Sub-Div.Hospitals

District Hospitals

(a) Coma/Cerebro
Vascular
Accident

-To maintain vital signs & airway (Ambubag, Oxygen)
-To exclude Diabetes & Renal failure
-To provide facility of   tracheostomy & Laryngoscope for incubation
-To exclude head injury by   doing x-ray skull.
-To start medical decompression treatment. Anti-biotic and to treat case of poisoning if any. If coma does not improve case to be referred to district level hospital.

-Same as CHC

Carry on treatment and surgical decompression if required to investigate and confirm diagnosis of CV accident. Brain tumor be referred to tertiary level institution of indicated.

(b) Meningitis

Initiate medical treatment and first aid refer to district hospital for further investigation.

To do CSF examination, start treatment, if no improvement after 48 hours refer to district hospital.

To do culture and sensitivity test, diagnose and treat

(c) Epilepsy

Initiate medical treatment and first aid treatment, refer to district level hospital for further investigation.

Same as CHC

Manage, investigate, do EEG, refer to tertiary level institution for surgery if required.

(d)Polio and other Acute flaccid Paralysis.

Intimate medical treatment maintain vital signs, remove discomfort, refer to district level hospital for CSF examination and stool culture.

Same as CHC

To treat and investigate

Diseases

CHCs

Sub-Divisional Hospitals

District Level Hospitals

Bronchial Asthma

To initiate medical treatment if no relief send to district level for further investigation

 Same as CHC

To investigate & treat

Upper Respiratory and Lower Respiratory
Infection

Initiate medical treatment & symptomatic treatment, observe for 48 hours, if no relief refer to district level hospital.

 Same as CHC

To investigate & treat

Tuberculosis

To investigate by sputum examination & x-ray chest, initiate antituberculosis treatment Review after 15 days, if no relief level health institution.

 Same as CHC

To investigate & treat

Lung Cancer

 To initiate symptomatic treatment & other supportive therapy, refer to tertiary level health institution.

 Same as CHC

Same as CHC & refer to tertiary level institute

Pleural Effusion

Initiate symptomatic treatment, do x-ray chest & diagnostic tap, start treatment &refer to district hospital, to confirm diagnosis.

 Same as CHC

To confirm the diagnosis start treatment, if malignant refer to tertiary level hospital.

Poisonous Gases Inhalation

Start first aid treatment give respiratory support.

 Same as CHC

Same as CHC

Foreign Body Inhalation

Give first aid, refer to district level hospital where facility of Broncho Scopy is available.

 Same as CHC

 Same as CHC

 CHCs

Sub-Divisional Hospitals

 District Level Hospitals

To initiate medical treatment of mild and moderate hypertension, refer to sub-divisional level hospital for treatment of accelerated hypertension.

Investigate and treat

 Investigate and treat

To initiate medical treatment
On clinical suspicion of disease, refer to district hospital for TMT & other rests.

Same as CHC

Investigate & maintain therapy.
Refer to tertiary level hospital for active intervention, if required (Coronary, Angiography, Angioplasty and By-pass surgery)

To initiate treatment by sedation, Vaso-dilator, thrombolytic therapy (Streptoknase). If within 24 hours there is no improvement or there is complication refer to sub-divisional level hospital.

To manage Myo-Cardial Infarction, if evidence of heart block refer to district hospital for pace maker.

To investigate and treat

Initiate treatment and observe, if decomposition persist refer to district hospital.

Same as CHC

To Investigate and treat

Asthma

Initiate treatment with Broncho Dilator, Diuretics, Oxygen, if no improvement refer to district hospital.

Same as CHC

Investigate and treat

 Start initial medical treatment, refer to district level for confirmation of
Diagnosis.

Same as CHC

Investigate and treat

Maintain vital sign and refer to sub-divisional hospital for Defibrillation.

Medical treatment and Defibrillation.

Medical treatment and Defibrillation.

Initiate treatment maintain vital signs and functions, IV fluids, Oxygen and observe. If no improvement within reasonable time refer to district hospital.

Same as CHC

To investigate and treat

Diseases

CHCs

Sub-Divisional Hospitals

District Level hospitals

Diseases Intestinal Bleeding and Ulses

Start medical treatment and supportive therapy. If No improvement within reasonable time refer to district level hospital for endoscopic investigation.

Same as CHC

Investigate and treat

Jaundice/ Hepatitis

Clinically diagnose and initiate medical treatment, refer to district for investigation especially if patient is in Coma.

Same as CHC

Investigate and treat

Gastro Enteritis/ Dehydration

Start oral Re- hydration therapy. Systemic anti-biotics if indicated Manage Gr 1 and Gr 2 Dehydration. If condition does not improve refer to district Hospital ( If there is  suspicion of Cholera or other epidemic case. It be immediately referred to district Hospitals)

Same as CHC

Investigate and treat

Ameobic Infection

Intestinal Infection to be investigated & treated, If suspicious of liver involvement refer to sub-Divisional Hospitals for Ultra Sound.

Investigate and treat

Investigate and treat

System & Diseases

CHCs

Sub-Divisional Hospitals

District Level hospitals

Urinary Tract Infection

Initiate symptomatic
Send to district Hospital for further investigation

Same as CHC

Investigate and treat

Haematuria

 Symptomatic treatment, alkaliser, pain reliever and investigate, if causes not identified refer to district Hospital.

Same as CHC

Investigate and treat

Acute Renal failure and chronic Renal Failure

Maintain vital signs and refer to Dialysis unit.

Same as CHC

Investigate and treat in 3-4hospitals only.

Arthritis

Start Palliative therapy, refer to district Hospital for investigation and Physiotherapy.

Same as CHC

Investigate and treat
Physiotherapy

CHCs

Sub-Divisional Hospitals

District Level hospitals

Anaemia/Infestation

Treat Nutritional anaemia, treat worms, if no response refer to District Hospital for investigation

Same as CHC

Investigate and treat

Leukaemia and REsystem Disorder

Give symptomatic treatment and refer to district Hospital for investigation

Same as CHC

Investigate and treat
And refer to tertiary
Level if needed.

Bleeding Disorder

Treat Anaemia give Haemostatic agents refer to district Hospital for investigation.

Same as CHC

Investigate and treat

CHCs

Sub-Divisional Hospitals

District Level hospitals

Diagnose and treat
Materia .In case complications develop or fever does not respond or G-GPD deficiency is suspected refer to district Hospital for investigation.

Same as CHC

Investigate and treat

Give treatment for the symptoms, if no response, refer to District Hospital.

Same as CHC

Investigate and treat

Give treatment for the symptoms, if no response, refer to District Hospital for
Investigation and treatment.

Same as CHC

Investigate and treat

All patients suspected of HIV infection should be referred to District Hospital for diagnosis or nearby HIV testing center.

Same as CHC

Investigate and diagnose. Manage as per NACO guidelines

Sub-Divisional Hospitals

Do

Same as CHC

Do

No

Same as CHC

Do

Do simple cases

Same as CHC

Do

Do

Same as CHC

Do

Symptomatic treatment & refer

Same as CHC

Refer to Tertiary Level Hospital

Initiate treatment & refer

Same as CHC

Treat

Refer

Same as CHC

Investigate & treat

Treat

Same as CHC

Investigate cause & treat Refer.

Refer

Same as CHC

Investigate & treat

Refer

Same as CHC

Investigate, treat & refer to Tertiary Level Hospital

Refer

Ensure

Ensure

Symptomatic treatment
& refer

Same as CHC

Investigate & treat
Including Laproscopic Cholecystectomy

Symptomatic treatment& refer

Same as CHC

Investigate & manage (for therapeutic endoscopy or surgery, refer to tertiary level)

Symptomatic treatment & refer

Same as CHC

Investigate & manage. Refer if complication

Yes

Same as CHC

Yes

Symptomatic treatment & refer

Same as CHC

Symptomatic treatment & refer to tertiary level

Initial treatment observe & refer if necessary

Same as CHC

Investigate & manage

Initial treatment observe & refer if necessary

Same as CHC

Investigate & manage

(i)Psychotic Patients

To start crisis management& refer to psychiatrist at district level hospital

Same as CHC

Treat

(ii) Depression &
Allied Disorders

Sedation treatment and refer to psychiatrist and follow up action on psychiatrist