Automated Perimetry

 HUMPHREY FIELD ANALYSER (HFA)

1.Perimetry should be performed in a distraction-free environment, to enable the patient to concentrate on the perimetric test.

2.The perimeter is automatically calibrated each time it is turned on. Ideally, patient data (date of birth, refraction, etc.) are entered before the patient enters the room.

3.Before putting the patient onto the machine, the requirements of the test itself are clearly explained and the patient is instructed as follows.

4. Before fully positioning the patient, the eye not being tested should be covered with an eye patch that allows the patient to blink freely.

INSTRUCTIONS TO PATIENT

• Perimetry tests your central and peripheral vision

• Be relatively still once positioned

• Always look straight ahead at the fixation target. Do not look around the bow for stimuli.

• Press the response button whenever you see the stimulus 

• The stimulus in a flash of light

• Only one stimulus is presented at a time

• The stimulus might appear from anywhere. Some stimuli are very bright. Some are very dim and sometimes no stimulus is presented. You are not expected to see all stimuli

• Do not worry about making mistakes

• Blink regularly to avoid discomfort. Don't worry about missing a point the device does not a measure while you blink

• If you feel uncomfortable or are tired close your eye for a moment the test will automatically stop. The test will resume once you open your eye.

• If you have a question, keep the response button pressed this will pause the test

5. The patient is positioned appropriately and comfortably against the forehead rest and chin rest. The lens holder should be as close as possible to the patient’s eye to prevent artefacts. 

6.The Analyser projects a series of white light stimuli of varying intensities (brightness), throughout a uniformly illuminated bowl.

 

 

7.The patient uses a handheld button that they press to indicate when they see a light. This assesses the retina's ability to detect a stimulus at specific points within the visual field. This is called retinal sensitivity and is recorded in 'decibels' (dB).

 

 

8.The Analyser currently utilises the Swedish Interactive Thresholding Algorithm (SITA); a complex mathematical formula which allows the fastest and most accurate visual field assessment to date.

For more information, see the youtube video (link below)

 https://youtu.be/TqL5KvvYJu4 

Written by our guest author - Jignesh Bhadarka

#Ae(ONE)INTERN

Blood Donation Criteria and Procedure

BLOOD DONATION

PRE-DONATION

HISTORY:

• Men can donate safely once in every three months while women can donate every four months.

• Age between 18 and 60 years 

• The donor should be in a healthy state of mind and body.

• Past one year - not been treated for Rabies or received Hepatitis B immune globulin

• Past six months - not had a tattoo, ear or skin piercing or acupuncture, not received blood or blood products, no serious illness or major surgery, no contact with a person with hepatitis or yellow jaundice.

• Past three months - not donated blood or been treated for Malaria. 

• Past one month - had any immunizations.

• Past 72 hours - had dental work or taken Aspirin 

• Past 48 hours - taken any antibiotics or any other medications (Allopathic or Ayurveda or Siddha or Homeopathy)

• Past 24 hours - taken alcoholic beverages

• Presently - not suffering from cough, influenza or sore throat, common cold

• Women should not be pregnant or breast feeding her child or menstruating.

• No diabetes, chest pain, heart disease or high BP, cancer, blood clotting problem or blood disease, unexplained fever weight loss, fatigue, night sweats, enlarged lymph nodes in armpits, neck or groin, white patches in the mouth etc. 

• No history of TB, bronchial asthma or allergic disorder, liver disease, kidney disease, fits or fainting, blue or purple spots on the skin or mucous membranes, received human pituitary - growth hormones etc.

EXAMINATION:

• Temperature - Normal (oral temperature not exceeding 37.50 C)

• Pulse - between 50 and 100/minute with no irregularities

• Blood Pressure -Systolic 100-180 mm Hg and Diastolic 50 - 100 mm Hg

• Body weight - not less than 45 Kg

• Haemoglobin - not less than 12.5 g/dL- 

Procedure to measure Hb using CuSO4:

1. Massage the finger to be pricked (preferably ring finger)

2. Disinfect it

3. Prick using disposable needle/ lancet

4. Put the drop of blood in CuSO4 containing beaker

5. If the blood drop sinks, Hb is more than 12.5, hence the person can donate blood (provided no other contraindication).

   

   
   

   
   

   PROCEDURE:

• Identify donor and label blood collection bag and test tubes 

• Ask the donor to state their full name.

• Ensure that: 

1. the blood collection bag is of the correct type;

2. the labels on the blood collection bag and all its satellite bags, sample tubes and donor records have the correct patient name and number;

3. the information on the labels matches with the donor's information.

• Select a large, firm vein, preferably in the antecubital fossa, from an area free from skin lesions or scars.

• Clean the site of venepuncture by alcohol and let it dry.

• Perform phlebotomy using a 16-gauge needle, which is usually attached to the blood collection bag. Use of a retractable needle or safety needle with a needle cover is preferred if available, but all should be cut off at the end of the procedure.

• Ask the donor to open and close the fist slowly every 10–12 seconds during collection.

• Remove the tourniquet when the blood flow is established or after 2 minutes, whichever comes first. 

• Ask the patient to squeeze a ball intermittently during the procedure.

• Monitor the donor and the donated unit.

• Remove the needle and collect samples.

• Cut off the needle using a sterile pair of scissors. 

• Collect blood samples for laboratory testing

POST-PROCEDURE:

DONOR CARE:

• ask the donor to remain in the chair and relax for a few minutes; 

• inspect the venepuncture site; if it is not bleeding, apply a bandage to the site; if it is bleeding, apply further pressure;

 • ask the donor to sit up slowly and ask how the person is feeling; 

• before the donor leaves the donation room, ensure that the person can stand up without dizziness and without a drop in blood pressure;

 • offer the donor some refreshments

BLOOD UNIT AND SAMPLES:

Transfer the blood unit to a proper storage container according to the blood centre requirements and the product 

• Ensure that collected blood samples are stored and delivered to the laboratory with completed documentation, at the recommended temperature, and in a leakproof, closed container

Reference: http://naco.gov.in/blood-transfusion-services-publications 

Written by our guest author - Harsh Jogi and Ayushi Gupta

Illustration by Devi Bavishi

#Ae(ONE)INTERN

 

Cardiotocography

 CARDIOTOCOGRAPHY

CTG machine has two sensors:

 

• Cardio probe: placed on the mother’s abdomen at the foetal anterior shoulder to measure the foetal heart rate. 

• Toco probe: placed on the mother’s fundus to record uterine muscle contraction.  

(Jelly is to be applied between the probe and the site of application of the probe)

 

CTG paper moves at rate of 3cm/min 

Therefore 1cm = 20 sec on x-axis

        

Also 1 cm = 10 bpm on Y axis

To be taken every 2 hours towards the end of pregnancy.

 When analysing a CTG look for 4 things: 

     1.      Baseline heart rate

     2.      Beat to Beat variability 

     3.      Accelerations

     4.      Decelerations 

1. Foetal Heart rate: Normal: 110-160 bpm 

2. Beat to beat variability:  Normal: 5-25bpm showing saw tooth pattern      

3. Foetal accelerations: 

• Abrupt increase in FHR above baseline. 

• If a rise of 15 bpm persists for 15 sec or more but less than 2 mins is seen twice during a 20 min period then this is adequate contractions or REACTIVE (after 32 weeks). 

 

4. Foetal decelerations: 

• Decrease of 15 bpm in FHR for ≥15 seconds  

• Time from onset of the deceleration to the lowest point of the deceleration >30 seconds in variable decelerations.

  
  

  
  
  

• Early decelerations: Cause: pressure on the foetal head during labour (normal)

 

• If late or variable decelerations are present, call a senior. 

 

    If all 4 parameters normal: REASSURING NST 

    If any 1 abnormal: SUSPICIOUS NST  

    If any 2 or more abnormal: PATHOLOGICAL NST 

 

If CTG is non-reassuring: 

• Set up IV line

• Start RL/Oxygen 

• Give left lateral position

• Call the resident

• Stop oxytocin

• Ask sister to give OT changes/scrubs  

Written by our guest author - Yash Bandewar and Anveshi Nayan

Illustration by Devi Bavishi

#Ae(ONE)INTERN

 

 

 

  

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OET Speaking

Speaking : (15-20 mins)

Speaking test is conducted on the same day for paper-based test while for the computer-based test it's one day before or after. How is it conducted? Speaking test has two role-plays.

OET Writing

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Writing : (45 mins)

Unlike IELTS, in OET, writing test includes letter writing for 45mins. The letter can be a referral, a transfer or a discharge according to the given case notes. But mostly for doctors ,it's a referral letter. Out of the 45 mins first 5 mins are to read the case notes and only after that we are allowed to write the letter.

OET Reading

Reading: (60mins)

Reading test has 3 parts where Part-A is for 15 mins and 45 mins is for Part-B,Part-C combined. All articles are related to healthcare scenarios.

OET Listening

Listening : (45 mins)

Listening test will be for around 45mins and has three parts,each part more difficult than the one before.The extracts are either monologues or conversations and are related to healthcare workplaces.