New House Officer's Orientation Guide

(Revised April,2019)

Cleared M.B;B.S. !

You thrived Well.

Now its time to apply your theoretical knowledge & clinical skills.

House job can help you decide what is the most suitable Specialization for you. At the end of your
Rotations you may be able to figure out if you are a doctor for bone repairs, or cutting n stitching
bowels, or to handle crying babies , or the one who reads x rays and watches TV(with ultrasound probe
in hand).

Or , before your House job begins , you may visit wards of your "interest" , meet senior doctors- see
their working routine and environment and decide about the field you wish to specialize in, and then
Plan your house job Rotations accordingly. Its better that you decide prior to start of house job about
your areas of interest since you have already have much exposure to Wards in clinical years.

Before you Begin- REVISE these topics.

(Download Medscape app, make account , download cntent, and study in medscape, its mostly the
latest stuff there)

Basic Evaluation of :

Dehydration (and t/m)

Shortness of Breath

Chest Pain

Abdominal Pain

Head Ache

Fits

Fever and its management

CPR protocol in adult and child

Diagnosis of Acute Appendicitis , Acute Cholecystitis

Pneumonia

Asthma
Hepatitis

Treatment of :

Gastroenteritis, Dysentry, Upper Resp. Tract Infections, UTI , Malaria , Enteric Fever

Interpreting CBC , RFTS, LFTS, S/E reports.

Clinically Picking up Pneumothorax and Acute Abdomen.

Basics of CXR , X ray Abdomen Erect ,

Picking Myocardial infarction changes in ECG

How to Effectively AMBU the patient.

https://healthfully.com/use-ambu-bags-5150006.html

How to measure Blood Pressure

How to draw venous and arterial blood samples

https://www.wikihow.com/Draw-Blood

How to counsel the Fussy Attendants to make them admit that their patient is about to die but your
team is trying the best to save the pt.

For Paeds Medicine House Officers we have Mayo Paediatricians Manual downloadable from:

https://paedsmanual.blogspot.com/

---------- Other Than the above mentioned topics, I assure you that all you need is to KEENLY
observe,take history, examine your patient, and be connected with your senior. If you wish to read
book, give foremost preference to any book of Physical Examination.

The Doctors Talk(Never write drug names in short forms or abbreviations,these lead to medical errors)

OD - once daily

BD, 12hrly - twice daily

TDS, 8hrly - three times a day

QID or QDS, 6hrly - four times a day

C/O complaining of

H/O - history of

D/W - discussed with

HEENT - head, ears eyes nose and throat

PERLA - pupils equal and reactive to light & Accomodation

JACCO - jaundice, anaemia, clubbing, cyanosis, oedema

NAD - no abnormality detected

N - Normal

NPO- Nothing Per Oral

DKA - diabetic ketoacidosis

URTI- Upper Respiratory Tract Infection

LRTI- Lower Respiratory tract Infection

SSTI - Skin and Soft Tissue Infection

GCS - Glasgow coma scale

LOC - loss of consciousness

ASOC Altered State of Consciousness

CXR - chest X-ray

MSU - mid-stream urine

C&S - culture and sensitivity

ATD - After Test dose

i/v intravenous

s/c subcutaneous

PO per oral

t/m treatment

o/e on examination

Rx medication

--------------- you ll learn more of these with time ! & advising a DRUG on chart is like computer
programming ! Just in 24-48 hours with your seniors you'll grasp the idea ! For example , if you wish to
advise 1 gram injection Ceftriaxone twice daily by intravenous route to your patient, you ll write on chart
this way : (so that the Staff nurse administers medicine accordingly)

inj Ceftriaxone X 1g X i/v X B.D (ATD)

(Do not forget to mention test doses specially with penicillins and cephalosporins)
Also, Do not forget the duration in which an infusion of a drug has to be given. Forexample,
Clarithromycin is very irritating drug, its infusion is made in 30 ml solution and given over 1 hour, very
slowly, via a microburette.

so the Orders are,

inj Clarithromycin X 125mg X i/v X slowly over 1 hour X B.D

But injection ceftriaxone is given in few seconds quickly !

A “Bolus" means that fluid is given over 20 to 30 minutes.

Other drugs such as vancomycin,meropenem,calcium, sodium bicarbonate,aminophyline are also given

as infusion, same applies to KCl given as infusion over hours. Such drugs when given rapidly prove toxic.

Hope you have idea !

While you have to give contrast agent to a patient for CT scan, MRI, Intra venous pyelography, etc,
always prepare injection adrenaline-injection avil , and inj hydrocortisone before hand. Very rarely
patients show anaphylaxis to these agents, and if inj adrenaline is not given immediately, patient will die
in no time.

Think about it.

& spread the word , whenever a contrast study involving intravenous contrast is to be conducted,
prepare yourself for worst outcome.

Ethics Review :

***Do NO Harm.

***Do the Right Thing.

*** Protect yourself first and have scene safety ensured before you save any life.

***Wear too Good a Dress, with so bright a Face, that you leave no other option for your Patient to
have immense confidence in You regarding Your skills and Management !

***Think for patient benefit while staying in the limits of your services (and doctor-patient distance),
and asking for services of others/other departments/NGOs.

***Regard Patient as the top most priority , but after your own self.
***Respect your patients' Religious beliefs.

***Never abuse-back a patient/attendant . Be very careful regarding what YOU utter, maintaining your
AUTHORITY at the working place.

***Examine Opposite sex patients only in the presence of a Chaperone.

***Do not Hate your patient. Is he I/V drug abuser with gangrenous leg and foul smelling discharge from
the wound ? So what- He is your patient - seeking your expertise & trusting you in this regard,Not
seeking your emotions.

***Do not JUDGE your patients. Do not let their POVERTY / RICHES make you their JUDGE. Do not let
their DISEASE develop good or bad feelings towards them.

***Keep Secrets of your patients that they tell you. Maintain full Privacy and Confidentiality. Do not post
patient's photos on social media, or share in a group at whatsap without their permission. Never share
patient's biodata with anyone.

***Respect your fellow doctors. Always be of help to them.

***Is there Nothing you can do for the patient's disease ? Oh well make the patient atleast PAIN Free
leaving rest to specialist or senior doctors ! Cant make the patient pain free, utter some SUGARY WORDS
to him then !

***Never be involved in gaining personal benefits from patients ! The only personal benefit you may
have is Prayers !

***Always wear GLOVES before handling patient's secretions/specimens. Protect yourself from getting
diseased. If you got flu, Wear mask so that you may not transmit the disease.

DRUGS THAT YOU SHOULD KNOW (atleast) :

DRUG : ACETAMINOPHEN

BRAND NAMES: Panadol , Calpol

DOSES: tab 500mg (usually advised 4 times per day)

COMMON INDICATIONS: Analgesic . Antipyretic

COMMON SIDE EFFECTS: Liver toxicity, Rash

DRUG : IBUPROFEN

BRAND NAMES: Brufen ,Bludol, Blufen

DOSES: tab 200mg , 400 mg , 600 mg, 800mg (usually advised 3 times per day)
COMMON INDICATIONS: Analgesic, Antipyretic , AntiInflammatory

COMMON SIDE EFFECTS: heart burn , Rash, Liver Toxicity , Renal Toxicity

DRUG : AMOXICILLIN

BRAND NAMES: Amoxil

DOSES: cap 250mg, 500mg (usually advised 3 times per day)

COMMON INDICATIONS: Tonsilitis , Otitis, Skin Infections , Helicobactor pylori Eradication

COMMON SIDE EFFECTS: Anaphylaxis , Diarrhoea/ GI Upset

DRUG : AMOXICILLIN/CLAVULANATE

BRAND NAMES: Augmentin , Co-Amoxi , Calamox

DOSES: tab 375mg, 625 mg, 1 gm (usually advised 2 or 3 times per day)

COMMON INDICATIONS: Tonsilitis, Sinusitis , Skin Infections

COMMON SIDE EFFECTS: Anaphylaxis, Diarrhoea

DRUG : CLARITHROMYCIN

BRAND NAMES: Claritek , Klaricid , Rithmo

DOSES: tab250mg , 500mg (usually advised 2 times per day)

COMMON INDICATIONS: Tonsilitis, Sinusitis, Pertusis, H.pylori Eradication

COMMON SIDE EFFECTS: BAD TASTE , GI Upset, Hepatotoxicity, Glossitis , Heart Burn

DRUG : CEFIXIME

BRAND NAMES: Caricef , Cef-OD , Cefspan

DOSES: (cap 200mg, 400mg) (tab 200mg) (usually advised once daily)

COMMON INDICATIONS: UTI , Lower Resp. Tract Infections

COMMON SIDE EFFECTS: GI Upset , Rash, Heart burn

DRUG : CIPROFLOXACIN

BRAND NAMES: Novidat , Ciprox, Ciproxin

DOSES:cap 250 mg, 500 mg (usually advised 2 times per day)

COMMON INDICATIONS: Infective Diarrhoea, UTI ,Enteric Fever, Lower Resp tract Infections, Anthrax,

COMMON SIDE EFFECTS: Rash , Bad Taste , Tremors, Palpitations

DRUG : METRONIDAZOLE

BRAND NAMES: Flagyl, ** Entamizole,** Metodine

DOSES:tab 200mg , 400mg (usually advised 3 times per day)

COMMON INDICATIONS: Amoebiasis - Giardiasis (DYSENTRY) , H. Pylori eradication , Aspiration

Pneumonia

COMMON SIDE EFFECTS: metallic taste ,neuropathy, GI UPSET, Disulfiram like reaction with Ethanol

DRUG : OMEPRAZOLE

BRAND NAMES: Risek, TEPH

DOSES:Cap 10mg , 20mg , 40mg (usually advised Once or Twice Daily)

COMMON INDICATIONS: Heart burn, GI ulcers, H.Pylori t/m

COMMON SIDE EFFECTS: Dizziness, Diarrhoea, Constipation

DRUG : METOCLOPRAMIDE

BRAND NAMES: Metomide

DOSES:tab 10mg (usually advised as when needed but not more than 2times per day)

COMMON INDICATIONS: Nausea/Vomiting , Diabetic Gastroparesis, GERD

COMMON SIDE EFFECTS: Dizziness, Diarrhoea, Galactorrhoea , Dystonia

DRUG : ARTEMETHER + LUMEFANTRINE

BRAND NAMES: Arceva ,Co-Mether

DOSES: tab 20/120mg , 40/240mg , 80/480mg (usually advised 2 times per day)

COMMON INDICATIONS: Malaria

COMMON SIDE EFFECTS: Dizziness, myalgia, palpitations, fatigue

For Paediatric Drug Doses Refer to Drug Doses Section in Mayo Paediatricians Manual

https://paedsmanual.blogspot.com/

Paeds Drug doses are also given at the end of this manual. Always confirm the dose from your senior
before you administer it.

____________________

ADMINISTERING DRUG TO PATIENT :

Administering a drug to any patient in any form per-Oral, I/V, I/M , S/C is an art.

It requires knowledge and practice regarding drug preparation, labeling, storage.

My advice to you is, let staff nurses administer drugs to patients. You should learn how to give medicine
via different routes to the patient. But, let staff nurses do their job. Otherwise mishaps could happen at
your hands.

If you are administering the drug, remember the 6 RIGHTS :

RIGHT Patient

RIGHT Drug

RIGHT Time

RIGHT Dose

RIGHT Route

RIGHT Documentation

You may study adverse effects of a drug, or method to administer it in MedScape app.

____________________

House Officer’s PROGRESS NOTES:

(SOAP)

Subjective:

Patient resting comfortably? Sick? Very Sick ? Active ? Good cry ?

Pink with Oxygen inhalation @ (say) 2 L/min or Pink in room air ? Playful ? Complaints or

issues over night? Fevers? Pain? Tolerating PerOral ? Include all relevant details from the
night before.

Objective:

Vital signs(Pulse rate, R.R , B.P , CRT, spO2,temp )

Weight (Weight change), I/O, UOP, Physical exam positive findings .

Latest Meds and labs can be listed in the margin or in this section.

IS THE PATIENT’S abnormal EXAMINATION finding of PAST improved yet ? Or is

there any Newer finding ?

Assessment/Issues:

For example:

Tachypnea

Oxygen dependence

fits not controlled on inj phenytoin 5mg/kg/day

low urine output

consolidation of right upper lobe

high TLC

Low platelet count

raised pCO2 in ABGs

PLAN:

Plan should address all the issues of the patient.

It should start from your very basic plan of management to advanced therapy you

may consider. Like:

i) continue oxygen inhalation via NG in nostril @ 1 L/min

ii) intermittent spO2 monitoring

iii) Keep cleared airway

iv) keep NPO as R.R is very high .

v) continue same A/B

vi) rehydrate the patient and monitor urine output

vii) monitor BSL

viii) increase dose of phenytoin from 5 to 7mg/kg/day

ix) if pCO2 goes beyond 60mmHg, consider Mechanical Ventilation

x) Monitor for bradypnea, ASOC, FITS, anuria, cardiac failure

xi) counsel father regarding patient’s current condition

xii) Consult Senior onCall regarding further management plan for rising pCO2

and so on.

(Plan illustrates how much you have been thinking for your patient).

▪ Things to keep in mind in every patient :

• Can I start patient per Oral/ advance the diet/ keep NPO / ?

• What supplies/home health does the patient need for home if being

discharged?

• Why does the patient still need to be in the ICU/hospital?

____________________

:::: When you are on 24-Hr Call Duty ::::

EAT WHENEVER YOU CAN.

SLEEP Whenever you get time.

Listen When Nature Calls.

While standing, if you get 5 min to Sit- Then SIT DOWN. Who knows that trauma cases will come in a
moment and you ll have to stand for next 5 hours on O.T table with attending surgeon.

While sleeping, if you re asked to attend a patient , always do so timely !

Find an activity. To drive you & your moods away from patients-books-drugs & drips. The better the
doctor is , the best hobbies he has ! Got no hobby - Find few !

:::: Be courteous to STAFF NURSES , WARD BOYS , GATE KEEPERS ::::

STAFF nurses have wide experience of working with many & more House Officers like you .

Learn from their experiences, listen to their management TIPS , BUT take decision based only on your
MENTAL PROCESSING ! It falls under the responsibility of Staff Nurses to make Syringes/DRUGS/ECG
machine/SUCTION MACHINES/OTHER EQUIPMENT available in ward .
Request them to provide the required things if not avaialble.

::::Install MEDSCAPE in your Cellphone::::

Its Free. It works Offline. & Will be your excellent guide throughout house job. Use Medscape to study
theory of a disease, DRUG dosage, DRUG Adverse Effects & contraindications, and specially the DRUG
interactions. It also has good theory on TECHNIQUES OF PROCEDURES e.g. doing Lumbar Puncture.

::::Trade name of any drug/active principle & its price can be searched from android app: Pharmapedia
pakistan::::

Finally,There is always room for improvement. Improve yourself. Gain clinical knowledge and Skill set ,
and apply it. House Job is for you to observe , observe and observe your patients and then plan a
supervised management !

Keen sensibility is doubtless a virtue of high order, when it does not interfere with steadiness of hand or
coolness of nerve; but for the practitioner in his working-day world, a callousness which thinks only of
the good to be affected, and goes ahead regardless of smaller considerations, is the preferable quality.

Cultivate, then, gentlemen, such a judicious measure of obtuseness as will enable you to meet the
exigencies of practice with firmness and courage, without, at the same time, hardening "the human
heart by which we live."

--------Sir William Osler

Good Luck !

Dr Tauseef Omer

Neonatal Fellow (Services Hosp, Lhe.)

FCPS Pediatrics ,

M.B;B.S. (KEMU)

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