PAEDIATRICS

INSTRUMENTS

BY MBBS GANG
 1. RYLE’S TUBE

GORY

14: Green
16: Orange
18: Red
20: Yellow

Description:

It is a flexible tube made of rubber or non-toxic, medical grade PVC compound, and
it has bidirectional potential. It can be used either to feed or remove the contents of
the stomach including air to decompress the stomach or to remove small solid
objects and fluid, such as poison from the stomach.

Different uses: The 2 main indications for use of Ryle’s tube are:

a) aspiration of gastric contents, and b) nutritional supplementation of the patient.

(A) Diagnostic—

1. Evaluation of upper gastrointestinal (GI) bleeding (i.e. presence and volume)

2. Aspiration of gastric fluid content

3. Identification of the esophagus and stomach on a chest radiograph

4. Administration of radiographic contrast to the GI tract.

(B) Therapeutic—

1. Gastric decompression including maintenance of a decompressed state after

endotracheal intubation, often via the oropharynx
 2. Relief of symptoms and bowel-rest in the setting of small bowel obstruction

3. Aspiration of gastric content from recent ingestion of toxic material

4. Administration of medications in comatose patients

5. Feeding when patient is unconscious or when the patient is conscious but

unable to swallow voluntarily

6. Bowel irrigation

• Gastric lavage is contraindicated in a) Corrosive poisoning (Ryle’s tube may

perforate the oesophagus in acid or alkali poisoning), and b) Kerosine oil,
paraffin or petroleum poisoning (gastric lavage increases the chance of
development of lipoid pneumonia).

Absolute contraindications for NG intubation include the following:

• Severe midface trauma

• Recent nasal surgery.

Relative contraindications for NG intubation include the following:

• Coagulation abnormality

• Esophageal varices

• Recent banding of esophageal varices

• Alkaline ingestion (the tube may be kept if the injury is not severe)

Verification of Position of Ryle’s Tube

• Verify proper placement of the NG tube by auscultating a rush of air over the
stomach using the 60 mL Toomey syringe or by aspirating gastric content

• Obtaining a chest radiograph

• Colorimetric capnography in mechanically ventilated patients

Ryle's Tube — Markings from Tip

• 1st Mark — 40 cm: Indicates tube has passes up to Cardiac orifice of stomach

• 2nd Mark — 50cm: Tube is at Body of Stomach

• 3rd Mark — 55 cm: Tube at Pylorus of Stomach

• 4th Mark — 65 cm: Tube has reached in Duodenum

 2. FOLEY’S BALLOON CATHETER

Male: [GORY]

14: Green
16: Orange
18: Red
20: Yellow

Female:

10: Grey

12: White

This is a variety of self-retaining catheter:

A. In 2-ways Foley’s balloon catheter, the side channel is used to inflate the balloon
so that it is kept indwelling. There is a valve in the side channel. The main channel is
for drainage of urine. The catheter number (no. 16 Fr.) and the balloon capacity (30–
50 mL) is mentioned on the main or side channel.

B. In 3-ways Foley’s balloon catheter, there is an additional third channel for either
irrigation or drainage.

Material: Medical graded PVC

Uses:

1. For relief of retention of urine by urethral catheterization.

2. May be used for suprapubic cystostomy

3. May be used for tube nephrostomy

4. May be used for urethral catheterization following urethroplasty

Contraindication: Urethral trauma is the only absolute contraindication to placement

of a urinary catheter.
3. UROBAG

• A urobag, or urinary drainage bag, is a medical device used for collecting and
storing urine in various situations:

1. Postoperative Care: Connected to a catheter after abdominal or pelvic

surgery until normal bladder function resumes.

2. Urinary Incontinence Management: Used by individuals with urinary

incontinence for discreet urine collection.

3. Immobile or Bedridden Patients: Facilitates hygienic urine collection for

patients with limited mobility.

4. Monitoring Urine Output: Critical in measuring and monitoring urine output

for kidney function and fluid balance.

5. Diagnostic Tests and Procedures: Employed to collect urine samples during

medical tests and procedures.
 4. PERIPHERAL IV CATHETER

Parts

1. Needle—pierces the skin

2. Flexible (outer) catheter: Made of soft silicon/Teflon that is threaded into the vein.

3. Port: For injecting medicines — available in a few cannulae

4. Knob in a few cannulae

Indication: Venipuncture for administering IV fluids and IV medications

Procedure

Identify the vein → clean the area with spirit → just insert cannula in the vein →
remove needle partially → advance the plastic cannula forward → remove the needle
and apply the knob on the hub → fix the cannula

Complications

• Thrombophlebitis, sepsis, and hematoma.

Change every 24–48 hours—earlier if blocked

Size Length Flow rate Uses

(mm) (mL/ min)
14 G 45 250-300 • Used for adolescent and adult major surgery
and trauma
• Infusion of large amount of fluids and colloids
16 G 45 150-240 • Adolescent and adult major surgery and trauma
• Infusion of large amount of fluids or colloids
18 G 45 100-120 • Adolescent and adult major surgery and trauma
• Infusion of large amount of fluids or colloids
20 G 32 55-80 • Older children, adolescent, and adult
• Ideal for IV Infusion or blood infusion
• Medication administration & Emergency
management
22 G 25 22-50 • Older children, adolescent, and elderly adult
• IV Infusion with moderate flow rate
• Medication administration
24 G 19 23 • Infant, toddler, and older children, also Major
surgery and trauma among children
• Can administer fluid and medications
26 G 19 10-15 • Neonate, infants, and elderly adults
• Suitable for infusion but infusion rate is low
 5. 3-WAY CANNULA

Description:

It is a T-shaped instrument with two inlets and one outlet. By adjustment, the outlet
may be connected with either of the inlets.

Different Uses:

1. To aspirate fluid from pleural, peritoneal or pericardial sac (fluid is withdrawn

through one inlet by connecting a syringe with the cannula and by adjusting the
screw, fluid in the syringe may be pushed into the kidney-tray via the outlet).

2. Through one inlet, IV fluid may be given (by an IV set) and the other inlet may be
used for medications or monitoring central venous pressure (CVP).
 6. IV DRIP SETS

Used for administering intravenous fluids, drugs, and blood products.

Intravenous (IV) fluids are administered through thin, flexible plastic tubing called an
infusion set or primary infusion tubing/administration set. The infusion
tubing/administration set connects to the bag of IV solution.

Primary IV tubing is either a Macrodrip set (delivers 10, 15, or 20 drops/mL), or a

Microdrip set (delivers 60 drops/mL).

Macrodrip sets are used for routine primary infusions. Microdrip IV tubing is used

mostly in pediatric/ neonatal care.

The drop factor can be located on the packaging of the IV tubing.

Primary IV tubing is used to infuse continuous or intermittent fluids or medication. It

consists of the following parts:

• Backcheck valve: Prevents fluid or medication from traveling up the IV

• Access ports: Used to infuse secondary medications and give IV push

medications
 • Roller clamp: Used to regulate the speed of, or to stop or start, a gravity
infusion

• Secondary IV tubing: Shorter in length than primary tubing with no access

ports or backcheck valve; when connected to a primary line via an access port
used to infuse intermittent medications or fluids. A secondary tubing
administration set is used for secondary IV medication.

• Flow Rate Calculation

· Macrodrip set (16 drops/mL) · Microdrip set (64 drops/mL)

[𝑉𝑉𝑉𝑉𝑉𝑉𝑉𝑉𝑉𝑉𝑉𝑉 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 (𝑖𝑖𝑖𝑖 𝑚𝑚𝑚𝑚) × 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷 𝑓𝑓𝑓𝑓𝑓𝑓𝑓𝑓𝑓𝑓𝑓𝑓 (𝑖𝑖𝑖𝑖 𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑 / 𝑚𝑚𝑚𝑚)]
𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹 𝑟𝑟𝑟𝑟𝑟𝑟𝑟𝑟 =
𝑇𝑇𝑇𝑇𝑇𝑇𝑇𝑇 𝑜𝑜𝑜𝑜 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 𝑖𝑖𝑖𝑖 𝑚𝑚𝑚𝑚𝑚𝑚𝑚𝑚𝑚𝑚𝑚𝑚𝑚𝑚
6a. INFUSION SET

(a) Common set —

(i) Uses:
• Infusion of parenteral fluids
• Administration of some medicines of larger volume — e.g., mannitol,
metronidazole, etc.
• Administration of some medicines which need slow infusion after dilution with
fluid - e.g., phenytoin, quinine, etc.
(ii) Rate of infusion:
• By adjusting the number of drops through ‘drop chamber’ of the set. Approx.
16 drops = 1 mL
(b) Microdrip set - It has a graduated cylinder (volume chamber) for a given volume
of fluid. The capacity of the cylinder is usually 110 ml. Uses are:
• Infusion of smaller volume of fluid in a given time
• Administration of some medicines diluted with calculated volumes of fluid,
e.g., quinine, dopamine
• Rate of Infusion: By adjusting the number of drops visible at the cylinder.
• 1 macrodrop (of common set) = 4 microdrops of microset
• Thus, 1 mL = 16 macrodrops = 64 microdrops
6b. TRANSFUSION SET

Transfusion set: Same as infusion set but having in addition a strainer to strain
clots or coagulated blood products

(i) Use: For transfusion of blood and blood products.

(ii) Rate of transfusion: By adjusting the drops at drop chamber.

Approx 1 ml = 16 drops.
6c. MV (MEASURED VOLUME) BURETTE SET 150 ML

A pediatric burette set is a volumetric IV solution administration set that uses a

metered cylinder to accurately administer a specific volume of solution. It is used for
the controlled infusion of medications, often over long periods of time.

Burette sets are available in sizes 110 mL and 150 mL. They have a standard drop
factor of 60 drops/mL.

Some other features of Pediatric Burette

Sets:

• IV sets: Connect the medication to the

needle inserted into the patient

• Metered cylinder: Allows for accurate

administration of a certain volume of
solution

• White band: Printed on the rear of the

scale for easy and near accurate
reading of volume by para-medic staff

• Cylindrical soft transparent

chamber: Allows for easy monitoring
and observation of the fluid level

• Silicon injection port with a

hanger: Ensures easy access for
medication administration
 7. PRESSURE MONITORING LINE

Description:
• Flexible, kink-resistant tubing for connecting patient to pressure monitor.
• Made of non-toxic medical-grade PVC, various lengths and sizes available.
• Sterile, single-use or reusable with proper cleaning.
Uses:
• Monitoring blood pressure: Non-invasive or invasive (arterial, central venous
lines).
• Monitoring intracranial pressure: External ventricular drain connection.
• Measuring airway pressure: During mechanical ventilation or CPAP.
Side effects:
• Local irritation, skin breakdown at connection sites (rare).
• Air embolism risk with improper central venous line insertion.
• Contraindicated in cases of known skin allergies to PVC or adhesive materials.
 8. LUMBAR PUNCTURE NEEDLE

Description
Lumbar puncture is a
technique done to obtain
CSF sample. It also provides
an indirect measure of
intracranial pressure (ICP). It
is usually done between L3
and L4 (3rd lumbar space) through the dura and into the spinal canal.
Indications for Lumbar Puncture
Diagnostic Indications
• Meningitis
• Encephalitis
• Subarachnoid hemorrhage
• Primary or metastatic
malignancy (e.g. acute
leukemias and lymphoma)
• Demyelinating diseases: Multiple sclerosis and Subacute sclerosing
panencephalitis (SSPE)
• Guillain–Barré syndrome
• Injecting the radio-opaque dye for myelography
Therapeutic Indications
• Spinal anaesthesia and epidural analgesia
• Intrathecal injection of chemotherapeutic drugs for CNS prophylaxis/relapse of
acute lymphoblastic leukemia (ALL), lymphomas
• Therapeutic CSF drainage in cases of normal pressure hydrocephalus
Contraindications for Lumbar Puncture
• Raised intracranial pressure, coagulopathy
• Local infective lesion
• Bony deformities at site of puncture
Complications of Lumbar Puncture
• Postspinal headache
• Introduction of infection by the lumbar puncture needle through the infected
skin or subcutaneous tissue.
• Herniation of cerebellum through the foramen magnum due to raised
intracranial pressure.
 9. BONE MARROW ASPIRATION NEEDLE(S)

Description:

The Bone Marrow Aspiration consists of 3 parts—

1. The needle proper—It is a stout wide bore needle (length is 5 cm); the needle is
shortly beveled at one end, and the base of the stylet or the nozzle of a syringe fits
in the other broad end.

2. The stylet—It keeps the needle patent during introduction. When kept inside the
needle proper, it helps to know whether the tip of the needle has entered into the
marrow cavity or not. The base of the stylet contains a small projection for better
fixation with the needle proper.

3. The adjustable guard—The adjustable screw guard prevents over-penetration of

the needle. The plane or flat surface of the guard should look down to the chest wall
of the patient.

There are 2 types:

(1) Salah (commonly used) and (2) Klima. The two varieties differ in the design,
especially in the type of the guard.

Klima’s variety contains an adjustable guard on the stem of the needle proper; Klima
has a central screw (Salah’s has a side screw).

The needle is sterilised by immersing in Concentrated Lysol solution.

Sites of puncture:
1. Posterior iliac crest.
2. Body of the sternum—2nd or 3rd body on either side of midline (manubrium
sterna is less cellular).
3. Upper part of the medial surface of tibia, just below the tibial tuberosity.
4. Spinous process of lumbar vertebrae.
5. Ribs (rarely used)
6. Any site of bone infiltration or tumour (in disease)

How to be sure that marrow cavity has reached?

1. Sudden loss of resistance.
2. The needle remains in vertical position without any support.
3. The tip of the stylet is smeared with red granular marrow material when removed
from the needle.
4. Reintroduction of the stylet will produce pain.
5. Suction by the syringe produces severe and intense pain (most reliable proof), and
is due to irritation of pain carrying nerve fibres surrounding the marrow cells.

Complications of bone marrow aspiration:

1. Over-penetration (if posterior table of sternum is penetrated, damage to aorta
and its branches, vital mediastinal structures) cardiac tamponade and pneumothorax
may develop.
2. Haemorrhage (haematoma) and bone pain.
3. Shock.
4. Infection (osteomyelitis)
5. Sudden death due to accidental injury to vital organs.
Causes of dry tap (Failure to obtain marrow): [Need to go for Trephine Biopsy]
1. Faulty technique.
2. Myelo-sclerosis/ myelo-fibrosis (marrow replaced by fibrous tissue).
3. Marrow aplasia or hypoplasia (marrow replaced by fat).
4. Gross marrow hyperplasia—May be seen in leukaemia.
5. Carcinomatous infiltration of the bone marrow (tightly packed with infiltrates).

Contraindications:
• Bleeding disorders and coagulopathy
• Local skin infection/osteomyelitis.

10. JAMSHIDI’S BONE MARROW BIOPSY NEEDLE

• Trephine Biopsy done when bone marrow tap is dry

• Also done for infiltrative disorders
 11. TRUCUT LIVER / KIDNEY BIOPSY NEEDLE

A needle with a gap near its tip is passed into the lesion. A surrounding sheath with
a cutting tip is passed down the needle. The sheath cuts a specimen corresponding
to the gap in the needle. The needle and sheath with the specimen are then
removed from the patient.

Use: For tissue biopsy— liver/ kidney.

 12. VIM-WILSMAN LIVER BIOPSY NEEDLE

Description
It has three parts:
1. Cannula
2. Stylet/trocar
3. Prong/fork/bifid needle—longer than needle and it protrudes out of the
needle. It has a very sharp cutting edge and has longitudinal groove. This
retains the tissue when the needle and cannula are withdrawn.
Indications for Liver Biopsy
• In evaluation of jaundice
• Liver cirrhosis
• Storage disorders: Glycogen storage disease, hemochromatosis, and Wilson’s
disease
• Granulomatous lesions like Tuberculosis and Sarcoidosis
• Infections: Viral [cytomegalovirus (CMV), Herpes, and Parasitic (amoebic liver
abscess where it is both diagnostic and therapeutic)]
• To diagnose Benign and Malignant neoplasms.
Contraindications of Liver Biopsy
• Bleeding diathesis • Hydatid cyst
• Hemangiomas • Severe ascites
Complications of Liver Biopsy
• Hemorrhage
• Infection
 • Adjacent structures can be injured (gallbladder, colon, and blood vessels)
• Rarely there can be precipitation of hepatic coma
13. INSULIN SYRINGES (40U, 100 U)

Description:

This is a syringe with capacity of 1 ml. The cylinder has markings on its outer surface
indicating the amount of insulin in units, present distal to the piston.

Insulin syringe resembles tuberculin syringe, though the piston is white in colour

(not blue).

Insulin is available in India as 40 units/ml or or 100 units/ml, thus the 1 ml is

graduated into 40 or 100 units.

Different uses:

1. To inject insulin in the subcutaneous (S.C) route in diabetic patients.

2. In neonates, insulin syringe may serve the purpose of a ‘hypodermic syringe’ for
giving injections by I.M or S.C route.

3. Sometimes it is used to give a test-dose on the forearm before administering a

drug (e.g., test of hypersensitivity reaction before giving injection penicillin).
 14. TUBERCULIN SYRINGE

Tuberculin syringes are small syringes with fine needles that hold up to 0.5 to 1 mL
of fluid, used to administer medication (antigen) under the skin and perform a TB
test called purified protein derivative (PPD)/ Mantoux test.
 15. 5 ML / 10 ML / 50 ML SYRINGE

Description:

A syringe has two parts,

a) Air-tight piston, and

b) Cylinder with a nozzle at one end for fitting tightly with the base of a needle,
scalp vein set or adaptor. The cylinder possesses markings on its outer surface
indicating the volume of the drug to be delivered.

The syringe is usually made of glass. Disposable plastic syringe is for single use. This
type of syringes (5ml) are often called ‘hypodermic’ syringe.

Sterilisation:

1. Keeping (heating) in boiling water minimally for 30 minutes, separating the piston
and cylinder (before putting in water, loosely wrap the piston and cylinder with
sterile gauze).

2. Autoclaving.

3. Gamma ray irradiation

4. Ethelene oxide
Different uses:

(A) 5 ml syringe—

a) Collection of venous blood samples for laboratory analysis, aspiration from

cyst/abscess, for myelography /IVP etc.

b) Parenteral administration of drugs by different routes like

• IM (inj. tetanus toxoid)

• IV (antibiotics)

• SC (terbutaline, adrenaline, erythropoietin)

• Intra-cutaneous (drug sensitivity, Mantoux test)

• Intra-arterial (arteriogram)

• Intra-articular (corticosteroid)

• Intra-thecal (methotrexate in ALL)

• Intra-pleural (for pleurodesis)

• Intra-peritoneal (anti-metabolites)

(B) 50 ml syringe—

a) Ryle’s tube feeding; gastric aspiration in intestinal obstruction, pyloric stenosis,

hematemesis or poisoning.

b) Aspiration of pleural and pericardial fluid, paracentesis abdominis.

c) IV aminophylline injection.

d) Aspiration of amoebic liver abscess.

e) Gastric wash by ice-cold saline in intractable hiccough.

 16. METERED DOSE INHALER (MDI)

• Most widely used aerosol device.

• Percentage of drug that reach lungs: 20%

• If used with spacer: 40–50%

• Delivers a fixed dose of medication in aerosol form, each time it is activated.

Parts

1. Canister – which
consists of:

a. Drug-micronized

b. Propellant: CFC
(chloro-fluoro-carbon)
which depletes the
ozone layer, so HFA
(hydrofluoroalkanes)
preferred

c. Surfactant-decreases the aggregation of particles.

2. Body

3. Mouth piece

Method

• Remove mouth cap + shake

well
• Exhale completely and hold
canister upright
• Open mouth, and press
while inspiring slowly and
deeply
• Wait for 1–2 minutes
• Rinse mouth and pharynx.
Advantages and disadvantages:

(A) Advantages—
1. Rapid onset of action.
2. Very small dose of the drug is necessary to have desired effect.
3. Very little medicine is allowed to reach other parts of the body, i.e., chances of side
effects tend to be minimum.
(B) Disadvantages —
1. The major limitation of the mode of administration is that training and skills are
required to coordinate actuation of drug from MDI.
2. Pharyngeal infection (e.g., candidiasis with inhaled corticosteroids) if the device in
not properly cleaned at a regular interval.

17. SPACER

A container made of plastic with uni-directional valve to increase efficacy of MDI.

Advantages
• Overcomes coordination difficulties
• Decreased oropharyngeal deposition
• No cold Freon effect
• Age—no bar
• Tidal breathing adequate
• Better lung deposition as decreased
particle size and velocity.

Ideal Spacer
• Length <20 cm
• Volume 750 mL
• Valve present
• Electrostatic attraction should not be
there occurs if—metal (steel/polyamide
material).
• No. of activation: Single.
 18. DRY POWDER
INHALER

Types of DPI

Single dose:

• Rotahaler
• Spinhaler

Multi dose:

• Turbhaler
• Disk haler
• Multihaler (30 dose cartridge)
• Novelizer (100 dose)

Rotahaler

• Breath activated—uses
drug in dry (capsule)
form.

• Technique:

Insert capsule → Rotate to

break away the capsule →
Inhale deeply + rapidly till cap
is empty → Rinse mouth and
pharynx

Advantages Disadvantages
• Small, compact, and easy to carry • Not possible in distressed,
• Cheaper vs MDI with spacer <6 years, elderly
• Can see the capsule emptying and rattling • Needs minimum inspiratory
sound (drug going in the body) flow rate of 28 L/minute
• “Capsule form”—socially more acceptable • Bad taste of drug in the
• No CFCs mouth
19. NEBULISER

What is a nebulizer?
A nebulizer is device where the liquid/ solution of the drug is converted into a
'mist' or aerosol of liquid particles by high flow oxygen or compressed air. This is
inhaled through the mask which covers both the nostrils and mouth of the child.
The mask, the nebuliser-chamber and the tubing - all are detachable.
Mention important steps in using a nebulizer.
To take the drug solution in calculated dose for salbutamol solution (5 mg/ml)→
0.15mg/kg;) commonly 0.5 mL taken + add 2 ml of Normal Saline. (Nebuliser
chamber capacity = 2-4 mL]
↓
To attach the face mask to the top of the nebulizer directly or through T-piece. To
attach the tubing to the bottom of nebulizer to the compressed air/oxygen
source.
↓
To make the flow on → a fine mist will came out → now to apply mask over face
of the child covering face and mouth.
↓
To treat till the liquid in the nebulizer chamber is nearly used up. The child inhales
the aerosol by tidal breathing. 10-15 minutes taken for one nebulisation.

What should be the flow rate if nebulisation is done by oxygen?

6-9 L/ minute. As there is wastage of oxygen, if the child does not require that
amount of O₂ flow, an electric air compressor is economic in that respect.
What are the advantages and disadvantages of nebulizer?
Advantages:
• It is effective with tidal breathing of the child and does not need high
inspiratory flow as in MDI or DPI. However MDI with spacer and face mask
yields comparable results to nebulizer, as it is also effective in tidal breathing.
In emergency room or home for acute attack of asthma it is preferred mode of
therapy.
• Mixing of the liquid preparation e.g., short acting b2-agonist with
anticholinergic solution is possible in the chamber and simultaneous
nebulisation therapy possible.
• No hand-mouth coordination required.
• Useful for all ages
• Best method for use in a child under mechanical ventilation
 Disadvantages:
• Not easily portable, not handy.
• 10-15 minutes taken for one dose therapy
Chance of cross infection, if the device is not earmarked as child-specific.

How to sterilize the nebulizer with mask?

After each use the nebuliser parts should be dismantled and the mask should be
washed with non-residue detergents and allowed to dry in the air. The nebulizer
chamber with the cups, tubing along with the mask should be sterilized daily by
immersion in Cidex solution for 4 hours. (It is best to earmark a set or device for
one child only.]

Name the drugs administered by aerosol therapy for bronchial asthma.

MDI MDI with Spacer DPI Nebuliser

1. Short-acting β₂- 1. Short-acting β₂- 1. Short-acting β₂- 1. Short-acting

agonist (e.g., agonist (e.g., agonist β₂-agonist (e.g.,
salbutamol, levo- salbutamol, levo- (salbutamol) salbutamol,
salbutamol, salbutamol, levo-salbutamol,
terbutaline) terbutaline) 2. Long-acting β₂- terbutaline)
agonist (e.g.,
2. Anti-cholinergic 2. Anti-cholinergic salmeterol, 2. Anti-
(ipratropium) (ipratropium) formoterol) cholinergic
(ipratropium)
3. Steroids 3. Steroids 3. Steroids Used for reliever
(beclomethasone, (beclomethasone, (beclomethasone, therapy mainly.
budesonide, budesonide, budesonide, Not commonly
fluticasone) fluticasone) fluticasone) used for
preventer
4. Long-acting β₂- 4. Long-acting β₂- 4. Sodium therapy.
agonist (e.g., agonist (e.g., Chromoglycate
formoterol, salmeterol, 3. Steroids
salmeterol) formoterol) (budesonide)

5. Sodium 5. Sodium
Chromoglycate Chromoglycate
 20. LARYNGOSCOPE

Required for Endotracheal Intubation

Also used in indirect laryngoscopy to visualize larynx and vocal cords.

Parts of Laryngoscope

• Handle

• Blades—00, 0, 1 for
extreme preterm,
preterm, and term
newborns.

Straight blade (Miller) used in

newborn.

Curved blade (macintosh) in

older children and adults.

• Bulb—yellow and white

light; detachable or
fixed.

• Extra batteries should

always be kept ready
Cleaning the Laryngoscope

Detach the parts and clean with soap and water with brush to remove dirt and then
clean under running tap water.

Chemical disinfection with Cidex can be

done for 4 hours.

How to Hold Laryngoscope

Laryngoscope is always held in left hand

irrespective of whether the person is
right-handed or left.

Indications

• Patients requiring emergent

intubation in conditions like acute
respiratory failure with inadequate
oxygenation and ventilation.

• In patients with altered sensorium for

airway protection.

• Nonemergent intubation occurs in the

perioperative setting as patients may
require general anesthesia.

Contraindications

• Suspected cervical spine injuries

• Patients who have supraglottic or glottic

pathology.

• A relative contraindication to laryngoscopy

includes patients with anatomy that does
not allow successful laryngoscopy use,
injuries to the area, or physiologic status
that is not conducive to the procedure.
21. DE LEE’S ORAL MUCOUS SUCKER WITH TRAP

2 types of oral mucus traps are available for clearing secretions in newborns:
(a) De Lee Type: Disposable, Autoclavable (reusable)
(b) Bulb Sucker
Uses:
• Clearing mouth and nose from secretions
Suction Sequence:
1. Mouth: Contains more secretions/fluid than the nose.
2. Nose: Suctioning nose can reflexively initiate respiration, drawing secretions to
the mouth.
Positions:
1. Supine: Suction should be short, intermittent, and avoid touching the
posterior pharyngeal wall to prevent bradycardia or apnea.
2. Head-turned-to-side: Gravity helps pool secretions at the cheek for easier
suctioning.
Suction Pressure:
• Use a negative pressure of around 100 mm Hg. Avoid higher pressures which
can damage delicate mucous membranes of the baby (seen with common
sucker machines at 200 mm Hg).
22. HEAD BOX / OXYGEN HOOD

Use:
To give oxygen to a baby who is calm and quiet in bed and requires oxygen only
for a while. High flow rate is given - 5 L/min, 30% oxygen.
* Keeping it over the head for too long causes CO2 accumulation.
 23. AMBU BAG (WITH FACE MASK, O2 RESERVOIR)

[SELF-INFLATING SILICONISED RESUSCITATION BAG AND MASK]

Parts of the Artificial Manual

Breathing Unit (AMBU) Bag

It is a self-inflating bag, 250–500 mL

used. It is compressible and non-
rebreathing bag.

Made of silicon rubber, which can be

easily cleaned and autoclaved for
reuse.

Posterior part has two inlet tubes—

smaller for oxygen inlet and bigger
for oxygen reservoir.

Three valves:

a. Pop off valve is a pressure release

valve, opens if excessive pressure
generated, so it does not reach baby—
prevent rupture alveoli and air leak. It
usually opens at 30–40 cm H2O.

b. Fish mouth valve: Near the patient

outlet
c. Air inlet valve near
the inlet tubes.

Expired air is let out

from the space around
the patient outlet.

Checking the efficacy

of Ambu bag:

1. Look for visible

tears/leaks

2. Check if bag self inflates

3. Cover the patient outlet with palm and check for

pressure and
self-inflation

4. Increase
pressure and
check pop off
valve release.

Types of Reservoirs

Face Mask

Cushioned rims—less
traumatic and better fit

Shape—round or
anatomical

Size—appropriate fit

Rim should cover tip of

chin, mouth, and nose
but not eyes.
Selection of Mask

Too large mask—may cause eye damage and may not seal well

Too small mask—will not cover mouth and nose and may occlude the nose.

Effective ventilation in a preterm baby with a term—newborn size mask is

impossible, so keep

appropriate size available.

Cleaning the Bag and Mask

Chemical disinfection for 30 minutes

Sterilization for 2 hours

Insert in Cidex solution

Bags are autoclavable

Reservoirs not to be autoclaved.

Method of Giving Bag and Mask Ventilation (BMV)

A self-inflating bag with mask, oxygen source, and reservoir is generally used.
Check the efficacy of bag and mask assembly by pressing against palm of hand and
checking for bag inflation and pop-off valve release.
Select the appropriate-sized mask.
Be sure there is a clear airway.
Position the baby’s head.
Position yourself at the bedside.
Cup chin in the mask and then cover the nose.
Airtight seal formed by using light downward pressure on the rim/gently squeezing
mandible toward mask (C-clamp).
Index, middle fingers, and thumb encircle mask; 4th and 5th fingers lift chin forward
(E-clamp).
Mask should cover mouth and nose not the eyes.

How much pressure to apply?

Squeeze bag just enough so that heart rate and oxygen saturation rise.
24. LARYNGEAL MASK AIRWAY (LMA)

Description:
Supraglottic airway device with inflatable
cuff forming seal around larynx.
• Oral or nasal insertion option based on
model.
• Sizes for infants to teens to ensure
proper fit.
Uses:
Airway management in emergency and
elective settings.
• Short-term ventilation during anesthesia or procedures.
• Alternative to endotracheal intubation in certain cases.
Side effects:
• Sore throat, cough, nausea (common, transient).
• Laryngospasm, dysphagia (rare, monitor airway).
• Contraindicated in difficult airway, facial
trauma, or active vomiting.
25. OXYGEN MASK

• An oxygen mask provides a method to transfer breathing oxygen gas from a

storage tank to the lungs. Oxygen masks may cover only the nose and mouth
(oral nasal mask) or the entire face (full-face mask). They may be made of
plastic, silicone, or rubber.

• Used to deliver supplemental oxygen in various medical situations:

1. Hypoxemia Management: Addresses conditions causing low oxygen levels,

e.g., high-altitude sickness or carbon monoxide poisoning.

2. Post-Surgery Recovery: Ensures adequate oxygenation in the immediate

postoperative period.

3. Respiratory Conditions: Aids individuals with chronic respiratory conditions

like COPD, asthma, or pneumonia.

4. Emergency Situations: Provides concentrated and controlled oxygen in

trauma, cardiac events, or severe
respiratory distress.

5. Critical Care: Essential in ICUs

for respiratory support in
critically ill patients.

6. Transportation: Maintains
oxygen levels during patient
transport.

7. Anaesthesia: Used for pre-

oxygenation in operating rooms
before administering
anaesthesia
 26. NEBULISER MASK

• A nebulizer mask consists of essential parts for delivering aerosolized

medication to patients with respiratory conditions:

1. Mask: Covers the nose and mouth, ensuring effective delivery of aerosolized
medication to the respiratory tract.

2. Tubing: Connects the nebulizer mask to the nebulizer machine, allowing the
flow of aerosolized medication.

3. Nebulizer Chamber: Holds liquid medication and converts it into a fine mist
for inhalation.

Uses:

• Administers bronchodilators,
corticosteroids, or other medications
to manage respiratory conditions like
asthma, COPD, or respiratory
infections.

• Provides targeted delivery of

medication to the lungs, optimizing
therapeutic effects.

• Effective for patients who may have

difficulty using inhalers or require
higher doses of medication.
 27. NON-REBREATHING MASK

This is an apparatus having:

Mask + Reservoir + Valve devices

The valve devices are -

• Valves at exhalation port of the mask to prevent entrainment of room air during
inspiration

• Another valve at the junction of the reservoir with the mask to prevent entry of
exhaled CO2 during expiration The CO2 reservoir is full of oxygen.

Mask should be lightly sealed over face.

Oxygen delivery 80-95% with flow rate of 10-15 liter/min.

 28. ANAESTHESIA MASK

• An anesthesia mask comprises:

1. Mask Shell: A pliable covering that creates a sealed interface with the patient's
face.

2. Inflatable Cuff: Surrounds the mask, inflated to secure airtight fit.

3. Port: Connects to anesthesia machine for gas delivery.

Uses:

• Administers anesthetic gases during induction or maintenance of general

anesthesia.

• Facilitates controlled and precise delivery of anesthetic agents.

• Ensures patient's airway is effectively managed during surgery or medical

procedures.
 29. HIGH FLOW NASAL CANNULA

Very simple and comfortable gadget

• Nasal prongs are cut off → holes are positioned directly under the nose, and the
cannula is fixed over the cheek by skin-friendly tapes.

• Humidifying, warming and physical defense function of the whole respiratory tract
is taken care of.

• Child's nose should be clean and without any mucus. Clearing the nose after
instillation of 2-3 drops of normal saline drop can achieve this.

• Required rate of flow of oxygen - 1-2 L/min (0.5-1 L/min for babies< 2 months of
age).

O2 concentration delivered= 30-35%

 30. O2 TUBES WITH NASAL PRONGS

Nasal prongs are one of the preferred methods of oxygen therapy in children.

• There are prongs of different sizes; only appropriately sized /fitting prongs should
be used

• Bi-nasal prongs are most commonly used. There are other types also.

• Required oxygen flow rate is 1-2 liter/min. Then oxygen delivery (F1O2) is 30-40%.
31. O2 CATHETER (8 Fr) / SUCKER CATHETER (10Fr)

OXYGEN CATHETER: NASAL

• Type: Simple catheter with opening at the end and sides near the end.
Available at all health facilities. Size = 8 F.
• Insertion Length: Distance from the tip of the nose to nasion.
• Advantage:
• The child is comfortable.
• Can be given when the baby is on the mother's lap.
• If the child needs NG
tube feeding, the other
nostril can be used.
• Disadvantage:
• Nasal warming,
humidification, and
physical defense partly
compromised.
• Chance of blockage by
nasal secretion (clearing
to be done at least
twice daily).
• Required O₂ Flow Rate: 1 liter/min (0.5 liter/min for babies < 2 months of
age).
• O₂ Delivery: 35 to 40%.

OXYGEN CATHETER: NASOPHARYNGEAL

• Type: Simple catheter with an opening at the end and sides near the end. Size
= 8 F.
• Insertion Length: Distance between alae nasi to tragus of the ear; catheter is
at the posterior pharynx.
• Advantage:
• Comfortable for the child.
• Can be given when the baby is on the mother's lap.
• Disadvantage:
• The physical defenses provided by the nose (e.g., humidification,
warming, etc.) are fully deprived of.
• Chance of blockage by pharyngeal secretions.
 • Required O₂ Flow Rate: 1 liter/min (0.5 liter/min for babies < 2 months of
age).
• O₂ Delivery to the Child: 45 to 60%.
• Best Use: Nasopharyngeal catheter is optimal O₂ therapy.

SUCKER CATHETER
• Recommended Size: 10 Fr. recommended.
• When to Use:
• During initial steps for
clearing mouth and
nose; catheter is
connected to a slow
suction machine (low-
pressure suction
apparatus).
• While clearing trachea
and larynx in meconium-
stained liquor with a depressed/asphyxiated baby.
• Types of Suction Machines:
• Electrical slow suction machine
• Mechanical foot-operated suction machine
• Wall suction (central suction system)
• Parts of a Suction Machine:
a) Suction tubing, b) Pressure gauge c) Suction bottle
• Precautions Before Using the Suction Apparatus:
• Ensure that the suction system is functioning by using the suction
apparatus, checking the distal end of the tube, and feeling negative
pressure.
• Pressure in the gauge must not exceed 100 mm of Hg.
• Suction tubing and the bottle must be disinfected with 2%
glutaraldehyde solution for 20 minutes daily, first washing with soap and
water.
• The suction bottle should contain some amount of disinfectant solution
(5% Lysol).
• Suction catheter connected to the tubing should be sterile and
disposable after each use.
• After each use, the tube should be flushed with clean water.
 32. ENDOTRACHEAL TUBE

Types of the ET Tube

• Sterile disposable tube -

recommended.

• Metal tube (previously

used and not used now).

It can be diameter-wise –

• Uniform diameter tube-

recommended

• Tapered cut end tube- not recommended

ET Tube should be shortened

with a clean oblique cut at 13
to 15 cm marking.

The connector should now be

connected. The connector
should be attached to the
resuscitation bag.

The vocal cord guide (a black

marking on the tube nearer to
the tip) should be at the level
of vocal cord after insertion.
In this position, the tip of
the ET tube is above
bifurcation of the trachea
(at its lower third).
Steps of Intubation

• Head slightly extended.

Resuscitator on the head end.
• Left hand to be used for
insertion of laryngoscope with
appropriately sized blade
• Blade should be advanced over
the tongue up to the vallecula →
now with a uniform pull directed
to the handle of the laryngoscope -
the laryngeal inlet gets clearly
visible as also vocal cord.
• Now the ET tube should be
inserted by the right hand.
• ET tube should be advanced till
the vocal cord mark of the tube is
at the level of vocal cord.
• Suction of the tube: by smaller sized tube e.g., 5F, 6F or 8 F - through ET tube.
• For suction of trachea in meconium-stained liquor - suction is applied directly to
the ET tube. Attempts should not be made to suck meconium from trachea by
passing suction catheter through ET tube, as the catheter is too small to remove
meconium
• For ET tube and bag
Tube Size (Internal Baby’s Gestational Age
ventilation: connector
Diameter in mm) Weight (in g) (in weeks)
of ET tube attached to
bag → ventilation by 2.5 <1000 <28
100% oxygen. 3.0 1000-2000 28-34

3.5 2000-3000 34-38

3.5-4.0 >3000 >38

Description of Adult ET Tube

It is a tube constructed of polyvinylchloride (PVC) that is placed between the vocal

cords into the trachea to provide oxygen and inhaled gases to the lungs. It also
serves to protect the lungs from contamination, such as gastric contents and blood
parts of endotracheal (ET) tube.
 1. The Tube
The endotracheal tube (ETT) has a length and diameter. The endotracheal tubes
size refers to its internal diameter in millimeters (mm). PVC is not radio-opaque,
and thus a radio-opaque linear material is included throughout the length of the
tube to make it easier to visualize the placement on X-ray. Ideally, the distal tip of
the ETT is 4 cm (+/−2 cm) above the carina on chest X-ray in adults.
2. The Cuff
A cuff is an inflatable balloon at the distal end of the ETT. The inflated cuff
produces a seal against the tracheal wall; this prevents gastric contents from
entering the trachea and facilitates the execution of positive pressure ventilation.
The cuff inflates by attaching an appropriate size syringe (10–20 mL for adult ETT)
to the pilot balloon.
3. The Bevel
To facilitate placement through the vocal cords and to provide improved
visualization ahead of the tip, the ETT has an angle or slant known as a bevel.
4. The Murphy’s Eye
Endotracheal tubes have a built-in safety mechanism at the distal tip known as
Murphy’s eye, which is another opening in the tube positioned in the distal lateral
wall.
5. The Connector
Endotracheal tube connectors attach the ETT to the mechanical ventilator tubing
or an Ambu bag.
Indications for ET Intubation
• Acute respiratory failure, inadequate oxygenation, or ventilation,
• Airway protection in a patient with depressed mental status.
• In the perioperative setting, endotracheal tubes may be placed in many clinical
circumstances including patients receiving general anesthesia, surgery involving
• Less frequently to manage increased intracranial pressure or to manage copious
secretions or bleeding from the airway.
Contraindications to Intubation
• Severe airway trauma or obstruction that does not allow safe placement of the
tube
• Severe cervical spine injury which requires complete immobilization, and
• Those patients with Mallampati III/IV classification suggesting potentially difficult
airway management.
 33. SPATULA

Description
• Flattened, typically metal blade with handle.
• Diverse shapes and sizes for specific uses.
• May be disposable or reusable (autoclavable).
Uses:
• Tongue depressor: Aids oral examinations and procedures.
• Spreading medications: Applying topical creams or ointments.
• Manipulating tissues: Holding specimens, applying pressure, separating
surfaces.
• Various procedures: Earwax removal, foreign body retrieval (depending on
type).
Side effects:
• Tongue depressor: Overly forceful use can cause gag reflex or injury.
• Skin application: Avoid abrasions if spatula used for other procedures.
• Contraindicated for deep or invasive procedures.
 34. TONGUE DEPRESSOR

Description:

• Flat, slender stick (wood, plastic, metal) for depressing the tongue.

• Different sizes and textures (smooth, grooved) for comfort and grip.

• Disposable or reusable (autoclavable) models available.

Uses:

• Oral examination: Visualizing throat, tonsils, oropharynx.

• Facilitating procedures: Swabbing, throat culture, airway management.

• Applying topical medications: Creams, ointments to oral tissues.

• Non-invasive foreign body removal (depending on size/location).

Side effects:

• Gag reflex: Overly forceful or deep placement can trigger gagging.

• Tissue injury: Rough edges or improper use can scratch or damage

tongue/gums.

• Contraindicated in cases of severe oral trauma or bleeding.

 35. PEAK FLOW MINI-METER

Parts:

• Portable spirometer measuring peak expiratory flow (PEF).

• Simple design: mouthpiece, spring-loaded piston, calibrated scale.

• Measures how fast a child can forcefully exhale air.

Uses:

Monitoring asthma: Tracks lung function changes, guides treatment adjustments.

• Diagnosis of asthma: Low PEF may suggest airway obstruction.

• Motivational tool: Encourages patients to track and manage their asthma.

Side effects:

• No direct side effects, improper technique can affect readings.

• Not a substitute for comprehensive airway assessments.

• May not be reliable for very young children or with severe airway limitations.
36. SCALP VEIN SET (BUTTERFLY NEEDLE / WINGED INFUSION SET)

Description/Parts:
• Sterile disposable needle with flexible wings for secure grip.
• Thin (20-26 gauge) and short needle minimizes discomfort and reduces risk of
vessel perforation.
• Flexible tubing connects to IV bags or syringes.
Uses:
• Venipuncture in infants and young children: Smaller veins, easier access
compared to arms.
• Repeated blood draws or short-term IV infusions: Minimizes needle sticks and
preserves veins.
• Scalp (preferred), hands, feet, or arms: Choose site based on vein visibility and
accessibility.
Side Effects/Contra-indications:
• Local irritation, bleeding, hematoma: Monitor site and apply pressure as
needed.
• Extravasation (fluid leakage): Stop infusion, elevate limb, apply cool compress.
• Contraindicated in scalp conditions like infections or eczema.
 37. UMBILICAL VEIN CATHETER

Why umbilical vein is preferred for catheterisation over other veins?

Because it is very easy to get umbilical vein through cord stump. Cord stump shows
single open umbilical vein (and two smaller contracted wall umbilical arteries).

What sized catheters are used?

Two sizes are used - 3.5 F for LBW babies and 5 F for term normal weight babies.

What length of catheter should be inserted?

It should be inserted till the tip of the catheter reaches just beneath the skin and free
flow of blood is present.
 [Link] TAPE

Different uses in clinical medicine:

It helps in the measurement of —

1. Abdominal girth in ascites (serial measurement is important).

2. Thyroid enlargement (at the most prominent part of the swelling in neck).

3. Expansion of the chest (specially in emphysema).

4. Head circumference (specially in hydrocephalus).

5. Assessment of nutrition (helpful in obesity and malnutrition).

6. To assess body mass index (BMI) and waist-hip ratio in obesity.

7. Height (e.g., cretinism, Marfan’s syndrome).

8. To confirm wasting or hypertrophy of muscles.

 [Link]

How to Use Infantometer [Length, Age upto 2 Years]:

1. Child lies straight on the horizontal board.
2. Head in Frankfurt's plane (ear canal to lower border of orbit).
3. Assistant steadies the head.
4. Person taking length steadies the straight legs.
5. Slide the footboard against the soles of the feet.
6. Feet at a right angle to legs.
7. Read the measurement on the horizontal board scale.
How to Use Stadiometer [Height, Age > 2 Years]:
1. Child stands barefoot, feet and knees close together.
2. Arms at sides, head at Frankfurt's plane.
3. Ensure shoulder blades, buttocks, calves, and heels touch the vertical
board/scale.
4. Move the sliding headboard/bar down to rest firmly on the top of the head.
5. Read the measurement on the vertical scale.
How to Calculate Expected Height:
• Ideally, use a nomogram with age, sex, and length/height.
• Quick bedside
calculation using
Weech's formula: [x =
Age (in years)]
• For ages 2 to 12
years: Expected height
(cm) = 6x + 77.
• Average newborn
length = 50 cm.
• End of the 1st year
= 75 cm.
• End of the 2nd year
= 87 cm.
 [Link] SCALE

(a) Digital Weighing Scale:

• Precision: 5 gm
• Mainly for infants
(b) Spring Balance:
1. Pan Type for Infants (Lying Down):
• Range: Up to 10 kg
• Precision: 50 gm
2. Pictform Type (Bathroom Scale):
• Taking weight in a standing position (more than 1 year of age)
• Range: 0-100 kg
• Precision: 100 gm
Drawback of Spring Balance:
• Loose spring may give erroneous results (more than actual weight).
• Rusted spring may give lower than actual weight.
(c) Beam or Lever Type of Balance:
• More accurate
• For taking weight in a standing position
• Range: 0-100 kg
• Precision: 100 gm
How to Record Weight:

1. Recording Weight on a Pan-Type Spring Balance (Supine Weight):

• Check zero of the machine.

• Remove extra clothing of the infant (preferably naked).

• Gently make the baby supine.

• Remove parallax error while taking the reading.

• Record the weight (error/precision ± 50 gm).

2. Recording Weight on a Platform-Type Spring Balance (Standing Weight):

• Check and adjust the pointer at '0' level.

• Remove extra clothing and shoes.

• Ask the child to stand symmetrically on the platform.

• Avoid parallax error while recording the weight.

• Record weight with precision/error = 100 gm.

How to Calculate Expected Weight According to Age:

• Ideally from a nomogram with age, sex, and weight parameters.

• Quick bedside calculation by Weech's formula: [x = Age]

• For 3-12 months: Weight in kg = x (in months) + 9

• For 1-6 years: Weight in kg = 2x (in years) + 8

• For 7-12 years: Weight in kg = [7x (in years) – 5]/2

[Link] WITH TEST STRIP

Use:
To measure blood glucose while monitoring
(Lab confirmation to be done before initiating management of suspected
hypoglycemia)
 [Link] (BP MACHINE)

Different uses:

1. To measure the BP.

2. Confirmation of,

a) Pulsus paradoxus.

b) Pulsus alternans.

c) Water-hammer pulse.

3. To demonstrate
postural hypotension.

4. To demonstrate Hill’s
sign in aortic
regurgitation.

5. Hess’ capillary fragility test.

6. To assess the respiratory reserve (blow through the tube and observe the rise in
mercury column).

7. In latent tetany (Trousseau’s sign).

8. To draw venous blood.

**Sphygmomanometer was discovered by Riva Rocci (Italy) in 1896.

Types:

There are two common types—

a) Mercury column type, and

b) Aneroid type or spring dial type (less accurate)

• Arterial blood pressure (BP) can be defined as the lateral pressure exerted by
the moving column of blood on the walls of the arteries.

• BP = Cardiac output × Peripheral resistance

Body Part Usual Cuff Phases Korotkoff Sounds
Size (in cm)
Phase 1 Thud [SBP]; Tapping sound
Small Adult Arm 22-26 Phase 2 Swishing
Adult Arm 27-34 Phase 3 Loud Knocking
Large Adult Arm 35-44 Phase 4 A disappearing blowing noise
(muffling)
Adult Thigh 45-52
Phase 5 Disappearance of Korotkoff
sounds [Taken as DBP]

Category [2014 JNC-8 ≡ 2003

Systolic (mm Diastolic
JNC-7 (Joint National
Hg) (mm Hg)
Committee) Guidelines]

Normal <120 AND <80

Prehypertension 120-139 OR 80-89

Stage 1 Hypertension 140-159 OR 90-99

Stage 2 Hypertension ≥160 OR ≥100

Isolated Systolic Hypertension

≥ 140 AND <90
(ISH)

Systolic blood pressure (SBP) Diastolic blood pressure

(DBP)
Defined as the maximum BP in
the arteries attainable during Defined as the minimum
systole pressure that is obtained at the
end of the ventricular diastole
Normal: < 120 mm Hg
Normal range: 60–90 mm Hg

Pulse pressure (PP) Mean arterial pressure (MAP)

Denotes the difference DBP + one-third Pulse Pressure
between systolic and diastolic
Normal = 95 mm Hg
pressure
PP = SBP − DBP = 40 mm Hg
 [Link] THERMOMETER

Description:
1. A glass tube with markings (graduations); usually 11 cm long.
2. Constricted terminal part containing mercury with the other end sealed.
3. Small lumen inside with constriction at the neck.
4. Cross-section of the body of glass tube is triangular.
5. Indication of normal temperature (98.6°F or 37°C) by an arrow-mark.
* Previously Fahrenheit scale (F) was used in the thermometer. Now-a-days,
temperature is recorded in Centigrade scale (C). The formula of conversion of
temperature is, C/5 = (F-32)/9
** A tympanic membrane thermometer (i.e., electronic thermometer placed in the
ear) is used for fast and accurate recording of core temperature.
*** Lower-oesophageal temperature closely reflect the core temperature.
 44.SpO2 MONITOR (PULSE OXIMETRY)

Uses:

• During or after surgery or

procedures that use sedation

• To see how well lung

medications are working

• To check a person’s ability to

handle increased activity
levels

• To see if a ventilator is needed

to help with breathing, or to
see how well the ventilator is
working

• To check a person has

moments when breathing stops during sleep (sleep apnea)

Pulse oximetry is also used to check the health of a person with any condition that
affects blood oxygen levels, such as:

• Heart attack

• Heart failure

• Chronic obstructive pulmonary disease (COPD)

• Anemia

• Lung cancer

• Asthma

• Pneumonia
THE END