Sunday, February 28, 2021

Essential tremor - a mnemonic.

Do you often forget the features of 'essential tremor'? Well shake no more, 'coz here's a mnemonic that will straighten things up for ya!

Tuesday, February 9, 2021

Ear Syringing


REQUIREMENTS:   Water (temperature being as close to body temperature as possible), kidney tray, Simpson’s aural syringe/ 50 ml syringe attached to 16-18 gauze needle or pulsating water device, towel (if available)


  • Examine the ear. 

(Do not irrigate if there is: severe pain, recent trauma or surgery or a dry perforation of tympanic membrane, inability of patient to sit upright, organic foreign body in the ear, opening into mastoid, severe otitis externa, history of middle ear disease, ear surgery, inner ear problems [vertigo] or radiation in the area) 

  • Ask patient to sit upright. 

  • Hold the pinna backwards and upwards in adults and backwards in children to straighten the ear canal.

  • Keep a towel on the shoulder. 

  • Use a kidney dish to catch solution.

  • While irrigating direct the syringe towards the ear canal, postero-superiorly.  

  • Apply firm and constant pressure to the syringe.

  • Dry mop the ear and check it again to see if everything is out.  


Written by our guest author - Abhineet Desai

Illustration by Devi Bavishi












Monday, February 8, 2021

Cu-T, Intrauterine Contraceptive Device




Written Informed consent, IUD, Povidone Iodine, Spirit and drapes, Sims’s speculum, Allis forceps, Uterine Sound 



  • Begin with the history and clinical examination to rule out contraindications. 

  • Before inserting the IUD, always do UPT to rule out pregnancy. 

  • The patient is taken up in the OT (but can be done in OPD or labour ward immediately post-partum). An anaesthetist should be present if in case perforation occurs. 

  • POSITION: Standard lithotomy position with legs in stirrups. 

  • Scrubbing, painting, and draping should be done. 

  • Bimanual examination to check for uterine size, position, version, and adnexal pathology. 

  • Depress posterior vaginal wall with Sim’s speculum and hold the anterior lip of cervix using Allis forceps. 

  • Using uterine sound, measure utero-cervix length and the accordingly adjust the bobbin. 

  • The technique used is “No Touch/ Withdrawal technique”. 

  • CuT is self-loaded. Remove the whole thing without touching CuT. 


  • Plunger should not touch the vaginal wall. Reach upto the uterine fundus. Pull the ring behind on the plunger. CuT is unfolded. 

  • Slowly remove the loader so as not to disturb the CuT. 

  • Cut the tail (2.5-3 cm). The patient should be made to feel the tail. 

  • Observe for about half an hour for uterine cramps (since foreign body inserted so uterus tries to expel it)  

Managed by giving Drotaverine/Dicyclomine. 


  • Record the date of insertion. Document it on CuT card and mention the date of expiry. Give it to the patient. 

  • Counsel the patient regarding all the possible complications and also regarding the follow-ups. 



Injectable Contraceptive DMPA (Under ANTARA programme) given as i.m. injection on outer upper quadrant of buttock. 

Dose: 150 mg every 3 months  

Written by our guest author - Ayushi Gupta