Practical Explanations

Question 1

Scaphoid Cast Applications
- Thumb SPICA

Answer 1

Indication
- Suspected scaphoid fracture

Equipment needed
- Stockinet, Orthopaedic wool, gloves, bucket of water, sling, wipes, plaster, crepe bandage, Thin cloth tape.

Position
- Forearm full pronation
- Slight radial deviation
- mild dorsiflexion

Plaster Landmarks
- Exclude All MCP joints
- 5-10cm away from elbow
- Include the 1st IPJ to immobilise thumb.
-

Steps
- Apply stockinette
- Apply 2 layers of orthopaedic wool
- Wet and place cut 6 layered plaster on palmar aspect of hand down anterior forearm
- Apply crepe bandage commencing proximally.
- Shape plaster into palm of hand.
- Check for free movement of elbow (Full ROM flexion and extension) and fingers (should be able to oppose thumb to index and middle finger).
- Pull back excess stockinette at extremities and secure with non-circumferential application of tape.
- Place in Sling with fracture remaining above heart leve.

Question 2

EpiPen Administration

Answer 2

When? -

How?
- Pull off blue safety release of unlock device
- Check to see if clear window is not obstructed. If it is, the pen has already previously been used.
- Place orange end of epipen to upper outer thigh and push it firmly until it clicks. Then count for 10 seconds. Then remove pen
- Seek immediate emergency care. Bring epipen with you to emergency department.

Question 3

How to use varying sorts of inhalers

Answer 3

• Wash hands
• Remove plastic cap over mouthpiece
• Ensure mouthpiece is clean
• Sit or stand in upright position
• Breathe out slowly and deeply away from the inhaler
• Place mouthpiece between teeth without biting it.
• Ensure lips make a tight seal on the mouthpiece.
• Breathe in slowly through the mouth and simultaneously press canister.
• Continue to breathe in slowly until lungs are full.
• Hold breath for as long as comfortable.
• Breathe out slowly away from inhaler.
• Replace the plastic cap after use.

Corticosteroid? Rinse out mouth after use.
Spacer? Wash spacer with water and kitchen detergent. Allow to air dry without wiping. Also remove inhaler and shake in between puffs.
Accuhaler

Question 4

Procedure for implanon insertion

Answer 4

• Insert Day 1-5 of menstrual cycle
• Can use quickstart method at any time of cycle. To perform urine-bHCG prior to insertion
• Will not be effective for 1st seven days. Follow up urine bHCG in 4 weeks at home or in clinic.
• Consent patient
• Record written consent and document discussion in patient record.

Positioning
- Lying on examination bed with non-dominant arm flexed and externally rotated.

Wash hands
- Mark insertion point 10cm above medial epicondyle. Mark guiding point 4 cm proximal to insertion point. Aim to place implant over bicep.

Administer 4mL 1% lignocaine

Re-wash hands and don sterile gloves.

Check implant is inside the needle after sliding off the cap.

Pierce skin at <30 degree angle, then re-angle to horizontal position.
- Tent the skin slightly as you progress the needle to ensure superficial insertion.

Pull back the purple lever to activate the device and retract the needle.

Palpate the implanon to ensure position

Place waterproof dressing.
- Ask patient to palpate the implant themselves.

Apply pressure bandage over the implant.

Education
- Leep site clean and dry for 3-5 days.
- Expect bruising.
- Remove pressure bandage after 24 hours.

Provide patient with post-instertion instruction.

Set reminder for repeat insertion in 3 years.