Unit 2 Orientation Manual

UNIT 2
ORIENTATION
MANUAL
DEPT. OF GENERAL SURGERY, IQ CITY MEDICAL
COLLEGE HOSPITAL, DURGAPUR
Dr. Surit Majumdar

PROFESSOR, DEPT. OF GENERAL SURGERY
Dr. Gaurab Das

ASSISTANT PROFESSOR, DEPT. OF GENERAL SURGERY
Dr. Anurag Chaudhuri

POST GRADUATE TRAINEE, DEPT. OF GENERAL SURGERY
UNIT 2 ORIENTATION MANUAL
CONTENTS
ROUNDS 2
PATIENT NOTES 3
MEDICINE CARD 4
ROLE OF INTERNS 5
PRE OP PATIENTS 6
OT 8
POST OP PATIENTS 9
EMERGENCY 10
DISCHARGE ADVICE 14
MISCELLANEOUS 15
1|Page
ROUNDS
Sir will start rounds at 9.45am everyday. Evaluate every patient in
detail and complete patient notes before that and be present at OPD or
patient side to start rounds with Sir.
Morning rounds start from ground to up.
Evening rounds usually from top to down. Evening rounds to be

informed to Surit Sir by WhatsApp in SOAP format.
2|Page
PATIENT NOTES
Given in SOAP pattern
Subjective
Objective
Advice
Plan
Date Time
POD
Daily diagnosis
Never write pt is A/c/c

Chief complaints
Vitals
Examination
Advice
Plan
Always write MEDICINE NAME in CAPS in advice

Signature in full with stamp
Get it countersigned by faculty
Never let intern write your notes
3|Page
MEDICINE CARD
Always write MEDICINE NAME in CAPS
Date and Sign in full
OPD PATIENT
Position patient for examination
Expose area of observation completely
Complete general examination before proceeding to local examination
For all newly admitted patients including CSR, files should be
completed before next day morning rounds including History
Examination Note and Advice.
CSR PATIENTS
Review all CSR patients before admission
All CSR patients should get a note on day of admission
ICU PATIENTS
Triple Rounds or more if necessary with three notes minimum daily
Inform Consultants after every round
Mention daily diagnosis
Mention current Issues
Mention G.C poor clearly if applicable
Consult Sirs before any decision
Pay special care to patients in ICU as they may deteriorate suddenly
4|Page
ROLE OF INTERNS
Fill Initial Assessment of all newly admitted patients on day of
admission
No short forms like PICCLE to be used
Get it counterchecked by PGT
Blood requisition form
Blood transfusion note
Never write notes in Patient File
Study and prepare for entrance exams (NEET-PG, INICET PG, PLAB,
USMLE)
Enthusiastic participation in unit activities
5|Page
PRE OP PATIENTS
Sirs write Preop Advice in OPD Sheet.
Check all reports and investigations, PAC. Add additional PAC advice to
preop advice.
Swastya sathi patients admitted two days before OT.

For other patients a day before.
OT day is Friday.
Maintain OT Listings with date in OPD either in diary or online notes

Date of Operation
Patient Name
Contact Number
Operation Name
Inform to Amrita Di of OT from OPD only
1. Informed Consent
Procedure
Laparoscopic/ Open Cholecystectomy
(OT Procedure name is written in OPD Sheet)
Risks (Example)
CBD injury, Gut injury, AMI, Visceral injury, Lung atelectasis, Pulmonary
embolism, shock, sepsis, Anaphylaxis , uncontrolled Bleeding
6|Page
We need to explain conversion to open surgery and all associated risks

to patient and party before signing.
2. Pre-op Advice
Pre-op advice is written in Sir's OPD sheet and is written on day of
admission itself. We need to add PAC advice if relevant.
3. OT Posting
4. Blood requisition if required
5. Keep pictures of all reports, PAC and OPD sheet in group for
reference.
7|Page
OT
Complete all Rounds, Patient Notes and Ward work before OT
Inform Sirs regarding patient status
Starts at 9.30am sharp
Transfer all patients to OT complex before 9 AM
Confirm OT order with Sir previous night
Transfer patient to OR and intubate patient only after informing Sir
Paint and drape
Study OT steps and come
8|Page
POST OP PATIENTS
PGT must stay inside OT till complete extubation and mobilisation of
patient.
Complete the following :

1. Medicine Card
2. Post op Advice in file
3. OT Note
4. Histopathology Page
9|Page
EMERGENCY
Faculty is the first point of contact after our seniors. No over the phone
advice for emergency patient. Attend patient within 10 minutes of
receiving emergency call. Always take complete history of patient and
examination before calling sir. Inform all patients to sir. Never admit
patient without informing Sir.
Present case in following order

Age Sex chief complaint duration associated complaints vomiting
nausea fever
passed stool last
Comorbidities
Allergic History
Previous OTs
ADVICE in the following manner (Example)

Admit / OPD Basis / Refer
Diet NPM or any diet

Fluid of choice IVF RL DNS 1:1 at 80ml/hr (rate based on patient factors
like weight and condition. Eg Pancreatitis patient gets 100ml/hr or
more. Reduce rate if Pleural effusion present)
Investigations
ECG 12 leads
X ray Chest P. A view Erect showing both domes of diaphragm
10 | P a g e
X ray Abdomen A. P view Supine

If required
USG (Whole Abdomen + Pelvis)
CECT (Whole abdomen) after confirming with Consultant
Blood test
CBC, LFT, RFT, PT-INR, RBS, Serology
If pancreatitis suspicion Amylase, Lipase, CRP
Medications
Triple antibiotics of choice
PIPZO 4.4 g IV TDS
METROGYL 500mg IV TDS
AMIKACIN 500mg IV BD or 1g IV OD
or as per Consultant’s advice
Painkillers of choice
DYNAPAR AQ 1 ampoule IM TDS
TRAMADOL (100mg in 100ml NS) with ONDEM SOS
PPI
PAN 40mg IV BD
Antiemetic
ONDEM 4mg or 8mg IV BD or TDS
11 | P a g e
If pancreatitis or choledocholithiasis
Add Inj BUSCOPAN 1 ampoule IV BD
In case of OPD basis

Tab TAXIM OF 1 tab BD x 10 days
TAB VOVERAN PLUS 1 tab TDS x 7days
CAP PANTOCID DSR 1 cap OD 1/2 hour before breakfast for 6 weeks
CAP BECOSULES Z 1 cap OD x 6 weeks
Ask before adding:

TAB UDILIV 300mg 1 tab BD x 3 months ( TDS for obstructive jaundice)
CAP HEPTAGON 1 cap BD x 6 weeks
If comorbid
HTN Add home medication BP monitoring two hourly with charting in
white page in front of file
Diabetes Add home medication Add CBG Charting TDS Send FBS PPBS
HbA1C
Thyroid Add home medication Send T3 T4 TSH
If Active vomiting present then Ryles tube

If pt needs urine output monitoring Foleys Catheter - Add input output
monitoring
Case of Cholecystitis
Rule out pancreatitis by Amylase,Lipase
12 | P a g e
If patient complaints of pain give analgesia in stepladder format

DYNAPAR AQ
TRAMADOL with ONDEM
Once pain has subsided call pt in OPD basis
Inform and confirm with Sir regarding patient before any such decision
13 | P a g e
DISCHARGE ADVICE
Diagnosis
Chief complaints
Comorbidities
Course in hospital in brief
OT Findings
OT Procedure
Advice containing diet, activity and medications
Review date
Full signature with stamp
Countersigned by Sir if necessary
14 | P a g e
MISCELLANEOUS
Carry your books and study in the OPD.
Follow time discipline, dressing etiquette and appropriate behaviour.
No jeans or sandals or uncollared shirts during working hours.
Never switch on Light above Sir’s desk. Sir will switch it on during
Morning prayer.
Always stand for Morning prayer and before Sir leaves at the end of the
day.
Study regularly and keep yourself updated with recent advances and
guidelines to make the most out of daily discussions.
15 | P a g e

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UNIT 2

Dr. Surit Majumdar

Dr. Gaurab Das

Dr. Anurag Chaudhuri

Morning rounds start from ground to up.

Evening rounds usually from top to down. Evening rounds to be

Never write pt is A/c/c

Always write MEDICINE NAME in CAPS in advice

Swastya sathi patients admitted two days before OT.

Maintain OT Listings with date in OPD either in diary or online notes

We need to explain conversion to open surgery and all associated risks

4. Blood requisition if required

Complete the following :

Present case in following order

ADVICE in the following manner (Example)

Diet NPM or any diet

X ray Abdomen A. P view Supine

In case of OPD basis

Ask before adding:

If Active vomiting present then Ryles tube

If patient complaints of pain give analgesia in stepladder format

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