SKILLS

Question 1

An intramuscular (IM) injection involves

Answer 1

inserting a needle into the tissue below the subcutaneous layer into the muscle

Question 2

A subcutaneous (SC) injection involves inserting a short needle into the tissue layer between

Answer 2

the skin below the dermis and above the muscle to inject the medicine

Question 3

how to give subcut injection

Answer 3

Identify an appropriate injection site: abdomen (preferred), front of thigh, upper anterior chest wall, or side/back of upper arm.

4 Pinch the skin to raise the adipose tissue away from the muscle. Your thumb and forefinger should be about 4 cm apart.

peace the skin at a 45 degree angle

Question 4

floe rate for neb

Answer 4

8L/min

Question 5

pelvic splint indications

Answer 5

A Suspected pelvic fracture where there are clinical signs of hypovolaemia. Assume that the pelvis is fractured if the patient has pain in the pelvic area, or is unable to report pain, and has a suitable mechanism of injury.
A Cardiac arrest secondary to trauma, if pelvic injury is suspected.

Question 6

landmark for pelvic splinting

Answer 6

Take the yellow band and place the folded edge against the side of the patient, with the centre of the band in line with the greater trochanter, noting that this is over the area where pubic hair is usually present:

Question 7

INDICATION FOR Sholder relocation

Answer 7

> The patient has had previous dislocation of the same joint.
The shoulder is dislocated anteriorly.
There is no clear evidence of acromioclavicular joint dislocation (as shown below).

Question 8

Contraindications: of shoulder relocation

Answer 8

> First time dislocation of the joint.
Dislocation other than anterior.
Possible acromioclavicular joint dislocation.
Possible fracture, including the humerus.
Dislocation which has occurred as a result of a major force.

Question 9

explain Modified Kocher’s technique

Answer 9

Position the patient supine or sitting, with their arm by their side.
2. Bend the elbow to 90 degrees.
3. Apply traction to the humerus (sholder to elbow bone) and slowly externally rotate the arm until resistance is felt.
4. Slowly abduct the arm.
5. Massage the head of the humerus if the shoulder does not relocate.
6. Check that the shoulder has successfully relocated.

Question 10

explain the Stimson technique

Answer 10

1. Place the patient prone on the stretcher with their affected arm hanging down towards the ground. Ensure that their arm does not touch the ground.
2. Apply continuous, downward traction on the hand or wrist for several minutes.
3. If the shoulder does not relocate, maintain traction and gently rotate the hand and wrist outwards and maintain this position for several minutes.
4. If the shoulder does not relocate, apply scapular rotation whilst maintaining downward traction on the arm.
5. Check that the shoulder has successfully relocated.
6. Document the shoulder relocation attempt on the ePRF, including which technique was used and whether or not the attempt was successful.

Question 11

Demonstrate the correct technique for flushing a blocked urinary catheter.

Answer 11

If the catheter cannot be replaced within the next few hours,
flush the catheter using a clean technique:
– Draw up 50–100ml of 0.9% sodium chloride or sterile water using a catheter tip syringe and warm under a tap if possible
– Detach the drainage tubing from the catheter and attach the syringe
– Flush the catheter firmly over 5–10 seconds. Some discomfort is expected but stop if there is severe pain
– Remove if possible the fluid using the syringe
– Re-attach the drainage tubing and ensure urine is flowing into the drainage bag

Question 12

Describe the checks required prior to flushing a blocked urinary catheter.

Answer 12

> Drainage bag is not full, and
Drainage bag is below pubic height, and
Tubing is not kinked or blocked, and
Tubing does not contain a one-way valve that has been incorrectly inserted facing the wrong way.

Question 13

Describe the contraindications and cautions for flushing a blocked urinary catheter.

Answer 13

> Surgery on the renal tract or prostate in the last four weeks
Signs of sepsis.

Question 14

what are suprapubic catheters

Answer 14

catheters can be inserted through the abdominal wall directly into the bladder;

Question 15

what are urethral catheters

Answer 15

urinary catheters are inserted through the urethra, the tube that usually carries urine from the bladder to the outside
of the body

Question 16

name the most common anticoagulants

Answer 16

Dabigatran, rivaroxaban and apixaban are oral anticoagulants which are alternatives to warfarin.

Question 17

when should midaz be administered

Answer 17

Administer midazolam if the seizure is generalised and continues for longer than five minutes, or seizures are recurrent

Question 18

dosage for IM midaz

Answer 18

10 mg of midazolam IM for an adult. Consider reducing the dose to 5 mg if a caution is present.

This may be repeated once after ten minutes

Question 19

adult arrest adrenaline

Answer 19

Administer adrenaline IV every four minutes:
1 mg IV for an adult.

Question 20

presentation of amiodarone

Answer 20

Ampoule containing 150 mg in 3 ml

Question 21

IM fent dosage

Answer 21

M and SC for analgesia if IV access cannot be obtained:
Adult:
50-100 mcg IM/SC.
Subsequent doses may be administered every 20 minutes up to a total of three doses.
Halve all doses if the patient is frail or has signs of shock.

Question 22

how long is the QRS

Answer 22

40-120ms (1-3) small box

Question 23

how long is PR interval

Answer 23

120-200ms (3-5) small box