BAL SHALYAKRIYA MISSION (BSM-2018)

Organised by
l GOVERNMENT MEDICAL COLLEGE AND HOSPITAL l
PEEDH PARAI INTERNATIONAL l BALAJI TEMPLE COMMITTEE l BALMITRA FOUNDATION

CASE REGISTRATION NO. :

SPECIALITY / SYSTEM OPERATION NOTES
Name of patient .............................................................................................................................................................................

Age .......................... Sex - Male / Female

Date of operation : ........................................................ Time : ...................................................

Name of Surgeon : ....................................................... Name of Anaesthetist : ...................................................
Name of Assistant : ....................................................... Type of Anaesthesia : ...................................................
Name of OT Sister : .......................................................

DIAGNOSIS

Name of procedure

Details of operative procedure

 BAL SHALYAKRIYA MISSION (BSM-2018)
POST OP INSTRUCTIONS
Date and Time

1. VITALS

2. NPO

3 02(Oxygen)
4. Nebulization
5. Antibiotics
. Inj. Ceftrioxone ( 1 gm)
. Inj. Ofloxacin (100 ml = 200 mg)
. Inj. Amikacin (250 mg)
. Inj. Metrogyl (100 ml = 2 mg)
6. H2 Blocker / Proton pump Inhibitor
. Inj. Rantac ( 1 ml = 25 mg)
. Inj. Pantocid ( 20 mg)
7 Anti - Emetic
. Inj. Zofer ( 1ml = 2 mg)
. Inj. Perinorm ( 1 ml = 5 mg)
8. Analgesics
. Inj. Contramal ( 100 mg )
. Inj. Fortwin ( 30 mg)
. Inj. Diclofenac ( 30 mg) / Inj. Voveron ( 1 ml = 75 mg)
. Suppository
. Justin/Jonac : 12.5 / 25 / 50 / 100
9. IV Fluids
. R. L. (500 ml)
. 0.45 DNS (500 ml)
10. ANY OTHER

Name &
Signature