INSTRUMENTS

Infant feeding tube

 How to determine the correct length? (size 5-
12).
 How to confirm its position in the gut?

Indications:
Diagnostic- TEF, upper GI bleed, gastric lavage-
AFB, choanal atresia.

Therapeutic- Feeding, drugs, gastric lavage-

poisoning. Can be used as urinary catheter. Rarely as
oxygen catheter.
Contraindication- fracture of cribriform plate
Simple Red rubber catheter
Uses:
Urinary-
Diagnostic: Sterile urine collection, radiological
evaluation.

Therapeutic- Acute retention, bladder

irrigation, intermittent catheterization.

Non urinary: As flatus tube, enema, bowel

wash, oral/nasal suctioning, as tourniquet.
Oral airway
 To maintain patency of airway

-Comatose patients
-Seizures.
ET tube
 Cuffed/uncuffed.
 Parts- Adaptor, tube, murphy’s eye, balloon,

balloon inflating tip, vocal cord guide.

 Size- Int diameter (size 2.5 to 7).

◦ Uncuffed- Age/4 + 4
◦ Cuffed- Age/4+3
 Fixation-3 times size.
 Technique of intubation.
 Indications: PPV, resuscitation, GA.
 Confirmation of position-ETCO2.
 Laryngoscope
 Parts- Blade: Straight- Miller, Curved-Macintosh. Light
source.
 Size- 0- preterm
1- term neonate and infants
2 & 3- older children.

Age group Size of the

blade
Preterm and LBW 0
neonates
Term neonates 1

2-10 yrs old 2

> 10 yrs old 3
 AMBU

 2 types- Self inflating bag

Flow inflating/Anaesthesia bag.
Advantage of reservoir- 100% O2.
Size- 250cc,500cc,1000cc,1500cc.
E & C technique.
Indications- resuscitation
Contraindications- CDH, meconium.
LP needle
 Parts- needle, stylet
 Site-

L3-L4/L4-L5
 Indications-
 Diagnostic-
 CNS infections, GBS.
Therapeutic- spinal anesthesia,
chemotherapy, decrease raised ICT.
 Contraindications-
 Papilledema, local site infection.
Lumbar puncture needle
BM aspiration needle
 Salah’s / Klima’s
 Parts- needle, stylet.
 Site- Iliac crest, tibia, sternum.
 Indications- Diagnostic- ITP
Aplastic anemia
Leukemia
Megalobalstic anemia
Infections; Enteric fever, Kalazar
Storage disorders-Gaucher’s
Myelofibrosis

Therapeutic- BMT.
Contraindications-bleeding disorder.
BM biopsy needle
 Jamshidi’s trephine biopsy needle.

 Indications- “Dry tap”

Liver biopsy needle

 Tru-cut disposable needle.

 Site- 9th or 10th intercostal space in the mid

axillary line.

 Indications- Chronic hepatitis, cirrhosis,

unexplained jaundice, metabolic liver disease,
malignancy.
Liver biopsy tru-cut needle
Renal biopsy needle
 Semi-automatic disposable/Bard Biopsy gun needle.

 Site- USG guided, below 12th rib, lateral to the

sacrospinalis muscle.

 Indications-

Acute Glomerulonephritis- Delayed resolution- Oliguria, azotemia,

hematuria persisting beyond 2 weeks.
Nephrotic syndrome- steroid resistant
Acute kidney injury- Unremitting acute kidney injury lasting more
than 2 to 3 weeks.
Asymptomatic proteinuria
Systemic diseases- SLE,HSP.

 Contraindications-single kidney.
Bard Biopsy gun needle
DRUGS
 Crystalline/Benzyl penicillin-
MOA-Cidal/static.
Dose-1-2 lakh u/kg/day q4-6hrs.
Indications- Pneumo, strepto,meningo,gono.
RHD prophylaxis.

Amoxycillin/Co-amoxyclav- Semisynthetic-extended
spectrum.
Oral- 30-50mg/kg/day q 6-8h.
IV- 80-100mg/kg/day q 6-8h.
 Cloxacillin, Ampilox- Anti staphylococcal.

 Piperacillin- tazobactam- Antipseudomonal.

 Ceftriaxone- 3rd gen cephalosporin.

 Amikacin- aminoglycoside, 15-20mg/kg/d,

UTI, 2nd line ATT.

 Gentamicin- 4-5mg/kg/d.
Hydrocortisone: 2-5 mg/kg.
-Status asthmaticus, anaphylaxis, shock,
addison’s disease, CAH.

Dexamethasone: 0.1-0.3mg/kg/dose.
- Cerebral edema, shock.

 Adrenaline - 0.01mg/kg,1:1000.
 Atropine- 0.02mg/kg
VACCINES
 OPV
 MMR
 Hep B
 Td vac
 DPT
 BCG
NUTRITION
 Item K Calories/100g Protein/100g

[ Rice 350 7

Egg 173 13.3

 Rice
wheat 350 10-11
Ragi 330 7
Bengal gram(Chana 360 17
dal)
Black gram (urd dal) 340 24
Green gram (Mung 340 24
dal)
Red gram (Tuvar dal) 340 22
Ground nut 560 25
Banana 110 1.2
Drumstick leaves 90 6
Jaggery 350 0.4
 Rice

NUTRITIVE VALUE(per 100g) PUBLIC HEALTH IMPORTANCE

Energy: 345 Kcal • Rice proteins are Good source of

B group vitamins, especially
Proteins: 6.8g
thiamine .
Fat: 0.5g • Richer in lysine than the other cereal
proteins.
• Poor source of calcium and iron
• Effect of Milling: Causes reduction in-
• Protein - 15%
• Thiamine 75%
• Riboflavin and Niacin 60%
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Rice
 Staple food.
 3 parts

◦ Seed coat
◦ Outer pericarp aleurone layer ( nutrients)
◦ Inner endosperm ( contains mainly starch)

 Rich in thiamine
Parboiling
 Soaking the paddy (unhusked rice) in hot
water at 65-70 deg for 3-4 hours.
 Results in swelling of grain.
 Followed by draining of water and steaming

the soaked paddy for 5-10min.

 The paddy is then dried and pounded.
Advantages of parboiling
 During the steaming process, the vitamins
and minerals in the outer aleurone layer are
driven into the endosperm layer.
 Heat used in drying hardens the grain which

makes it resistant to insect invasion.

 Disadvantage- peculiar smell.

Millets

 The term “millet” is used for small grains which includes jowar (sorghum), bajra

(pearl millet), ragi, kodo, etc.,

 They are ground and eaten without having the outer layer removed.

 The calorie and protein contents of millets are similar to that of the

cereals.

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 Ragi

NUTRITIVE VALUE(100g) PUBLIC HEALTH IMPORTANCE

• Cheapest among millets

Energy : 328 Kcal
• It is a good source of iron,
Protein:7.3g phosphorus, thiamine and a
fair source of niacin and
Rich in calcium : 344 mg
riboflavin

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 Ragi-rich in calcium.

 Egg-60 g, energy-60kcal, fat-6g, protein-6g

 Groundnut- rich in proteins, vitamin B.

 Jaggery- rich in iron.

 Pulses (dhal)- Bengal gram (chana), green

gram (mung), black gram (urd), red gram
(tuvar)