GUTD ELI}{ES FOR TIOT.

ISE SURGEONS IN D OF
PAEDIATRICS
D,*. ?OOe\Ikr.4 K N,.4SSOCIA?X_PROFESSOR, MO IL\CIIARGE OF HOASE SAB-GEOi\S
Sperial th$nks: DSJIXNL &!]U!E{!}

GENERAL INSTRUCTIONS

All HS should maintain good behavior

All duty HS should follow the instrrrctioas of the duty MO aad duty PG.

Always listen to fhe patient, hear the complaints of the bystanders and have a sympathetic
approach.

Keep warm relationship with bystanders and other stafflike nurses, attenders etc.

Any complaints from patients, nursing staff, office staff, PG and MO will be taken seriously
and if found genuine they will be given one week extensioa. Decision will be taken by the
HOD.

HS can take 1 leave during their postiag with prior permission, without affecting the duties.
HS taking treave is responsible f,or arraogrng their deties with other HS. They should inform
the concerned unit chief, give the written leave letter, and get sign fiom the HS responsible for
their duties in their absence.

Leave shauld not be taken without prior perrnission. fftaken they will have ta do one week
extension.

If any emergency arises, they can iniorm the unit chief througfu phone or by SIv{S if phone call
is not attended.

All house surgeons should reach by S.00 a.m. and should sign in the momiug and also
aftemoon after 12.00 Noon.

Those who are posted in Pl, P2, P3, OBNABN should meet the respective uait chief.
In the unit, they should assist the PG, write down iuvestigation forms, draw blood for
investigation, rrrite discharge book aud follcw ofher instnrctions givur by the M.O. Al1 entries
on the front page of the discharge book should be completed. After w"ritiag the discharge book,
it should be counter signed by the unit PG.

Department of Paediatrics, GTDMCH, Alappuzha

CASUALTY DUTY

Those who are posted in casualty should reach there by 12.00 noon on week days preferably
5 mins earlisr. If they are having rounds, they may get the perrnission of the M.O. and should
reach the casualty on time.

On Sundaythey should reach casualtyby 8.00 a.m,

Casualty night HS should leave the casualty on next day morning only after the arrival of
HS/PG in the OPD.

In the casualty they should maintain the casualty register dai1y.

In the casualty ticket they should write the time of exanniaing fhe patient. They also should
write dorain the chief complaint and vitals iike Respiratory rate, Pulse rate and temperature. BP
should be documented whsrever necessary.

While taking duty they should get the mobile nurnber of duty PG and Duty MO.
If they leave the casualty for anypurpose" it should be with the permission of PG/IVIO.
ALL REF'ERRED CASES A}[D INTFANTS LESS TEE 3 MONTITS SHCULD BE SIIOWN TO PG OR
MO.

WARD DUTY
HS posted in ward should reach by 12 p.m. and sho*ld bs there till 8.00 p.m. They should
send investigations for all nerv adurissions, enter the investigation reports in the case sheets
and also hand ovsr the discharge card to the parents ofpatients.

They should attend the complaints of patients admitted in the ward. They should also monitor
the children as instructed by correspondiag units. If needed can discuss with dufy PG/I{O

NE\tr BORN DUTY

Those who are posted in IBN should be there till 8.00 p.rn. You should assist in the ICU rounds
and postaatal rounds.

ICU DUTY
HS posted in ICU should assist the PG. Detailed instructions given in PICU.

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 MANAGE},IEi\T OF T] CASES I}T OP I CASUALTY

BpSPTRATORY
1. -
May be URI. Prescribe Synrp.paracetamol, Saline Nasal drop,
Fever, Rhinitis, Cougfu:
S3rp. Salbutamol
2. Fever, Cough, Dyspuoea :- tr RI. May be Bronchopneumonia, Broochial asthma (W"heezing) or
broachiolitis
In Bronchopneumonia: - There will be fever, tachlrynoea, chest indrawing and on
auscultation crackles will be present. Show the child to
PG/M.O.
Bronchial Asthma flVheezing): There will be past history of wheezing and fever usually
aot significant. O/E there will be B/L Rhonchi- Few crackles
maybe present.
Look for sigas of hypoxia. If SPOz is more than 90 and no
features of hlpoxia give MDI or nebulization with
salbutamol 3 times at 20 minutes interval. If not improving
show the child to PG I M.O.
In Broachiolitis: Child will be around 6 rnouths of age and will not be sick
looking. Auscultationmay show few rhonchi. Show the
child to PG / M.O.

GIT

l. Vomiting: I-ook for any ryecific cause. If there is fever look for sigas
of meaingitis, UTI- Ifno definite sause is found give oral
damperidone or Gndansetron along with ORS. It may be
repeated orlce or twice. If persisting show the child to PG /
M. O. No IM injections. Always suspect increased
intracranial tension as a cause of persistent vomiting.
Odollum poisoning should be suspected if there is
vomiting and irregular pulse.
2. Diarrhoea: Ask for pressnse of blood to rlo dysentery and foul smell to
do iafective diarrhea. Iook fior signs of dehydration and
ask whether child passed urine recently. If no signs of
dehydration give ORS, Zinc with or without pre-probiotics.
Advise mother th*t diarrhcea maypersist for
5 to 7 days and ORS is to prevent dehydration. If there is
some dehydratioa or severe dehydration show the child
PGll,IO. Reassess the child ia between.

Department of Paediatrics, 6TDMCH, Alappuzha

 3. Pain abdomen: Look for features of aeute appendicitis and volvulus. In
small infants look for intussusception. Child may be sent ts
Pediatric $rgery casualty a{ter showing the child to
PGI]\,{O

CNS

1. Seizure: Take child to ICU. Even if the seizure has subsided child
should be admitted as there is a chance for recurrence .
2. Altered behavior: May be encephalitis or eleckolyte imbalance. Admit the
child in ICU.

CVS

1. Palpitation Take ECG and do cardiology coosultation.

2. Chestpain Usuallynon cardiac. ECG and X-ray chest maybe taken to
rio ALCAPA & Cardiomyopathy.

1. Excessive clT: Maybe colic, ear ache, meningitis or intussuscqrtion.

Sedate the child and reassess.
2. Urticaria: Auscultate chest for rhonchi. Check BP for Hypotension.
Syrup Hydroxyzine and Calamine maybe glven. If severe
injectian Adrenaiine and oral steroids may be given' Keep
the child under observatior.

ALL SERIOUS C}IILDREN SHOTJLD BE TAKEI{ DIRECTLY TO ICU AI{D

PREFERABLY ACCOMPANIEI} BY A HS.

Department of Paediatrics, GTDMCH, Alappuzha

DQSAGE OT COUUONLY USED DBUGS TN PEDIATRIC OP i CASUALTY
posE FoRA toKGCHILD

l. Synrp- Paracetamol [12515m1] l0-15mg&g/dose 5ml3 times a daY

2. Sy.up. Salbutamol [zmglsmt] 0.1-0.2mg&g/dose 2.5m13 times a day

3. Syrup. Cetirizine lsmelsm{ 0.2mglkg/day 2.5mI HS

4. Synrp. Arnoxycillin [125mgl5ml] lSmg/kgldose TDS 5ml 3 times a day

5. Synrp. Azithromycin [l{Xknglsml] l$mg/kgl day 5ml OD

6. Symp. Cefixime [50mg/5ml] 5mg&g/dose BD 5r*12 times a daY

7. Synrp. Domperidone fimgllml] 0.2mg&gldose 2.5m1up to 3 times

8" Syrup. Ranitidine psmgism[ 2mg&gldose

L Syrup. Ondanseton [2mg/srn{ 0.lmg/kgldose 2.5m1up to 3 times

I 0. Synrp. Albendazole [200mg/5ml] > 2yrs I Oml HS as single dose

11. Synry. Py:antel palmoate l0mg/kgidose 2.5m1HS re,peat after 2 wks

12. Syrup. Hydroxizine IOmg/5ml] 2mglkg/day 2.5ml TID or QID

13. Synrp- Zinc [20mg/5ml] >6months 20mg OD for l4days {2-6m 10mg OD)

14. T. Pantoprazole 40mg lmg/kg/dose OD

15. T. Lanzapruzole I5mg lmg&g/dose OD
16. T- Clobazam 0.75 - lmglkgldayBD

Tablets should be given only to older children {> Eyrs} after asking them whether the child
will take oral t*trlets.

STRENGTH OF COMMON TABLETS"

o Tab. Faracetamol 5 00rng/ Syp. Paracetamotr [25 0/5i, [ 1 2515 ], [ 1 00/ I ]

a Tab. Salbutamol Zmg, mg Tab. Cetirizine 10mg

a Cap. Amoxycillin 250mg,500mg Tab. Cefixime 100mg,200mg

a Tab.Azithromyciu 100mg,250mg,500mg Tab.Albendazole400mg

a Tab. Eomperidone 10mg Tab. Ondansekon 2mg,4mg

a Tab. Pantaprazole 40mg Tab. Lanzoprasale 15mg

Department of Paediatrics, GTDMCH, Alappuzha

 NEBULIZATTOi{

Salbutamol 0.5rr1+ 3mlNS + Oz [Children <20kg]

1m1+ 3ml NS + Oz [Children >20kg]
Ipratropium <1 Yr 0.5 mI+3 mI NS + Oz
>1 Yr 1 ml+3 mlNS + Oz
For children < 3 months avaid Neb. Salbutamol

lutTIsF{AL II}{}{UI}{IZATIOI\{ SCHEDULE

a At birth - BCG, OPV - 0, Hep. - B birth dose

o 1%month6weeks Inj. Pentavatent (l) + OPV (l) + fIPV (l) + PCV (l) + Rota (1)

a 2Yzmanth 10 weeks Inj. Pentavalent (2) + OPV {2) + Rota (2)

a 3 tAmofib 14 weeks Iqi. Pentavalent (3) + OPV (3) + fIPV (2) + PCV {2) + Rota (3)

t 9 rnonths Inj. Measles-Rubella (MR) + PCV(Booster) Oral Vit.A I L unit

a I Yeyearc (15 month) Inj. MR

o I rAyexs Iqi. DPT {booster 1) + OPV (boosted + Inj. IE + Oral Vit. A 2 L unit

t 5 years Inj. DPT (booster 2) + Orat vit. A 2 L Unit

a 10 years & 16 years Inj. Td

Department of Paediatrics, GTDMCH, Alappuzha

 I}TSCHARGE CARI} DETAILS
a Fill the front page and l " pug* of the discharge card.

r Presentingcomplaints

J Vitals : Temp.
: Pulse Rate
: Respiratory Rate
: Blood Pressure
I Anthropomstry : $/eight
: Ht / Length
: Head circumference
r Head to fcot : Anypositive finding

t Systern examination : Positive findings

a Investigations : Urine routine examination

: Blood routine examination
: X-ray chest
: RFT
: LFT
: Other investigations if any
e Consultation dane & advise given

a Final diagnosis: Diagnosis + Nurition status + Developmental

status + Immuai r"ation status

. Treatment given

a Discharge srunmary and Discharge advice (By PG)

fRecherk the name, &g€, [P No.,, DOA, I]f]D, LTnit, Diagnosis and advise
after writing fhe discharqe book.
HS should sign and write the name and designation at the end of the
discharge. The discharge trmk should be caunter-signed by a PG befbre
handing over tc the parent.J

Department of Paediatrics, GTDMCH, Alappuzha

 WELCOME TO TT{E PAEDIATRIC ICU

You are resident doctors in the PICU who are essantial to patient care. Kindly consider
yourselves as such and do not degrade yourselves by ycur actions"

The followingarc a list of your responsibilities in the Paediakic ICU"

1. As the resident doctor, kindlyfarniliarize yourselfwith the patisnts in the PICU, at least
with their primary diagnosis-
2. Familiarize yourself with all emergency and life-saving equipment ia the PICU during
your rotation, Please be careful when handiing equipmenf in PICU so that we cau avoid
damage to the same.
3. All procedures conducted in the PICU including fV cannulation are part of yow
learning experience. You are required to help nursing staff and PGs for the same.
4. Monitoring of all patients admitted to the PICU should be done and their monitoring
charts should be completed aud attached to the case sheet beftne the end of your shift.
The relevant parametsrs and the &equency of monitoring will vary from child to child
and the also according to the severity of illness. Kindly canfirm with the respective PG
on duty regardiag the same and also make it a point to eaquire and understand why you
are required to monitar them.
5. Orders for each respective day have to be written by the HS on the night shift before 7
am-
a. It is MANDATORY to sign the drug sheet entry once complete.
b. The drug orders slrouldbe COMPLETE and IEGIBLE and SHOULD include
the NAME of the drug (preferably in capital letters), the DOSE, ROUTE and
FREQUENCY of adminiskation.
c. Any corrections made while writing especially with dosage and frequency,
CANNOT be made by overwriting. The ENTIRE order has tc be crossed off
and re-written.
6. Compietion of the demographic details on ALL pages of the case sheet especially
Name, Age, IP no and weigfut of the cldld is entusted to you. These shouid be entered
on EYERY page especialiy the dnrg charls and reference requests to other departments.
7. Requests for all investigaticns, outside drugs, local purchase and investigations should
be complete and ificlude all necessary details. Please also ensure they are sent on time.
8. House surgeons should maintain the HS HANDOVER book ir the PICU. This register
is ta be maintained for EACH shift. During each shift, the namss af the children in the
PICUhave to be eaterediathe following format.

No Name IP Ns Diagnosis Investigations seirt Investigations

during my shift pending to be
collected

Coltect all relevant investigations promptly and easure they are entered in the case
sheet. Once they have been entere4 they may be crossed off the second iast column.
The last column should be fiIIed prior to handoyer to the next shift.
9. Coilection of RAT and RTPCR for COYID19 in indicated patients, packing and
labelling of RT-PCR. samples along with completely filled forms, completion of
COVID19 sampling register AND proper and safe disposal of the used equipmeat/kit
is entrusted to you.

Department of Paediatrics, GTDMCH, Alappuzha