am deeply thankful to my parents and the faculty members of Institute of

Pharmaceutical Sciences, UoL for their unwavering encouragement and guidance, which have
been a source of strength throughout this journey. This training experience has been truly
enriching, and I am immensely grateful to everyone who contributed to its success.

Thank You

Vivek Yadav

5
 TABLE OF CONTENTS

S.NO., TOPIC PAGE NO.

1. Declaration 2

2. Certificate of Training 3-4

3. Acknowledgement 5

4. List of Tables 6

5. List of Figures 7

6. List of Symbols/Abbreviations 9

7. Objectives of Hospital Training 10

8. Introduction to Hospitals 11-14

9. OPD 15-16

10. Prescription 17-19

11. OTC 19-21

12. Categories of Medications in OPD 21-28

13. Emergency Department 29-35

14. Learning Experience in ED 36-42

15. References 43-44

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List of Tables

Table 1: Various Services Provided by OPDs

Table 2: Several Types of Prescription

Table 3: Several Types of OTC Medications

Table 4: Medications used in skin treatment in OPD

Table 5: Medications used in ENT department in OPD

Table 6: Medications used in paediatrics in OPD

Table 7: Medications used in Gastrointestinal in OPD

Table 8: Medications used in Gynaecological OPD

Table 9: Equipment used in Emergency Department

Table 10: Sample Table of Vital Signs Recorded

Table 11: Sample Table for Injection Administration

Table 12: Wound Care Essential

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List of Figures
Fig 1. Premises of the Training Organization (Hospital)

Fig 2. Dispensary Shelves in the Hospital

Fig 3. A Normal Dental Chair

Fig 4. Visual Depiction of a Dental Ward

Fig 5. OPD in a Community Health Centre

Fig 6. Depiction of a typical Emergency Ward

Fig 7. Emergency Department Layout

Fig 8. Equipment in a Government Hospital Emergency Department

Fig 9. Commonly Used Injections in Emergency Department

Fig 10. Common Requirements for Dressing

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List of Symbols/Abbreviations

CHC: Community Health Centre

OPD: Outpatient Department

IP: Indian Pharmacopeia

OTC: Over the Counter

ENT: Ear Nose Tongue

IV: Intravenous

GI: Gastrointestinal

GERD: Gastroesophageal Reflux Disease

NSAID: Non-steroidal anti-inflammatory drug

COCs: Combined Oral Contraceptives

PCOS: Polycystic Ovary Syndrome

HRT: Hormone Replacement Therapy

PID: Pelvic Inflammatory Disease

IM: Intramuscular

ED: Emergency Department

ICU: Intensive Care Unit

POCT: Point-of-care equipment

ECG: Electrocardiograph

CT: Computed Tomography

CPR: Cardio Pulmonary Resuscitation

ABG: Arterial Blood Gases

AEDs: Automated External Defibrillators

BVM: Bag-valve mask

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OBJECTIVES OF HOSPITAL TRAINING

1. Build a solid foundation in pharmaceutical sciences and clinical pharmacy practices.

2. Gain practical experience in drug dispensing, compounding, and dosage calculations.
3. Improve communication skills to effectively interact with patients and healthcare
professionals.
4. Learn to counsel and educate patients on the appropriate use of medications.
5. Develop expertise in medication management and optimization.
6. Cultivate the ability to make evidence-based decisions in collaboration with the
healthcare team.
7. Understand and implement quality assurance practices in pharmacy services.
8. Acquire knowledge of medication safety, error prevention, and adverse event reporting.
9. Become familiar with pharmacy information systems and electronic health records.
10. Gain skills related to infection control in pharmacy practice.
11. Understand the pharmacist's role in preventing the spread of infectious diseases.
12. Participate in medication therapy management to enhance patient outcomes.
13. Collaborate with healthcare professionals to optimize medication regimens.
14. Foster a commitment to continuous learning and professional growth.
15. Stay informed about new drugs, treatment guidelines, and emerging trends in pharmacy.
16. Uphold ethical standards and adhere to legal regulations in pharmacy practice.
17. Engage in research activities related to pharmacy and healthcare.
18. Develop an understanding of pharmacy administration and management principles.
19. Learn about inventory control, budgeting, and other operational aspects of pharmacy.
20. Provide culturally sensitive and patient-centred care.

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INTRODUCTION TO HOSPITAL

Community Health Centre (CHC) is a government healthcare facility located in Itaunja,

Lucknow. It primarily focuses on providing quality healthcare services to patients, especially
the underprivileged and needy. The hospital is committed to ensuring that all patients receive
proper treatment and care. Its friendly and supportive staff, along with dedicated doctors, work
tirelessly to create a welcoming environment.

The hospital maintains high standards of cleanliness and sanitation to prevent the spread of
diseases, bacteria, pathogens, and dust.

CHC houses several departments, including:

1. Eye Care Department

2. Dental Department
3. Outpatient Department (OPD)
4. Emergency Department
5. Pathology
6. X-ray

These departments are well-organized and operational on most days of the week. Among them,
the emergency department is the busiest, often crowded throughout the day and occasionally
during the night.

Fig. 1. Premises of CHC

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WARDS IN THE HOSPITAL

Wards in a hospital are specialized sections designed to cater to specific medical conditions and
patient needs. Each ward is staffed with healthcare professionals equipped to provide
appropriate care for the patients within their unit. At CHC, the following facilities and wards
are available:

1. Dispensary
2. Outpatient Department (OPD)
3. Emergency Ward
4. Injection Room
5. Dental Ward
6. General Ward
7. Paediatric Ward
8. Eye Care Ward
9. Rabies Vaccination Unit
10. Dressing Room
11. Pathology Laboratory
12.X-Ray Unit

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DISPENSARY

A dispensary is a designated area where medications are dispensed, primarily serving

outpatients.

Medications are distributed based on prescriptions provided by physicians.

The dispensary operates with three pharmacists at all times and features two separate service
windows for men and women.

In district hospitals, the distribution of medications is provided free of charge to patients.

Fig. 2: Dispensary Shelves

The medications distributed at the dispensary include:

1. Paracetamol (tablets and syrup)

2. Iron tablets
3. Calcium tablets
4. Vitamin B-complex tablets
5. Amoxycillin & Potassium Clavulanate Tablets I.P
6. Fluconazole Tablets I.P
7. Tramadol injections, among others.

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DENTAL WARD

A dental ward is a specialized section of a hospital where dental professionals provide care for
teeth and gums.

1. It offers a wide range of services, including routine cleanings, fillings, extractions, and
other dental treatments.
2. The ward adheres strictly to hygiene and sterilization protocols to ensure patient safety.
3. Designed to prioritize patient comfort, it provides a welcoming and calming
environment.

Whether for regular check-ups or addressing specific dental issues like cavities or toothaches,
the dental ward is dedicated to maintaining healthy, happy smiles.

Fig. 3. A Dental Chair

Fig. 4. Visual Depiction of a Dental Ward

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OPD (Outpatient Department)

Outpatient Departments (OPDs) are a crucial component of modern healthcare systems,

providing essential medical services to patients who do not require hospitalization. These
departments offer a wide range of diagnostic, therapeutic, and preventive healthcare services,
catering to the diverse needs of patients. An OPD is a healthcare facility that provides non-
emergency medical care and treatment to patients on an outpatient basis. Patients visit the OPD
for consultations, diagnostic tests, and treatments, and return home the same day without
requiring overnight hospitalization.

Fig. 5. OPD in a Community health centre

Importance of OPDs

• Early Detection and Treatment

• Convenience and Accessibility

• Cost-Effectiveness

• Reduced Hospitalization Rates.

• Improved Patient Satisfaction

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Services Provided by OPDs

There are various services provided by OPDs as mentioned in Table 1.

Table 1: Various Services Provided by OPDs

S. No Service Category Specific Services Description

1. General Medicine Routine check-ups, Health Outpatient medical

screenings, Treatment for care
common medical conditions
2. Specialized Services Dermatology, Cardiology, Expert medical
OrthopaedicsG, care for specific
Gastroenterology, conditions
Ophthalmology
3. Diagnostic Services Laboratory tests, Imaging Tests and
services (X-rays, ultrasound, procedures to
MRI), Other diagnostic diagnose
procedures
4. Surgical Services Minor surgical procedures, Outpatient surgical
Biopsies, Wound care, procedures
Removal of minor lumps and
bumps
5. Preventive Care Vaccinations, Health Preventive
screenings, Education on medical care and
healthy lifestyles, disease education
prevention, and management
6. Prescription Services Filling of prescriptions, Pharmacy services
Medication counselling,
Refills
7. OTC Medications Sale of over-the-counter Over-the-counter
medications, Patient pharmacy services
education on proper use

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 8. Pathology Services Blood tests, Urine tests, Educational
Tissue diagnosis services for
patients

Prescription

A prescription is a written or electronic order from a licensed healthcare professional, such as

a doctor, nurse practitioner, or dentist, to a pharmacist or other healthcare provider, directing
the dispensing of a specific medication or treatment to a patient.

Types of Prescriptions

There are several types of prescriptions, including the ones mentioned in Table 2.

Table 2: Several types of prescriptions

S. Type of Prescription Description Benefits

No.
1 Written Prescriptions Prescriptions written on Provides a permanent record, reduces
paper or electronically errors, promotes patient safety
2 Verbal Prescriptions Prescriptions given Used in emergency situations, timely
verbally by the prescriber treatment
to the pharmacist
3 Electronic Prescriptions transmitted Improves prescription accuracy,
Prescriptions electronically from the reduces errors, promotes efficient
prescriber to the communication
pharmacist
4 Renewal Prescriptions renewed or Ensures timely refills, reduces
Prescriptions refilled without a new medication discontinuation,
prescription promotes treatment adherence

Importance of Prescriptions

Prescriptions are essential because they:

• Ensure Patient Safety

• Promote Effective Treatment

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 • Enhance Patient Care
• Accurate diagnosis
• Minimizes adverse reactions
• Prevents Misuse and Abuse
• Prevents counterfeit medications.
• Promotes Patient Education and Adherence.

Parts of a Prescription

A prescription typically consists of the following parts:

1. Date: The date the prescription is written. This date is essential for tracking prescription
validity, ensuring that patients receive timely refills, and monitoring medication use.

2. Patient Information: The patient's name, address, and contact information. This
information ensures that prescriptions are accurately matched to patients, reducing the
risk of medication errors.

3. Prescriber Information: The prescriber's name, signature, and contact information.

This information verifies the prescriber's credentials, ensures accountability, and
facilitates communication between healthcare providers.

4. Medication Information: The name of the medication, dosage, frequency, and duration
of treatment. This information provides clear instructions on medication use, ensuring
that patients receive the correct treatment.

5. Directions for Use: Instructions for the patient on how to take the medication. These
instructions promote patient understanding, improve adherence, and reduce the risk of
medication errors.

6. Refills: The number of refills allowed, if any. This information ensures that patients
receive timely refills, reducing the risk of medication discontinuation and promoting
treatment adherence.

7. Special Instructions: Any special instructions or warnings for the patient or pharmacist.
These instructions provide additional guidance on medication use, ensuring that patients
receive safe and effective treatment.

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Prescription Handling

Prescription handling involves the following steps:

• Prescription Writing: The healthcare provider writes a prescription for the patient,
taking into account the patient's medical history, allergies, and current medications.

• Prescription Review: The pharmacist or nurse reviews the prescription for accuracy,
completeness, and authenticity.

• Medication Dispensing: The pharmacist dispenses the medication to the patient,

ensuring that the patient understands the dosage, frequency, and potential side effects.

• Patient Counselling: The pharmacist or nurse counsels the patient on the proper use
of the medication, potential side effects, and any necessary precautions.

• Prescription Documentation: The prescription is documented in the patient's medical

record, including any notes or instructions.

Characteristics of OTC Medications

OTC medications have the following characteristics:

• Non-Prescription

• Self-Selection

• Limited Strength

• Labelling Requirements

• Widely Available

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Types of OTC Medications

There are several types of OTC Medications available in a hospital.

Table 3: Several types of OTC Medications

S. No Category Uses
Medication Examples

1. Pain Relievers Acetaminophen (Tylenol), Relieve pain,

Ibuprofen (Advil, Motrin) reduce
inflammation
2. Cold and Flu Medications Decongestants (Sudafed), Relieve
Cough suppressants symptoms of
(Robitussin) colds and flu
3. Allergy Medications Antihistamines (Benadryl), Relieve allergy
Nasal sprays (Flonase) symptoms
4. Digestive Medications Antacids (Tums), Relieve
Laxatives (Metamucil digestive
symptoms
5. Skin Care Medications Hydrocortisone cream Relieve skin
(Cortizone), Acne conditions
treatments (Clearasil)

Benefits of OTC Medications

OTC medications offer several benefits, including:

• Convenience
• Cost-Effective
• No prescription required
• Timesaving
• Quick relief
• Increased Patient Autonomy

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Safe Use of OTC Medications

• Reading and Following Label Instructions

Read the label carefully before taking any OTC medication. Follow the recommended
dosage and do not exceed it unless advised by a healthcare professional..

• Understanding Potential Interactions

Inform your healthcare professional about all prescription medications you are taking
before taking any OTC medication. Be cautious when taking multiple OTC
medications, as they may interact with each other.

• Being Aware of Potential Side Effects

Be aware of common side effects, such as stomach upset, dizziness, or allergic
reactions. Know the signs of serious side effects, such as difficulty breathing, chest
pain, or severe headache.

• Taking Special Precautions

Consult a healthcare professional before taking any OTC medication during pregnancy
or breastfeeding. Always consult a healthcare professional before giving OTC
medications to children or infants.

• Storing and disposing of OTC Medications

Store OTC medications in their original containers, away from children and pets.
Regularly check expiration dates and dispose of expired medications.

• Seeking Medical Attention

If unsure about any aspect of OTC medication use, consult a healthcare professional.
If experiencing side effects, consult a healthcare professional for advice.

Various categories of medications given in an OPD

➢ Skin

These medications are commonly found in hospital pharmacies and are used based on
patient needs for various dermatological conditions, including infections, inflammation,
acne, psoriasis, and other skin issues.
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Table 4: Medications used in skin treatment in an OPD

Category Medication Formulation Primary Use

Topical Steroids Betamethasone Cream, Ointment, Strong anti-

Lotion inflammatory for
inflammatory skin
conditions like
eczema and
psoriasis.
Antibiotics Neosporin Ointment, Cream Used for minor cuts,
burns, and skin
infections.

Antifungals Clotrimazole Cream, Lotion, For fungal skin

Powder infections like
athlete’s foot,
ringworm, and jock
itch.
Emollients Dimethicone Cream, Lotion, Used to treat dry or
Ointment irritated skin,
common in eczema
and dermatitis.
Topical Lidocaine Cream, Ointment, Local anaesthetic for
Anaesthetics Gel pain relief from
burns, minor cuts,
and other skin
irritations.
Acne Treatments Salicylic Acid Gel, Cream, Lotion Used for acne
treatment and
exfoliation of the
skin.

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➢ ENT

These medications are prescribed for a range of ENT conditions, including infections,
allergies, inflammation, pain, and chronic respiratory issues. The choice of medication
depends on the nature of the condition, its severity, and whether it is viral, bacterial, or
related to allergies.

Table 5: Medications used in ENT department in an OPD

Category Medication Formulation Primary Use

Antibiotics Amoxicillin Oral, Injection Used for bacterial

ear infections
(otitis media),
sinus infections,
and throat
infections
(pharyngitis).
Antihistamines Oral, Injection, Used for allergic
Diphenhydramine
Topical rhinitis, allergic
reactions
affecting the nasal
passages, and ear
conditions like
eustachian tube
dysfunction.
Decongestants Phenylephrine Nasal Spray, Oral Used for nasal
congestion and
sinus pressure
relief.

Cough Dextromethorphan Used to suppress

Oral
Suppressants dry, non-
productive cough
associated with

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 throat or upper
respiratory
infections.

Analgesics and Ibuprofen Oral, IV Nonsteroidal anti-

Antipyretics inflammatory
drug (NSAID) for
pain relief and
inflammation in
ENT conditions.

➢ Pediatrics

This table covers a range of medications commonly prescribed for paediatric patients,
addressing various conditions such as infections, pain, respiratory issues, gastrointestinal
concerns, immunization, and more. The choice of medication and dosage is adjusted based
on the child’s age, weight, and specific medical condition.

Table 6: Medications used in pediatrics OPD

Category Medication Formulation Primary Use

Antibiotics Amoxicillin Oral, IV Treatment of
bacterial infections
like otitis media,
pneumonia, and
streptococcal
throat infections.
Pain and Fever Acetaminophen Oral, Rectal, IV Pain relief and
Management (Paracetamol) fever reduction,
commonly used
for fever, post-
operative pain, and
mild to moderate
pain.

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 Respiratory Montelukast Oral Leukotriene
Medications receptor antagonist
used for asthma
and allergic
rhinitis.
Antipyretics Paracetamol Oral, IV Fever management
and mild pain
relief in pediatric
patients.
Antihistamines Cetirizine Used to relieve
Oral
allergy symptoms
like runny nose,
sneezing, and itchy
eyes.
Gastrointestinal Ondansetron Antiemetic for
Oral, IV
Medications preventing nausea
and vomiting
caused by
chemotherapy,
infections, or other
conditions.

➢ Gastrointestinal (GI) medications

These medications are used for a wide range of gastrointestinal conditions, including acid
reflux, peptic ulcers, inflammatory bowel diseases, constipation, diarrhoea, nausea, and GI
infections.

Table 7: Medications used in Gastrointestinal (GI) OPD

Category Medication Formulation Primary Use

Proton Pump Omeprazole Oral, IV Used for the treatment
Inhibitors of gastroesophageal
(PPIs) reflux disease (GERD),
peptic ulcers, and

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 Zollinger-Ellison
syndrome.

H2-Receptor Ranitidine Oral, IV Reduces stomach acid

Antagonists production; used for
GERD, peptic ulcers,
and indigestion.
Antacids Sodium Used to relieve
Oral
Bicarbonate heartburn and
indigestion by
neutralizing stomach
acid.
Antidiarrheals Loperamide Oral Used to treat diarrhoea
by slowing bowel
motility.

Laxatives Lactulose Oral, Rectal Osmotic laxative used

for constipation and
hepatic encephalopathy.

GI Protectants Misoprostol Oral Used to prevent

NSAID-induced ulcers
and for the treatment of
gastric ulcers.
Enzyme Lipase Oral, Capsules Used to replace
Replacement digestive enzymes in
patients with pancreatic
insufficiency

➢ Gynecological medications

This table provides a broad overview of medications used in gynaecology for various
conditions, including contraception, fertility treatments, menstrual disorders, pregnancy-
related issues, infections, and menopause.

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Table 8: Medicines used in Gynecological OPD

Category Medication Formulation Primary Use

Hormonal Combined Oral Oral Used for birth
Contraceptives Contraceptives control, regulating
(COCs) menstrual cycles,
and treating acne
or PCOS.
Estrogens and Estradiol & Oral, Patch, Used for hormone
Progestins Progesterone Injectable, Vaginal replacement
therapy (HRT),
treating
menopausal
symptoms, and in
contraception.
Antihypertensives Labetalol Oral, IV Used for managing
in Pregnancy hypertension
during pregnancy
(e.g., gestational
hypertension
Antifungals Fluconazole Oral, IV Used for treating
vaginal candidiasis
(yeast infection)
and systemic
fungal infections.
Antibiotics Clindamycin Oral, IV, Topical Used for bacterial
(Gynaecological) infections like
pelvic
inflammatory
disease (PID),
bacterial
vaginosis, and
other infections.

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Menstrual Medroxyprogesterone Oral, Injectable, Used for
Regulation IM regulating
menstrual cycles,

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Emergency Department in a Government Hospital

INTRODUCTION

The Emergency Department (ED) is a critical component of any healthcare facility, particularly
in government hospitals, which often serve as the primary healthcare providers for the general
public. The ED operates 24/7, providing immediate medical care to individuals facing life-
threatening conditions, injuries, or other medical emergencies. It serves as the frontline of
healthcare delivery, addressing acute medical issues and stabilizing patients for further
treatment.

Government hospitals often cater to a diverse population, including underserved and

economically disadvantaged groups. The emergency department in these hospitals plays a
pivotal role in ensuring equitable access to timely and essential medical care. It is designed to
manage high patient volumes, address public health emergencies, and serve as a critical link
between pre-hospital care and definitive treatment.

Objectives of the Emergency Department

1. Immediate Care Provision

To provide prompt diagnosis, treatment, and stabilization for patients experiencing medical
emergencies such as cardiac arrests, trauma, strokes, and other critical conditions.

2. Triage and Prioritization

To assess and prioritize patients based on the severity of their condition to ensure that those
with the most urgent needs are treated first.

3. Comprehensive Emergency Services

To deliver a range of emergency medical services, including resuscitation, pain management,

diagnostic testing, and minor surgical procedures.

Importance of the Emergency Department

1. Life-Saving Care

The ED is often the first point of contact for patients experiencing life-threatening conditions,
making it essential for saving lives through immediate interventions.

2. Accessibility for All

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As government hospitals are generally accessible to people from all socioeconomic
backgrounds, the ED ensures that even the most vulnerable populations receive timely medical
care.

3. Emergency Readiness

Preparedness to handle any medical crisis, from road traffic accidents to natural disasters, is
crucial to reducing mortality and morbidity.

4. Continuity of Care

The ED acts as a bridge between pre-hospital care (e.g., ambulances) and specialized hospital
services, ensuring seamless care delivery for patients.

5. Training and Education

Emergency departments in government hospitals often serve as training grounds for medical
professionals, offering hands-on experience in managing critical cases.

Location and Layout of the Emergency Department in a Government Hospital

Location of the Emergency Department

Fig 6 : Depiction of a Typical Emergency Ward

1. Proximity to Main Entrance

The ED is typically located near the main entrance of the hospital, ensuring easy accessibility
for ambulances, walk-in patients, and emergency vehicles. Dedicated ambulance bays or drop-
off points are usually adjacent to the ED entrance to facilitate quick patient transfer.

2. Centralized Position

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In larger government hospitals, the ED is often centrally located to ensure quick access to other
critical departments such as radiology, surgery, intensive care units (ICU), and laboratory
services. This central positioning reduces delays in transferring patients for specialized care or
diagnostic evaluations.

3. Separation from Non-Emergency Areas

The ED is strategically separated from outpatient clinics and administrative offices to minimize
disruptions and ensure that emergency services are prioritized. Signage and pathways are
clearly marked to guide patients and visitors to the ED without confusion.

4. Disaster Preparedness

The ED location accounts for disaster response needs, with proximity to helipads (in tertiary-
level government hospitals), additional entry points, and decontamination areas for handling
mass casualties or public health crises.

Layout of the Emergency Department

The layout of the ED is designed to optimize patient flow, ensure efficient use of space, and
provide a safe and organized environment for staff and patients.

Fig 7 : Emergency Ward Layout

Department Components Purpose

Reception and Triage - Registration desk for patient Acts as the first point of
Area details. contact for patients arriving
at the ED.

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 Triage area for assessing and
categorizing patients based on
urgency.
Comfortable seating for walk-in
patients and their attendants.
Resuscitation Room - Equipped with ventilators, Dedicated for managing
defibrillators, oxygen supply, and critically ill patients needing
emergency drugs. immediate life-saving
- Located close to the ambulance interventions.
bay for quick transfer of critical
patients.
Trauma Care Unit Multiple trauma bays with Specialized for managing
advanced monitoring equipment. patients with severe injuries
Easy access to the radiology from accidents or violence.
department for immediate
imaging.
Examination and Several rooms for examining and Handles general medical
Treatment Rooms treating minor injuries or illnesses. emergencies.
Staffed with trained doctors and
nurses.
Observation/Short- Beds with monitoring systems for For temporary monitoring or
Stay Unit continuous observation. treatment before discharge
or transfer to another
department.
Diagnostic Support • Point-of-care testing Provides quick access to
Area (POCT) equipment for essential diagnostic tools.
blood tests, ECG machines,
and ultrasound devices.
• Direct links to radiology
(CT scan, X-ray) and
laboratory services.

32
 Staff Workstations Desks with computers, patient Centralized areas for
records access, and healthcare providers to
communication systems. document and coordinate
care.
Waiting Area for Seating, restroom facilities, water Offers a comfortable and
Attendants dispensers, and vending machines. secure environment for
patient attendants or family
members.

Emergency Department Staff in a Government Hospital

1. Medical Staff

The medical staff is responsible for diagnosing, treating, and managing patients in the ED.

Emergency Physicians:

Lead the clinical care of patients in the ED.

Perform critical procedures like intubation, suturing, and resuscitation.

Make decisions on patient admissions, referrals, or discharges.

Residents and Medical Officers:

Work under the supervision of senior physicians.

Handle initial patient assessments, basic procedures, and documentation.

Assist in triage, stabilize patients, and initiate treatment protocols.

Specialist Consultants (On-Call):

Provide expertise in specific fields such as cardiology, orthopaedics, neurology, or surgery.

Called in for complex cases requiring advanced care or surgical intervention.

2. Nursing Staff

Nurses form the backbone of the ED, ensuring continuous patient care and support for medical
procedures.
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Emergency Room (ER) Nurses:

Assist in triage and prioritize patients based on the severity of their condition.

Administer medications, monitor vital signs, and provide bedside care.

Collaborate with doctors during critical interventions like CPR or wound care.

3.Pharmacists:

Dispense medications and advise on drug interactions or contraindications.

Assist in managing drug stocks and ensuring the availability of essential emergency
medications.

Fig 8 : Equipment in a Government Hospital Emergency Department

Table 9: Equipment used in Emergency Department

Equipment Name Purpose/Use

Resuscitation Equipment Multi-parameter monitors to track heart rate,
blood pressure, oxygen saturation, and
respiratory rate. Central monitoring systems
to observe multiple patients simultaneously.

34
Resuscitation Equipment Defibrillators (manual and automated
external defibrillators, or AEDs). Bag-valve
masks (BVM) for manual ventilation.
Laryngoscopes, endotracheal tubes, and
suction devices for airway management.
Imaging Equipment Portable X-ray machines for bedside
imaging. Ultrasound devices for FAST
(Focused Assessment with Sonography for
Trauma). CT scanners for head injuries,
strokes, or internal injuries.
Diagnostic Tools Electrocardiogram (ECG) machines for
cardiac monitoring. Glucometers for blood
glucose testing. Blood gas analyzers for
evaluating respiratory and metabolic status.
Intravenous (IV) and Infusion Equipment IV stands and pumps for fluid administration.
Syringe pumps for controlled drug delivery.
Infusion warmers for temperature-sensitive
fluids.
Oxygen and Ventilation Support Oxygen cylinders and central oxygen supply
systems. Mechanical ventilators for patients
with respiratory distress. Nebulizers for
delivering respiratory medications.
Surgical Instruments Sterilized kits for minor surgical procedures
like suturing, wound dressing, and abscess
drainage. Advanced surgical equipment for
trauma cases.
Wound Care Supplies Dressing materials, sutures, and adhesives.
Antiseptics, wound irrigation systems, and
bandages.

35
Learning Experience in the Emergency Department

Taking Vitals of the Patients

One of the key learning objectives during the training is to understand and practice the process
of taking vital signs of patients in the Emergency Department (ED). Monitoring vitals is a
critical aspect of patient care, especially in emergency settings, as it provides essential
information regarding a patient’s immediate health status.

Overview of Vital Signs

Vital signs refer to a set of key indicators that are used to monitor a patient's basic bodily
functions. These include Heart Rate (Pulse), Blood Pressure, Respiratory Rate, Body
Temperature and Oxygen Saturation.

Procedure for Taking Each Vital:

1. Heart Rate (Pulse):

Location: Radial pulse (wrist) or carotid pulse (neck)
Method: Count the pulse for 60 seconds, ensuring accuracy.
2. Blood Pressure:
Procedure: Apply the cuff to the patient’s upper arm, inflate, and gradually
deflate to listen for Korotkoff sounds using a stethoscope.
Categories: Systolic (first sound) and Diastolic (last sound).
3. Respiratory Rate:
Procedure: Observe the rise and fall of the patient's chest for 30 seconds, then
multiply by 2 to calculate breaths per minute.
4. Body Temperature:
Method: Use a digital thermometer to measure oral, axillary, or tympanic
temperature based on patient condition.
5. Oxygen Saturation (SpO2):
Method: Use a pulse oximeter attached to the patient’s finger to assess oxygen
saturation levels.

36
Documenting and Reporting: After measuring the vitals, it is important to accurately record
the readings in the patient's medical chart and inform the healthcare team (doctor or nurse) of
any abnormalities. The values obtained could serve as a baseline for monitoring the patient's
progress over time and determining the need for immediate intervention.

Table 10: Sample Table of Vital Signs Recorded

Patient Id Date Heart Rate Blood Respiratory Temp (o C ) SpO2
(bpm) Pressure Rate (%)
(mmHg) (Breaths/min)
001 05/06/2024 90 120/80 18 37.2 98

002 05/06/2024 110 140/95 22 38.1 96

003 05/06/2024 75 130/85 16 36.8 97

Taking vital signs in the Emergency Department is a vital part of emergency management,
providing a deeper understanding of patient monitoring in urgent care settings.

Injections in the Emergency Department

The training provided the opportunity to observe, assist, and perform the preparation and
administration of various injections prescribed for patients in critical conditions. Administering
injections is vital in managing acute symptoms, providing rapid relief, and stabilizing patients
until further treatment can be initiated.

Fig 9 : Commonly Used Injections in Emergency Department

37
General Methodology for Injection Administration

The following steps are followed in the Emergency Department to administer these injections
safely and effectively:

1. Preparation:
o Verify the medication prescribed and the correct dosage.
o Confirm the route of administration (IV, IM).
o Check the expiry date and integrity of the medication.
2. Patient Identification:
o Ensure the patient's identity by matching the wristband with the medical record.
o Verify any known allergies or specific health conditions to prevent adverse
reactions.
3. Injection Technique:
o Intravenous (IV):
▪ Select the appropriate vein (usually in the forearm or back of the hand).
▪ Clean the injection site with an alcohol swab.
▪ Insert the needle at a 45o angle, aspirate to check for blood return, and slowly
inject the medication.
▪ If using an IV line, the medication is diluted in a saline solution and infused
over a specific period.
o Intramuscular (IM):
▪ Choose the injection site (deltoid, vastus lateralis, or gluteus).
▪ Clean the site with an alcohol swab.
▪ Insert the needle at a 90° angle to the skin.
▪ Slowly inject the medication while stabilizing the syringe.
▪ Massage the site gently after injection to ensure proper absorption and
reduce pain.
4. Post-Injection Care:
o Monitor the patient for any immediate adverse reactions such as swelling, redness,
or anaphylaxis.
o Dispose of the syringe and needle properly in a sharps container.

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Table 11: Sample Table for Injection Administration

Medication Route Common Route Injection Site Administration

Method
Paracetamol IV/IM Pain Relief, Fever Vein, Muscle Slow IV infusion
Reduction or Deep IM
injection
Dicyclomine IM Abdominal Cramps, Upper arm, Deep IM Injection
Hydrochloride IBS Gluteal Region
Metoclopramide IV/IM Nausea, Vomitting, Vein, Muscle Slow IV Push or
GERD Deep IM Injection
Etofylline and IV Bronchodilator for Vein Slow IV Infusion
Theophylline Asthma and COPD over 10-15 minutes
Ranitidine IV Gastric Ulcer and Vein IV Push
Acid Reflux
Diclofenac Sodium IV/IM Pain, Inflammation Vein, Muscle Slow IV Infusion
or Deep IM
Injection

Dressing of Wounds, Cuts, Burns and Related Techniques

The dressing of wounds, cuts, and burns is an essential skill in the emergency setting, as it
directly impacts the healing process, infection control. During the hospital training in the
Emergency Department (ED), learning the techniques of proper wound care, as well as the
selection and application of appropriate dressings, was an important aspect of the curriculum.

Fig 10 : Common Requirements for Dressing

39
Wound Dressing Technique :-

1. Cleansing the Wound:

o The first step in dressing a wound is cleaning it to remove debris, dirt, or foreign
particles.
o Saline Solution: Normal saline (0.9% NaCl) is commonly used for wound cleaning, as
it is isotonic and does not irritate the tissue.
o Antiseptic Solutions: In some cases, antiseptic solutions such as iodine-based
(Betadine) or hydrogen peroxide solutions may be used to cleanse the area before
dressing, depending on the severity of the wound.
2. Controlling Bleeding:
o For cuts or abrasions that are bleeding, pressure is applied to control the bleeding.
o If needed, sterile gauze or a bandage is used to apply pressure to the wound.
3. Applying the Dressing:
o For Cuts and Wounds: The sterile gauze is placed over the wound, and a bandage is
used to secure it in place. In some cases, a layer of antibiotic ointment is applied before
dressing.
o For Burns: After cleaning and applying any burn ointments or creams, a specialized
burn dressing is placed. This helps prevent infection, reduces pain, and promotes healing
by keeping the area moist.
4. Securing the Dressing:
o Once the dressing is in place, it is secured using adhesive tape, a bandage, or a
compression bandage, depending on the location and size of the wound.
o The dressing should not be too tight to avoid restricting blood flow, nor should it be too
loose to prevent contaminants from entering.
5. Monitoring the Wound:
o After the dressing is applied, it is important to monitor the wound for signs of infection,
such as increased redness, swelling, or drainage.
o Dressing changes are performed regularly to ensure that the wound remains clean and
free from infection, and that the healing process is progressing.

40
Types of Liquids and Salines Used in Wound Dressing

1. Normal Saline (0.9% NaCl):

This is the most commonly used solution for wound cleaning, as it is isotonic and does
not cause any damage to the tissues.

2. Antiseptic Solutions:

i. Povidone-Iodine (Betadine): An iodine-based solution used to cleanse

wounds before applying dressings. It is effective against a broad range
of pathogens.
ii. Hydrogen Peroxide: Used sparingly to clean deeper wounds, though it
may cause some tissue damage if overused.
iii. Chlorhexidine: Another antiseptic used for wound cleaning, particularly
in surgical wounds or where infection risk is high.

3. Burn-Specific Ointments:

i. Silver Sulfadiazine (Silvadene): Applied to second-degree or third-

degree burns to prevent infection and promote healing.
ii. Aloe Vera Gel: Sometimes used for minor burns, providing soothing
effects and helping to reduce inflammation.

4. Topical Antibiotic Creams:

Neosporin or other topical antibiotics may be used on clean, minor wounds to

prevent infection.

41
Table 12: Wound Care Essentials

Wound Type Dressing Used Liquid Used

Minor Cuts Adhesive Bandage Normal Saline

Deep Cuts Sterile Gauze Betadine
1st Degree Burn Hydrocolloid Dressing Aloe Vera Gel
2nd Degree Burn Silver Sulfadiazine Silver Sulfadiazine
Surgical Wounds Transparent Film Chlorhexidine
Abrasions Gauze aur Bandage Normal Saline

The dressing of wounds, cuts, and burns is a crucial aspect of patient care in the Emergency
Department. Through this training, an understanding was gained of the various techniques,
dressings, and solutions required to properly care for these injuries. The training enhanced
practical skills and provided important insights into the healing process, infection control, and
patient comfort.

42
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