Medical Student Survival Skills

Procedural Skills

Philip Jevon, Ruchi Joshi

• Publisher: Wiley-Blackwell
• Year: 2019
• Print ISBN: 9781118870570
• eBook ISBN: 9781118870549
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Education

Medical students encounter many challenges on their path to success, from managing their time, applying theory to practice, and passing exams. The Medical Student Survival Skills series helps medical students navigate core subjects of the curriculum, providing accessible, short reference guides for OSCE preparation and hospital placements. These guides are the perfect tool for achieving clinical success.

Medical Student Survival Skills: Procedural Skills is the ideal guide for medical students tasked with performing a core set of clinical procedures. A vital part of any medical training, these procedures range from basic body temperature and blood pressure measurements to more advanced arterial blood gas sampling and ophthalmoscopic techniques. This indispensable guide enables students to quickly lookup relevant information on the go, carry out clinical procedures with minimal supervision and apply procedural knowledge to their OSCE exams.

1
Measuring body temperature

Introduction

• Normal body temperature ranges between 35.8 °C and 37.2 °C (depending on circadian variation and from which part of the body it is measured)
• Core temperature represents the balance between the heat generated by body tissues during metabolic activity, especially of the liver and muscles, and heat lost during various mechanisms
• Taken orally, temperature has been found to be 0.5–1 °C lower than when measured from the rectum
• The most widely used device to measure temperature is the infrared tympanic thermometer (Figure 1.1). This is inserted into the external acoustic meatus and measures the infrared radiation emitted from the tympanic membrane
• Temperature is regulated by the thermoregulatory centre in the hypothalamus through various physiological mechanisms, e.g. sweating, dilation/constriction of peripheral blood vessels and shivering

Figure 1.1 Electronic tympanic thermometer.

Indications

• Acute illness – part of the ABCDE approach
• Routine observations

Methods for measuring body temperature

• Tympanic thermometer (most commonly used method)
• Rectal thermometer (particularly in hypothermia)
• Oesophageal/nasopharangeal probes
• Bladder probe
• Pulmonary artery catheter

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NB Important definitions:

• Hypothermia: <35 °C
• Hyperthemia: >37.5 °C

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Procedure using an electronic tympanic thermometer

• Assemble equipment: electronic tympanic thermometer, new hygiene probe, and waste bag
• Identify correct patient
• Introduce yourself to the patient
• Explain procedure to the patient and gain consent
• Ascertain which ear was used for previous readings
• Wash hands
• Turn on electronic thermometer and attach new hygienic probe cover following manufacturer’s recommendations
• Gently pull back the pinna upwards and backwards and insert the thermometer in the external acoustic meatus (Figure 1.2)
• Press the button on the device to measure the temperature and a reading should appear
• Remove the thermometer from the ear canal and then dispose of the hygiene probe into the waste bag
• Wash hands
• Document information on temperature chart of correctly identified patient including time and date taken
• Clear away equipment and ensure that the electronic tympanic thermometer is stored following the manufacturer's guidelines

Figure 1.2 Inserting an electronic tympanic thermometer.

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OSCE Key Learning Points

Good practice

• Wash and dry hands
• Use the same ear for consecu...

Table of contents

• Cover
• Table of Contents
• About the companion website
• 1 Measuring body temperature
• 2 Measuring pulse and blood pressure
• 3 Transcutaneous monitoring of oxygen saturations
• 4 Peak expiratory flow
• 5 Venepuncture
• 6 Managing blood samples correctly
• 7 Taking blood cultures
• 8 Measuring capillary blood glucose
• 9 ECG monitoring
• 10 Recording a 12 lead ECG
• 11 Basic respiratory function tests
• 12 Urine multi-dipstick test
• 13 Advising patients on how to collect a mid-stream urine specimen
• 14 Taking nose, throat, and skin swabs
• 15 Performing a pregnancy test
• 16 Administering oxygen
• 17 Airway management
• 18 Ventilation
• 19 Defibrillation (manual and automated)
• 20 Cardiopulmonary resuscitation
• 21 Establishing peripheral intravenous access
• 22 Use of infusion devices
• 23 Making up drugs for parenteral administration
• 24 Dosage and administration of insulin and use of sliding scales
• 25 Administering a subcutaneous injection
• 26 Intravenous injections
• 27 Administration of blood transfusion
• 28 Male and female urinary catheterisation
• 29 Instructing patients in the use of devices for inhaled medication
• 30 Skin suturing
• 31 Application of a sling
• 32 Safe disposal of clinical waste, needles, and other ‘sharps’
• 33 Arterial blood gas sampling
• 34 Examination of the ear
• 35 Ophthalmoscopy
• 36 Relieving foreign body airway obstruction
• Index
• End User License Agreement