April 14  2015, Tuesday
Victims must get full treatment: SC
Dr KK AggarwalKrishnadas Rajagopal: The Hindu

In an order likely to have far-reaching effects, the Supreme Court ruled on Friday that private hospitals could neither “turn away” victims of acid attack nor wash their hands of after providing first aid.

The court made it mandatory for these hospitals across the country to provide full and free medical treatment to the victims. The order said the term “treatment” included reconstructive surgery, free medicines, bed, rehabilitation and aftercare.

The order came on a public interest litigation petition filed by Laxmi, an acid attack victim, following nine years of fighting for the rights of victims.

Ms. Laxmi was only 15 when three men, one of whom she had refused to marry, threw acid on her near Tughlaq Road in New Delhi. She has been fighting a lonely battle since 2006 in the Supreme Court, and in the process, succeeded in getting the Indian Penal Code amended to make acid attack a special offence. She further persuaded the court to increase the compensation for victims to Rs. 3 lakh, besides procuring a complete ban on over-the-counter sale of acid.

Friday’s order dealt with Ms. Laxmi’s final demand for getting victims proper treatment, aftercare and rehabilitation.

In its order, the Social Justice Bench of Justices Madan B. Lokur and U.U. Lalit directed that “all States should take up with private hospitals and ensure that they do not deny treatment to acid attack victims. We see there is a reluctance on the part of some private hospitals to provide free treatment.”

The court clarified that “free treatment would mean not only free medical treatment but also availability of medicines, food and reconstructive surgery.”

The court directed the State governments to take action against the hospitals turning away victims.

The Bench was interpreting Section 357C of the Criminal Procedure Code, inserted in Feb. 2013, to deal with the issue of cost of treatment of acid-attack victims.

IMA News Editor’s Comments

The above Supreme Court Judgment has large implications not only in cases of acid burn but also victims of child sexual abuse and rape. Let us revise the various provisions of law.
  • CrPC Chapter XXVII: S. 357 C (Code of Criminal Procedure): Treatment of victims (1) Description: " All hospitals, public or private, whether run by the Central Government, the State Government, local bodies or any other person, shall immediately, provide the first-aid or medical treatment, free of cost, to the victims of any offence covered under section 326A, 376, 376A, 376B, 376C, 376D or section 376E of the Indian Penal Code, and shall immediately inform the police of such incident."
  • 2. '326A. Whoever causes permanent or partial damage or deformity to, or burns or maims or disfigures or disables, any part or parts of the body of a person or causes grievous hurt by throwing acid on or by administering acid to that person, or by using any other means with the intention of causing or with the knowledge that he is likely to cause such injury or hurt, shall be punished with imprisonment of either description for a term which shall not be less than ten years but which may extend to imprisonment for life, and with fine: Provided that such fine shall be just and reasonable to meet the medical expenses of the treatment of the victim: Provided further that any fine imposed under this section shall be paid to the victim.
  • 376. (1) Whoever, except in the cases provided for in sub-section (2), commits rape, shall be punished with rigorous imprisonment of either description for a term which shall not be less than seven years but which may extend to imprisonment for life, and shall also be liable to fine.
(2) Whoever,—

being a police officer, commits rape— (i) within the limits of the police station to which such police officer is appointed; or (ii) in the premises of any station house; or (iii) on a woman in such police officer's custody or in the custody of a police officer subordinate to such police officer; or

(b) being a public servant, commits rape on a woman in such public servant's custody or in the custody of a public servant subordinate to such public servant; or

(c) being a member of the armed forces deployed in an area by the Central or a State Government commits rape in such area; or

(d) being on the management or on the staff of a jail, remand home or other place of custody established by or under any law for the time being in force or of a women's or children's institution, commits rape on any inmate of such jail, remand home, place or institution; or

(e) being on the management or on the staff of a hospital, commits rape on a woman in that hospital;
  • Refusal to provide medico legal examination and treatment is punishable by imprisonment for up to 1 year as per section 166B IPC. Section 166B of Indian Penal Code (IPC) 1860: " Whoever, being in charge of a hospital, public or private, whether run by the Central Government, the State Government, local bodies or any other person, contravenes the provisions of section 357C of the Code of Criminal Procedure, 1973, shall be punished with imprisonment for a term which may extend to one year or with fine or with both)"
  • This examination can be performed by any registered medical practitioner (Section 164 (A) CrPC).
  • Section 53 a of CRPC: b)"registered medical practitioner" means a medical practitioner who possesses any medical qualification as defined in clause (h) of section 2 of the Indian Medical Council Act, 1956 and whose name has been entered in a State Medical Register.
  • Section-164 A of Cr.P.C- Medical examination of the victim of rape
164 A. Medical examination of the victim of rape. – (1) Where, during the stage when an offence of committing rape or attempt to commit rape is under investigation, it is proposed to get the person of the woman with whom rape is alleged or attempted to have been committed or attempted, examined by a medical expert, such examination shall be conducted by a registered medical practitioner employed in a hospital run by the Government or a local authority and in the absence of a such a practitioner, by any other registered medical practitioner, with the consent of such woman or of a person competent to give such consent on her behalf and such woman shall be sent to such registered medical practitioner within twenty-four hours from the time of receiving the information relating to the commission of such offence.

(2) The registered medical practitioner, to whom such woman is sent shall, without delay, examine her and prepare a report of his examination giving the following particulars, namely:-
    1. the name and address of the woman and of the person by whom she was brought;
    2. he age of the woman;
    3. the description of material taken from the person of the woman for DNA profiling;
    4. marks of injury, if any, on the person of the woman;
    5. general mental condition of the woman; and
    6. other material particulars in reasonable detail.
(3) The report shall state precisely the reasons for each conclusion arrived at.

(4) The report shall specifically record that the consent of the woman or of the person competent to give such consent on her behalf to such examination had been obtained.

(5) The exact time of commencement and completion of the examination shall also be noted in the report.

(6) The registered medical practitioner shall, without delay forward the report to the investigation officer who shall forward it to the Magistrate referred to in section 173 as part of the documents referred to in clause (a) of sub-section (5) of that section.

(7) Nothing in this section shall be construed as rendering lawful any examination without the consent of the woman or of any person competent to give such consent on her behalf.

Explanation. – For the purposes of this section, “examination” and “registered medical practitioner” shall have the same meanings as in section 53’
213th Meeting of the Central Working Committee of Indian Medical Association at Hotel Radisson Blu, New Delhi.
  • The 5-alpha-reductase inhibitors (5-ARIs) used to treat benign prostatic hyperplasia (BPH) do not increase the risk of prostate cancer-specific or all-cause mortality in men newly diagnosed with prostate cancer, suggests a study published online in JAMA Oncology.
  • A single dose of a broadly neutralizing HIV-1 antibody (bNAb) significantly decreased viral load up to 8 weeks, reported a small phase 1 clinical trial published online April 8 in Nature.
  • New research shows that it is possible to kill drug-resistant bacteria by alternating two antibiotics at doses that would ordinarily boost bacterial resistance and survival when used alone or combined. The findings are published in the journal PLOS Biology.
  • A new study suggests that obesity could be a protective factor against dementia, while people who are underweight may be at increased risk. Being underweight was linked with a 34% increased dementia risk, while being severely obese reduced dementia risk by 29%. The study is published in The Lancet Diabetes & Endocrinology.
  • Hematopoietic stem cell transplant recipients should receive influenza vaccine beforehand, if possible, suggests new research published in Bone Marrow Transplantation.
Dr KK Spiritual Blog
Vedic principles behind cognitive behavior therapy

1) What is counseling?

A: The mental process involves generation of a thought or idea, which is analyzed and then acted upon. Thought, analysis and action therefore are the primary three process of human mind. Counseling involves action at all three levels.
2) What are different types of counseling?
A: Counseling involves basically two principles: Cognitive counseling and behavioral counseling. Behavioral, when the concentration is only on the actions and cognitive, when the concentration is on the changes in either the thought process or in the interpretation of the thought process.
3) What is cognitive behavior therapy?
A: As against a pure behavior therapy where a person is counseled to do pre–defined things on regular intervals, cognitive behavior therapy involves changing the actions by changing observations of the interpretation of a particular situation.
4) What is the origin of counseling in India?
A: The origin of counseling goes back to Vedic era. Upanishads were basically text books on counseling based on the original knowledge of Rigveda, Yajurveda, Samveda and Atharvaveda.
5) Is there a relationship of Bhagavad Gita with Counseling?
A: Bhagavad Gita is counseling done by Krishna to resolve the conflict in Arjuna’s mind whether to fight or not. At that time there were no doctors and hence counseling was done by the elders in the family.
6) Are the principles of Bhagavad Gita followed today?
A: All the principles of cognitive behavior therapy today are basically principles that have originated from Bhagavad Gita.
7) What is the first principle?
A: The first principle is that "counseling cannot be done in 1 or 2 sessions." It requires up to 18 sessions which is what Krishna did in Bhagavad Gita. Bhagavad Gita contains 702 dialogues in the form of Shlokas therefore a proper counseling involves in–depth conversation between the counselor and the patient.
8) What is the second principle of counseling?
A: The second principle of counseling is to listen to the patient in the first session in great detail and this is what Krishna did in Bhagavad Gita. In Chapter 1, only Arjuna speaks and Krishna does not utter a word. A patient listening is half the healing done.
9) What is the third principle?
A: As per the third principle, the second (first interactive) session between counselor and the patient should be the longest one. Chapter 2 of Bhagavad Gita is the gist of Krishna’s counseling.
10) What is the fourth principle?
A: The fourth principle is that after giving a detailed counseling in the second session, it is expected that the patient will be confused. This is what happens in start of Chapter 3 where Arjuna says to Krishna "I am confused. Sometimes you are talking about one path and other time you are talking about another path. Guide me again." The third counseling session therefore, is the most important where one has to counsel slowly and in great detail.
11) What is the fifth principle?
A: The next principle is to give reasoning to the counseling. One should not take the patient for granted. Krishna discusses each and every aspect of life with Arjuna in great detail giving scientific reasoning at every stage.
12) What is the sixth principle?
A: Reassure the patient again and again. During counseling Krishna assures Arjuna on multiple occasions that you did your job and do not worry. I am with you.
13) What is the seventh principle?
A: The seventh principle involves creating some fear in the patient’s mind. This is what Krishna does while showing his virat swaroop. This especially works in patients of addiction. Some degree of fear with re–assurance from the counselor always works.
14) What is the eight principle?
A: The summing up counseling session should be as long as the second session. The Chapter 18 of Bhagavad Gita is as big as Chapter 2 where the whole Bhagavad Gita is summarized again.
15 What are the ingredients of counseling?
A: Counseling basically involves in-depth knowledge of dharma, artha, kama and moksha. They are greatly described in Dharmashastra, Arthashastra, Kamasutra and Upanishads through various Vedas.
16) What is stress?
A: Stress is the reaction of the body or the mind to the interpretation of any situation.
17) How can stress be managed?
A: Stress can be managed by either changing the response of the body through yogic living, or changing the interpretation by understanding the principles of counseling or change the reaction by willful actions.
18) Are different nitis of our scriptures based on counseling?
A: Yes. Vidur Niti was the counseling given by Vidur to Dhritarashtra and Chanakya Niti was based on how to rule a country. Yoga Vashishtha was the counseling given by Vashishtha to Rama to acquire higher levels of spiritual knowledge.
Cardiology eMedinewS
  • Patients with gout who take allopurinol may have a reduced risk of myocardial infarction (MI), pointed a case-control study published in Annals of the Rheumatic Diseases.
  • Percutaneous circulatory support devices should be considered for complicated acute myocardial infarction (MI) patients, recommends a consensus statement from the Society for Cardiovascular Angiography and Interventions, the American College of Cardiology Foundation, the Heart Failure Society of America, and the Society for Thoracic Surgery.
Pediatrics eMedinewS
  • Vaccinating boys against the human papillomavirus (HPV) might be a cost-effective way to prevent HPV-related oropharyngeal squamous cell cancer, suggests Canadian research published online April 13 in Cancer.
  • Scans of activity in the brains of infants as young as 1 year of age have given a neural picture of those children who will develop along the autism spectrum with poor language abilities compared with those who will develop good levels of communication. The report is published online April 9 in Neuron.
Make Sure
Situation: Doctor, this patient has developed acute renal failure (ARF).
Reaction: Oh my God, I forgot that he was on furosemide. I gave him a full dose of amikacin.
Lesson: Make sure, before calculating the dose of aminoglycoside (amikacin) that furosemide and other loop diuretics, which enhance its nephrotoxicity are not being given.
Dr Good Dr Bad
Situation: A 40-year-old male developed dyspnea for the first time in life.
Dr. Bad: It is an attack of asthma.
Dr. Good: Get an ECG done.
Lesson: First onset of breathlessness after the age of 40, unless proved otherwise, is cardiac in nature.
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Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh, SM Heart Care Foundation Fund, Post CAG
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Sonal Namaste
Regular handwashing, particularly before and after certain activities, is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others.
Facts about Tuberculosis (TB)
Since the treatment duration is long what happens if a patient has to shift his residence?

  • Under RNTCP there is a provision of ‘Transferring Out’ to ensure continuity of treatment if a patient has to shift his residence to an area which is outside the TB unit in which he/she has been registered. This could be another district or even another State anywhere in the country.
  • The treatment is continued at the DOT centre nearest to the new residence of the patient.
Sonography machines to be kept shut on April 15
By Nozia Sayyed, Pune Mirror | Apr 13, 2015, 02.30 AM IST

Last month, the radiology department of Sassoon General Hospital came under the scanner.

Irked at govt's apathy regarding the PCPNDT Act, all members of national medical associations like IMA, IRIA, will protest the 'discrimination', also wear black bands

Alleging a lackadaisical attitude of the government regarding the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, national bodies like Indian Medical Association (IMA) and Indian Radiological and Imaging Association (IRIA) have announced a day's protest on April 15, when all the ultrasonography (USG) machines will not be used.

All members of the national associations will also be wearing a black band the entire day in support of the protest. This will be carried out to stress the fact that the current PCPDNT Act needs a change as it has many lacunae and includes a non-bailable offence for an incomplete column of the Form F, a technical glitch that can be easily left out by doctors while filling forms. Also, no strict action has been taken by the government authorities against the government-run Sassoon hospital's radiology department that had come under the scanner for erroneous behaviour.

"Considering all aspects about favouring its own hospital and being stricter with the private sector under the PCPNDT Act, we at IMA have decided to call a day's protest. This will be observed nationally," said Dr K K Aggarwal, national secretary, IMA, on Sunday. He added, "Looking at the increasing cases of doctors being harassed and put behind bars for silly reasons, like not signing a form or leaving a column incomplete after conducting sonographies, we have decided that a protest is the need of the hour. We have also demanded certain changes in the current Act and also IMA's inclusion in the PCPNDT national body, so that no favouritism takes place."

Over 2.5 lakh doctors across the country will participate in the protest.

"It is sad that the government favours its own institutions and troubles private practitioners. It becomes extremely difficult for doctors to fill the Form Fs manually and also online, supposed to be submitted to the government. Moreover, the government hospital has not been filing the same — still no strict action has been taken. This is unfair," said Dr Nitin Bhagali, a member of IMA Pune.

"As many as 300 radiologists and sonologists will be shutting down their USG machines on April 15. This harassment needs to stop and technical faults should not be considered as non-bailable offences. Under the current Act, a single incomplete column is equal to conducting a sex determination test which is ridiculous. The act needs to be rethought," said Dr Viren Kulkarni, president of IRIA, Pune.
PCPNDT protest: 1,000 sonologists in city to shut shop on April 15
Monday, 13 April 2015 - 6:00am IST

DNA Correspondent

Around 1,000 sonologists in the city will be on a day-long stop-work protest on April 15 against the alleged high-handedness of government health officials in implementing the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, said Indian Medical Association, an umbrella body of allopathy doctors in India.

The decision was taken at IMA's working committee meeting in Delhi on Saturday. The association is demanding amendments in the Act, as presently, the punishment for paperwork errors and for doctors performing sex selection procedures is similar.

IMA president Dr KK Agarwal said, "We are supporting radiologists and sonologists. They will be pulling their shutters down and carrying out only emergency ultrasounds. Non-emergent ultrasound will be postponed for the day."

Dr Agarwal said that 4,000 sonologists in Maharashtra are participating in the pan-India protest.

IMA has demanded immediate release of doctors prosecuted under clerical errors until sex determination crime is proven against them. IMA has also asked the government to separate clerical errors from actual performance of sex determination. "How can you seal ultrasound machines and suspend a doctor for clerical errors? We are supporting government on improving child sex ratio and against fetal sex determination. Warning and recheck of clerical errors and fine for repeated clerical errors is understandable," said Dr Agarwal.

While the IMA has announced strike across India, the Indian Radiological and Imaging Association and Federation of Obstetrics & Gynaecological Societies of India (FOGSI), the two important bodies of gynaecologists and radiologists who are affected by the PCPNDT Act has decided to stay away from the protest.

Dr Jignesh Thakker, president of IRIA said that they had met state's health minister two weeks back and will not be participating in April 15 protest. "We are not participating in any protest. It will be work for us like any other day. The state health minister has agreed to look into the points raised by us. When the minister is already working on our demands, why should we protest?" Dr Thakker said. IRIA has around 1,000 members in the city and 16,000 in the country. Agreeing to Dr Thakker, Dr Prakash Trivedi, president of FOGSI said that since they have not called for the protest, they won’t be part of it.
New norms to examine sexual assault survivors
K.A. Shaji

Doctors must provide free treatment to female survivor immediately

In a major relief to sexual assault survivors who face discrimination and humiliation during the mandatory medical examination that usually takes place in unfriendly environments, a new medico-legal protocol for their examination has come into force in the State with even private hospitals coming under its purview.

The new Kerala Medico-Legal Protocol for Examination of Survivors of Sexual Offences came into force on January 31 as the government found that existing formats and guidelines had drawn severe criticism from rape victims, their families, women’s organisations, and trial courts.

As per the new protocol, it will be mandatory for all doctors and hospitals to provide first aid and medical treatment immediately to a female survivor of sexual offence free of cost.

No payment must be accepted for consultation, medicines, and clinical investigations. If the survivor needs in-patient treatment, adequate facilities must be provided in an atmosphere where there will be no threat or inducement from the accused.

The protocol prevents doctors from conducting two-finger test and similar examinations to prove previous sexual experience of the survivor, as such attempts violate the privacy of the survivor. It also reminds doctors of legal action and incarceration if they not treat survivors with humane and sympathetic considerations in an unbiased and impartial atmosphere.

Talking to The Hindu here, Palakkad District Police Surgeon P.B. Gujaral, who drafted the new protocol in consultation with the National Rural Health Mission, said the elaborate manual prepared against the backdrop of the Delhi rape case and recommendations of the Justice Verma Commission would help uphold the integrity of the survivor and the successful trial and prosecution of the culprits.

Doctors across the State would be soon be provided with copies of the protocol, and workshops would be organised to explain to them its provisions.

Dr. Gujaral said the protocol stressed the privacy of the assault survivors even while focusing on scientific validation of the crime.
Inspirational Story
A Strong Woman vs. Woman of Strength

A strong woman works out every day to keep her body in shape... but a woman of strength kneels in prayer to keep her soul in shape...

A strong woman isn't afraid of anything... but a woman of strength shows courage in the midst of her fear...

A strong woman won't let anyone get the best of her... but a woman of strength gives the best of her to everyone...

A strong woman makes mistakes and avoids the same in the future... a woman of strength realizes life's mistakes can also be God's blessings and capitalizes on them...

A strong woman walks sure footedly... but a woman of strength knows God will catch her when she falls...

A strong woman wears the look of confidence on her face... but a woman of strength wears grace...

A strong woman has faith that she is strong enough for the journey... but a woman of strength has faith that it is in the journey that she will become strong...
Quote of the Day
You have to learn the rules of the game. And then you have to play better than anyone else. Albert Einstein
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Wellness Blog
5 steps to lower Alzheimer’s risk (HealthBeat)

  • Maintain a healthy weight.
  • Check your waistline.
  • Eat mindfully. Emphasize colorful, vitamin–packed vegetables and fruits; whole grains; fish, lean poultry, tofu, and beans and other legumes as protein sources; plus healthy fats. Cut down on unnecessary calories from sweets, sodas, refined grains like white bread or white rice, unhealthy fats, fried and fast foods, and mindless snacking. Keep a close eye on portion sizes, too.
  • Exercise regularly. Aim for 2˝ to 5 hours weekly of brisk walking (at 4 mph) or try a vigorous exercise like jogging (at 6 mph) for half that time.
  • Keep an eye on important health numbers. In addition to watching your weight and waistline, keep a watch on your cholesterol, triglycerides, blood pressure, and blood sugar numbers.
Reader Response
Dear Sir, very informative news. Regards: Dr Kartik
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Frying Eggs

The wife was busy frying eggs, when her husband came home. He walked into the kitchen and immediately started yelling.


The wife was very upset, "What is wrong with you? Why are you yelling like this? Do you think I don't know how to fry an egg?"

The husband calmly replied, "I wanted to show you what it feels like for me when I am driving with you sitting next to me."
eMedi Quiz
Mummification refers to:

1. Hardening of muscles after death.

2. Colliquative putrefaction.

3. Saponification of subcutaneous fat.

4. Dessication of a dead body.

Yesterday’s Mind Teaser: Acantholysis is characteristic of:

1. Pemphigus vulgaris.

2. Pemphigoid.

3. Erythema multiforme.

4. Dermatitis herpetiformis.

Answer for yesterday’s Mind Teaser: 1. Pemphigus vulgaris.

Correct Answers received from: Dr Poonam Chablani, Dr Jainendra Upadhyay, Raju Kuppusamy, Dr KV Sarma, Daivadheenam Jella, Dr Avtar Krishan.

Answer for 12th April Mind Teaser: 1. The gain in weight of young animals per unit weight of protein-consumed.

Correct Answers receives: Dr Jainendra Upadhyay, Dr K Raju, Dr Avtar Krishan.
UP should bring Ordinance against Prevention of Violence and Damage to Property Act immediately; IMA
In a letter written to Shri Akhilesh Yadav, Hon’ble Chief Minister, Govt. of UP, Indian Medical Association has shown deep concern about the assault on a senior member of the Association Dr. Rohit Gupta, 53 Years old. He is a renowned Gastroenterologist in Allahabad. The senior doctor was assaulted around 4.00 AM on Sunday the 12th April 2015 in Anand Hospital, Allahabad.

The relatives of the 80 year old patient who came with multi organ failure died in the morning. When Dr. Rohit came to see the patient, the relatives brutally beat him for 10 to 15 minutes, snatched his mobile and gold chain and damaged ICU infrastructure.

The local Branch of Allahabad has gone on strike and UP State Branch has called a State wide agitation.

Dr. A. Marthanda Pillai, National President, IMA and Dr. K.K. Aggarwal, Hony. Secretary General, IMA has urged the Chief Minister of UP to intervene the matter immediately, so that doctors can work with more fearlessness and do justice to the profession and to the patients.

In the letter, IMA has asked the Chief Minister that:
  1. Directions may be issued to the police for arresting all the people who are involved in beating and they will be charge-sheeted under IPC Section 44. 445, 304, 302, 307, 323, 324, 325, 326, 504, 506 and 34, a part from any other applicable Section.
  2. UP Ordinance to be immediately issued on the lines as has been done in other 14 States in the name of UP Medicare service Persons and Medicate Service Institutions (Prevention of Violence and Damage to Property Act 2005).
In 14 States in the country Prevention of Violence and Damage to Property Act/Ordinance are in place which makes such offence a non bailable offence. These States are AP, Chhattisgarh, Delhi, Gujarat, Haryana, MP, Maharashtra, Orissa, Punjab, Rajasthan, Tamilnadu, Tripura and West Bengal.

Letter addressed to Sh.Akhilesh Yadav
Rabies News (Dr A K Gupta)
What are the precautions to be taken while administering RIGs?
  • Patient should not be on an empty stomach.
  • The RIG vial should be kept outside for a few minutes, after taking it out of the refrigerator, to warm it to room/body temperature.
  • While infiltrating RIG into the bite wound, care must be taken to avoid injecting into blood vessels and nerves.
  • While injecting into the finger tips, care must be taken to avoid compartment syndrome.
  • All emergency drugs and facilities for managing any adverse reactions must be available.
  • For ERIG, keep the patient under observation for at least one hour after ERIG administration and then send home.
  • RIGs can be infiltrated even to already sutured wounds without disturbing the sutures.