Procedure for Managing Patients

General management of patients

There are four important steps while managing a patient.

  1. History
  2. Physical Examination.
  3. Investigations

One more desirable aspect to the patient care is proper Bedside manners.

Generally, these four important steps are to be followed in the same order. However, in emergency situations, this order may not be followed Hence approach to the patient in casualty and in the regular wards is different.

Management of cases in the casualty ward:

The word Intensivist is mentioned frequently in this manual. Intensivist means the specialist who is in charge of Intensive care unit. In our hospital, the Intensivist is generally an anesthesiologist who is always available in Gokul ICU.

When you are posted to Casualty ward sometimes also called Emergency   ward,

  1. First take charge of the patients who are already in the casualty ward. Find out the essential details of these patients and recognize the seriousness of their condition and attend to them giving priority on the basis of seriousness.
  2. Find out the bed availability in,
  3. Gokul ICU
  4. Sindhu ICU
  5. Post Operative ward. (As far as possible, do not admit the patient in Post operative ward. Only if the bed in Post operative ward is clearly vacant and not booked by any consultant and if the patient needs urgent admission, then only consider admitting in Post operative ward)

If there are no beds available in Gokul ICU/Sindhu ICU/Post operative ward

When a new patient is brought to the hospital, do not allow the patient to be taken out of the vehicle. Instead, have a look at the patient in the vehicle itself. If the patient appears to be serious, politely inform that the patient needs care in ICU, the ICU beds in our hospital are full and hence to take the patient to some other hospital immediately. Please help them to contact other hospitals to find out the availability of the beds in other hospitals.

  1. If the condition of the patient is not serious, and if he has come only for routine admission, injection, or dressing, then you may take the patient in to the casualty ward.
  2. If the beds are available in our ICUs.
  3. As soon as the patient is brought to the Casualty, see that the patient is taken in the Casualty ward and put on the bed. As soon as the patient is put on the bed, even before you ask the attendants about the details, check,

Vital parameters:

These features listed below indicate the intactness of the vital functions of the body. Hence they are called vital parameters

  1. Consciousness: Ideally patient should be able to understand and answer your questions correctly.
  2. Pulse: Should be between 60 to 100 per minute.
  3. : Normal 98.4 F or 37.0 C
  4. Breathing:  Normal 12 to 18 breaths per minute.
  5. Blood pressure: Normal: Systolic not more than 140 mm Hg and diastolic not more than 90 mm. Hg.
  6. SPo2 : Normal: 98 to 100%
  7. Random blood sugar: Not more than 140 mg%

If you think that the patient is very serious because,

  1. Patient is semiconscious or unconscious,
  2. Pulse rate is too high or too low,
  3. Temperature is very high
  4. Breathing is difficult,
  5. Blood pressure is very high or very low,
  6. SPo2 is less than 90%
  7. Random blood sugar is less than 70mg%

 

Then call the intensivist in Gokul ICU and inform the patient’s condition. After informing the intensivist,

  1. Start Oxygen administration,
  2. Start an IV line with normal saline.
  3. Nebulisation if breathing is difficult.
  4. IV 25% glucose 200 ml if the RBS is too low
  5. Pass a nasogastric tube if it is a case of suspected poisoning.

 

If the patient’s condition is not serious, see whether the patient has brought a Reference letter. If the patient has a reference letter, see to whom the patient is referred to and call up that consultant and ask for the instructions. If that consultant is not available or cannot be contacted, inform the patient about it and ask him if he wants any other consultant. If he wants some other consultant, call up that consultant and ask for the instructions. If he does not mind any other consultant, then call up the consultant on call on that day and take the instructions.

If the patient has no reference letter, then take certain details of the patient in the Casualty information sheet, decide which specialist is needed and call up the consultant of that specialty on call on that day. Sometimes more than one specialty may be involved. In which case, first call up the specialist for the main problem and according to his choice, call consultants from other specialty.