LETTER FROM HEAD OF INSTITUTE

INSTRUMENTS WITH THEIR USE

SPHYGMOMANOMETER or blood pressure meter is a device used to measure blood pressure. It is composed of an inflatable cuff to restrict blood flow, and a mercury or mechanical manometer to measure the pressure. It is always used in conjunction with a means to determine at what pressure blood flow is just starting and at what pressure it is unimpeded . Manual sphygmomanometers are used in conjunction with a stethoscope.

SPHYGMOMANOMETER
The usual unit of measurement of blood pressure is millimeters of mercury {mmHg} as measured directly by a manual sphygmomanometer. In humans the cuff is placed smoothly around upper arm at roughly same vertical height at heart. The subject is seated with arm supported. With a manual instrument listening with stethoscope to the brachial artery at the elbow, the examiner slowly releases the pressure in the cuff. As the pressure on the cuff falls a whooshing sound is heard and blood flow first starts again in the artery.

SPHYGMOMANOMETER
The pressure at which this sound begins is noted and recorded as systolic blood pressure. The cuff pressure is further released until the sound is no longer be heard. This is the diastolic blood pressure.

ELECTROCARDIOGRAM
An Electrocardiogram also called EKG OR ECG is a simple, painless test that records the heart electrical activity. With each heart beat an electrical signal spreads from the top of heart to the bottom. As it travels, the signal causes the heart to contract and pump blood. This process repeats with each new heart beat. An EKG shows : How fast your heart is beating. Whether the rhythm of your heart beat is steady or irregular.

ELECTROCARDIOGRAM
The strength and timing of electrical signals as they pass through each part of your heart. Doctors use EKGs to detect and study many heart problems such as heart attacks, arrhythmias and heart failure. The test result also can suggest other disorders that affect heart function.

Stethoscope
The stethoscope is an acoustic medical device for auscultation or listening to the internal sounds of human or animal body. It is often used to hear lung , heart , intestinal sounds. It is also used to listen blood flow in arteries and veins. In combination with a sphygmomanometer it is commonly used for the measurement of blood pressure. Acoustic stethoscopes are familiar with most people and operate on the transmission of sounds from the chest piece, via air filled hollow tubes, to the listeners ears.

Doctors syringe
The syringe is simple pump consisting of plunger that fits tightly in a tube. The plunger can be pulled and pushed inside a cylindrical tube(called barrel), allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube. The open end of the syringe is fitted with a hypodermic needle, a nozzle to help direct flow into and out of the barrel. Syringes are used to administer intravenous or intramuscular drugs into the bloodstream.

OPERATING THEATRE
Operating theatre has an operating table in the centre of the room which can be raised and lowered in any direction. The operating room lights are over the table to provide bright light during surgery. The anesthesia machine is at the head of the operating table. The anesthesia cart is next to the anesthesia machine which contains medications, equipments and other supplies which are required by the anesthetist. An electronic monitor which records the heart rate and respiratory rate are placed in the patients chest. The pulse-oxymeter machine is attached to patients finger.

OPERATION THEATER
Automated blood pressure machine that automatically inflates the blood pressure cuff on patients arm. People in the operation theatre wear sterile surgical clothes to prevent infections. A protective cap over their hair, mask over their lower face, glasses over their eyes, vinyl gloves on hand, long gowns, etc.

MISCELLANEOUS INSTRUMENTS
Torch-to examine throat, eyes and the body. Hammer-to examine the nervous system of the patient. Examination table-for the examination of the patient. Dressing tray-ointments, bandages, cotton pads, etc. for dressing.

MISCELLANEOUS INSTRUMENTS[CONTD.]
IV stand-to give IV drip to the patient. Reference books-for referring the patient blood/urine examination, for X- ray of the affected part, for prescribing the medicine. Instruments used in O.T. Focused light-for focusing the area to be operated. Quotry machine-for stopping the blood during operation.

 Oxygen cylinder-during operation, patient is given oxygen. Suction machine-to suck blood , pus, etc. Formalin chamber-formalin tablets are placed for instrument sterilisation. Kidney tray-kidney-shaped trays are used to discard dirtied dressings etc. while operating.

 Trolley-to keep the dressing tray, small instruments like scissors, kidney tray, syringes, etc. Waste baskets, vomitting bowls,etc. Formalin liquid-for sterilisation of O.T.

YOUR OBSERVATIONS
A female aged 8 yrs was suffering from fever, cough and vomiting since 5 days. Her fever was not responding to standard treatment. Her cough was productive and yellow in color. Usually the cough was prominent in morning hours with expectoration. She was thoroughly investigate by the doctor and found to be suffering from bacterial infection of lungs.

YOUR OBSERVATIONS
A young boy aged 15 yrs had come with complains of high grade fever and bleeding form nose. He was coming form poor family. He was not responding to standard treatment. With laboratory investigations the doctor diagnosed the boy suffering from Dengue fever. He has been given parenteral fluid replacement therapy. ( 0.9% NACL) He has been asked to follow up after 24 hours.

YOUR OBSERVATIONS
A female aged 35 years came in the OPD with symptoms of fatigue, weakness, lethargy, shortness of breath and recurrent infection. On examination, she was having severe pallor of skin and nails. With laboratory investigations, she was found to be suffering from anemia. She was given oral Fe therapy and multivitamin drugs. She has been advised for follow-up after one month of treatment.

YOUR OBSERVATIONS
An Adult male of 55years had come to the doctor with complaints of chest pain, dyspnoea and high B.P. Immediately, his echocardiogram was taken and he was diagnosed as a case of heart attack. Immediately, he was transferred to intensive coronary care unit in the civil hospital, Rajkot by ambulance.

YOUR OBSERVATIONS
An elderly male of 55 years had come with complaints of chronic diarrhoea, occasional blood in stool, back pain and indigestion.The doctor found that patient was suffering from mild pallor. On per rectal examination the doctor found internal piles [moles in rectum ]. The patient had also given history of constipation. The doctor advised him laxatives and anti-piles ointment. The patient was called back after one month of treatment.

YOUR OBSERVATIONS
A girl of 10 years had come in the O.P.D. with complains of mild fever, vomiting, left abdominal pain and indigestion. On clinical examination, doctor found icterus in the eyes of patient. Further laboratory examination confirmed the diagnosis of jaundice. She was advised diet restrictions, sorbitol syrup and plenty of glucose. The doctor advised her to come back after one week of treatment.

YOUR OBSERVATIONS
A male patient of 40 years age had come in the O.P.D with complaints of high grade fever with rigor, weakness, vomiting and sweating. The fever was intermittent in nature and high grade. The doctor diagnosed of malaria. The patient was given antimalarial injections, antipyretic drugs and rest for 5 days.

WORK DONE BY YOU

In the internship, I have done following type of tasks : Detailed history of patient with special importance on duration of illness. General condition of the patient Measurement of pulse and blood pressure. Prescription writing with proper drugs, doses and total duration of treatment. Measurement of height and weight of certain patients. Advise for specific laboratory test in certain patients. Preparation of syringes and needles for parenteral treat

ANY UNUSUAL EXPERIENCE

A doctor is not only the one who heals the body but also the souls. Truly, after my memorable experience with Dr. Jayantibhai Kacchela, I started believing the above statement. I used to think before my internship that doctors would be very serious people owing to the great amount of responsibility of someones life that rests on their shoulders. But, Dr. Kacchela truly

changed my perception. I observed that every time a patient came up to him, he would first talk to him about anything other than his disease. He sometimes even cracked jokes. But by the time he suggested some treatment the patient would be already well at ease. He would always end a case saying, You will be fine after this.