SAMPLE BOTTLE
1. Blood sample bottle
It contains thioglycochocolate broth. Anaerobes grow at the bottom
while aerobes grow at the top
Precautions
In infective endocarditis, 6 separate blood culture specimen,
minimum of 3
Specimen collected at peak of fever or 1 hour apart.
Causes of culture negative
i) Right sided endocarditis
ii) Prior antibiotic use
iii) Non- bacterial (fungal endocarditis)
iv) Unusual bacteria
v) Incorrect diagnosis
2. Sterile universal bottle (white cap)
CSF sampling for MCS
Urine ״
Specimen ״
Stool ״
Gastric washout sampling
3. Plain bottle
Blood group and cross matching
Coomb's test and other serological studies
Serum bilirubin
4. Blue cap
It contains lithium heparin
Taking sample for U/E/Cr
5. Green cover bottle
It contains EDTA
Hematological- FBC, PCV, Blood Film for MP, ESR
6. Yellow cover bottle
It contains fluoride oxalate
RBS, FBS, CSF, Chemistry
GIVING SET
1. IVF giving set
a) it has no filter or sieve b) It is plain c) 20 drops = 1ml
2. Blood given set
a) Red colour code b) filter sieve c) has a balance d) 15
drops = 1ml
3. Soluset
a) Graduated b) has diaphragm to prevent fluid overload c)
special point for injection of IV injection d) prevent air embolism e)
60 drops = 1ml.
IV FLUIDS
1. Ringer's lactate: Na= 130mmol/l, Cl= 109mmol/L, K= 4mmol/L, Ca=
3mmol/L
2. 1/2 strength darrows: Na= 61mmol/L, K= 18mmol/L,
3. Normal Saline: Na = 154mmol/L, Cl = 154mmol/L
4. Dextrose Saline 43% dextrose in 0.18 (1/5) Saline:Na = 30mmol/L,
dextrose = 236, Cl = 30mmol/L
IV cannula Uses Complication
Ash --- 16G IV fluids administrations - Cellulitis
Green --- 18G Blood - Tissued line
Blue ---- 20G Intermittent delivery of drug -Thromboembolism
Pink ---- Blood sampling - Air embolism
Yellow --- - Septicemia
PHARYNGEAL AIRWAY (GUEDEL'S AIRWAY)
Oropharyngeal airway is made of hard rubber on plastic.
It is used to prevent biting and obstructions of the endotracheal tube.
It also facilitates suctioning of pharyngeal secretions.
Endotracheal tubes
Endotracheal tube are made of rubber (Magill variety) or synthetics
It may be cuffed or non- cuffed.
It is required to administer anesthesia where face cannot be used.
It is possible to give positive pressure ventilation with endotracheal tube
cuffed red rubber endotracheal tubes are usually used for orotracheal
intubation.
Size of endotracheal tube = Age in years
______________ + 4 (in mm)
4
Magill's endotracheal intubation forceps
Use in intubations; as aid for passage of endotracheal tube.
Laryngoscope
It is an instrument meant for direct examination of the larynx and for intubation
during anesthesia or assisted ventilation.
To examine congenital abnormality like laryngeal web
It consists of battery. Continuing handle with a blade attached to it by a hinge.
The bladder is curved in Macintosh type and straight in Magill's type of
laryngoscope. The straight blade is preferred for small children.
Contraindication
Acute epiglottis, Pertuisis, Diphtheria
Ambu Bag
Means Ambulatory manual Breathing Unit
Component Part
- Face mask: often made of transparent plastic for visualization of vomitus
- Unidirectional value
- Self inflator bag can be enriched with oxygen via a tube
Indications
Cardiopulmonary resuscitation
Newborn with no respiratory effort or low APGAR Score
Apnoeic patient
Congestive cardiac failure with sense ventilation perfusion mismatch
Near drowning
Complication
Infection
Gastric distension
Subcutaneous emphysema
Face mask
Face masks are made up of autistatic rubber
Used in cardiopulmonary resuscitation
Foley's catheter
Monitor urine output
Taking urine sample
Relative obstructions
Pulse oximeter
It is used to measure oxygen saturation and temperature. In cases like
Asthma
Severe Pneumonia
Bronchitis
Foreign body aspiration
Congestive cardiac failure
uroscope
A
Parts: aural speculomy + Self limiting electric devise.
Points to note; Color of tympanic membrane
Mobility of ear drum
Ability to reflect light
Presence of hyperemia in the ear drum
Indications
Infections: Otitis media, external
Foreign bodies in the ear
Trauma to the ear
Neoplasm of the ear
Nasal speculum
Indication
Nasal discharge ___ Epistaxis
Nasal polyps _____ Foreign body
Ophthalmoscope
Parts: 2 apertures, filters, mirror, adjuster, moveable switches, beam light for examine
corneal ulcerations. The right eye of the examiner is used to examine the patients
right.
Points to note
Color of the optic disc
Clarity of the disc
Elevation of the disc
State of the vessel of the disc
Indication
To detect raised ICP by blurring of the outline of the disc
To check for choroid tubercle of Tb meningitis
To check for dot hemorrhage of Hypertensive retinopathy
To check for the cotton wool spot of debate retinopathy
Tongue depressor: wooden or metallic
Uses:
Empyema of the larynx
Empyema of enlargement of the tonsils
Deviation of the uvula
Candidiasis
Membrane or pseudomembrane in the pharynx
Peritonsillar abscess
Dental caries
Suction machine
Parts: pump, vacuum and container containing hibitane antiseptic solution to prevent
the growth of organism in stagnant fluid. Rubber tubing and nozzle.
Indication
Tetanus
Cerebral machine
Meningitis
Bulbar poliomyelitis
Rabies
Meconium aspiration
Liquor aspiration
Viral encephalitis with coma
Metallic encephalopathy
Nebulizers
It is a compartment in which liquid drugs can be acted upon by a driving force
converting it into aerosol which can be inhaled into the respiratory tracts through a
face mask.
Types; set nebulizers, ultrasonic nebulizers
Parts; chamber with rubber tubing
- Cap with a mouth piece
- Face mask
- Compressor unit.
Indication
To deliver β - agonist to a patient with severe asthma
To deliver a β- agonist or Ipratropium bromide to a patient with acute
exacerbation of asthma or chronic airway obstruction
To deliver prophylactic medications such as sodium cromoglycate or
corticosteroids to a patient who cannot use inhaler device.
To deliver antibiotic such as cotistin in chronic purulent infections like
bronchiectasis
To deliver pentamidine for the prophylaxis and treatment of pneumocystic
carinii pneumonia in AIDS patient.
Oxygen cylinder/concentrator
Oxygen cylinder does not depend on electricity, but there is risk of explosion when
flame is brought close to it
Parts: - Oxygen cylinder contains the gas. White color indicate close oxygen
- Oxygen tank
- Pressure gauge: measure patient pressure of oxygen in the tank
- Flow meter: which measure the rate at which oxygen is given in L/min
0.5L/min ------ young infant
1- 2L/min -------- older children
- Bubble humidifier: contains water that humidifies the dry oxygen
- Rubber tubbing: which direct oxygen flow to the patient
Oxygen concentrator
- Air filter: severe dust particles from atmospheric air
- Start button
- Indicator light
Yellow ------ suboptimal function
Green ------- full function
- Flow meter
- Pressure gauge: bubble humidifier
- Rubber tubbing
Method of oxygen delivery
- Nasal catheter - Severe anemia
- Face mask - Oxygen hood
- Nasal Prong - Oxygen tent
- Nasal pharyngeal catheter - Head boxes
Indications
- Pneumonia - Severe anemia
- Bronchial asthma - Grunting baby
- Bronchiolitis - Severe Malaria with acidosis
- Pertusis - Congenital heart disease
- Diphtheria
- Heart failure
Exchange Blood Transfusion (EBT) Set
Contents
Three way tap
Extension rubber tubbing
Umbilical catheter (sizes 5 & 8F)
Three styles syringes (20mls) and a 5ml syringe
Blood giving set
Waste blood container/ bag
15cm ruler to determine the position of the catheter
1 Vial of 10% calcium gluconate
Three gauge syringes, cotton wool and spirit
EBT recording chart
Indication for EBT
In neonates with severe neonatal jaundice, severe anemia, DIC, severe
resistance sepsis, dialysis for toxemias
In Sickle cell disease patient in CVD stroke and priapism
Procedure
Complications
Due to the blood: hemolytic transfusion reaction, thrombocytopenia, acute
febrile reactions, allergic reaction, transmission of infection, hyperkalemia,
circulatory collapse.
Due to the procedure: hypovolaemia, circulatory overload, hypothermia,
sepsis
Due to umbilical cord catheterization: hemorrhage, infection, thrombosis,
embolism and cardiac arrhythmias
FLUID THERAPY
Normal saline
Plasma expander in stroke (20 – 30mls)
Moderate to severe dehydration
Irrigation of eye in conjunctivitis
Gastric wash out/aspirate
Administration of nebulised drugs
Administration of anti- Snake venom
Transport of biopsy specimen
Ringer's lactate
Severe shock
Hypovolaemia
Acidosis
4.3% dextrose in 0.18 Normal Saline
Maintenance fluid therapy
For child who can eat
D10 (make dextrose to10% for child who cannot eat but has
norglycemia
D12.5 (make up to 12.5%) or bolus dextrose 6hourly for -----------
D50/D10
Cerebral malaria
Protein energy malnutrition
Administration of quinine
Conditions requiring NPO
Any condition leading to hypoglycemia 20ml/kg in double dilution
1/2 strength Darrows
Diarrhoeal disease
Malnutrition
Paralytic ileus
DKA
Drug induced hypokalemia
Metabolic alkalosis: Pyloric stenosis
Renal tubular acidosis
Bather's syndrome
Indications for the use of nasogastric tube
Diagnostic and therapeutic
Diagnostic
i) Hollander's test is done to find the sources of vagotomy. The Ryle's tube
is passed to collect the gastric aspirate for acid studies.
ii) To diagnose pyloric stenosis: if the volume of total gastric aspirate after
12 hours fasting exceeds 200 c.c then gastric outflow obstruction may be
suspected.
iii) To diagnose tracheoesophageal fistula and ano rectal fistula small size
infant feeding tubes are used.
iv) To know the rate of gastric hemorrhage and its response to treatmrnt.
Once the hemorrhage stops, the aspirate is no more blood tinged or coffee
ground colored.
v) To collect the gastric lavage for acid fast bacillus.
Therapeutic
i) Acute intestinal obstruction is one of the most important
indication for passing a nasogastric tube. The three major
steps for managing a case of intestinal obstruction are
gastroduodenal suction drainage, fluid and electrolyte
replacement and the relief of the obstruction. The
preliminary gastric suction relieves the distension, and
hence the discomfort of the patient. It also decreases any
chances of aspiration. The decompression of the bowel for
removing the obstruction. The nasogastric tube is kept in,
even during the post operative period. The nasogastric tube
should be removed only when whole of the bowel has
regained its motility, i.e., when the patient has passed the
flatus.
ii) Acute peritonitis as it causes paralytic ileus
iii) Post operatively in cases of bowel surgery: the gastric tube
is passed to avoid acute gastric dilatation following bowel
surgery.
iv) In cases of gastric hemorrhage for instiling sclerosing agent
for cold vasopressin drip
For feeding
i) In commatose patient feeding and to avoid aspiration
ii) Following faciomaxillary injury or surgery
iii) in patient who cannot take orally for reasons like anorexia, the
nasogastric tube may be used for forced feeding.
iv) Administration of ORS
Infant feeding tube
It is similar to Levine's tube but is much smallere in size znd has no lead shot. It is
used in small children and infants for all the purposes discussed above