ABC of Practical Procedures

The ABC of Practical Procedures is a fully illustrated guide to the core skills and procedures all those at the frontline of care need to know. With over 280 full colour illustrations, every stage of each procedure is illustrated with colour step-by-step photographs as it is being performed. Covering key competencies such local anaesthesia, blood taking, and thoracic drain and central venous catheter insertions, each practical procedure is accompanied with useful hints and tips for key learning. This new ABC provides a guide to performing the most common practical procedures undertaken by healthcare professionals including junior doctors, nurses and paramedics. It is also ideal for the needs of the Foundation Programme, for all trainee doctors and medical students. Dr Tim Nutbeam MB ChB , Department of Emergency Medicine, Good Hope Hospital, Sutton Coldfied, UK CONTENTS 1) Introduction: Different reasons for performing practical procedures and how they are divided in the book (sampling, access, therapeutic, monitoring) the best ways in which to learn practical procedures (educate, observe, practice, perform), the basis behind a log book and what constitutes "competency" in a procedure. Adequate supervision and competence assessment (emphasise the book itself is not a substitute for practical experience). 2) Consent and Documentation: The four elements of informed consent (and the legal aspects behind this), the importance of complete documentation, examples of incomplete and complete documentation. 3) Universal Precautions and Infection Control: The principals and practice of setting up a sterile field, various skin preps (iodine, chlorhexidine etc). Immunisation schedule of health care workers, what to do in the event of a needle stick injury. 4) Use of Local Anaesthetics and Safe Sedation techniques: The various local anaesthetics, maximal doses, half lives and means of application (amitop, emla, lignocaine, bubivicaine etc), the principals behind ring blocks and local anaesthetics mixed with adrenaline. Various methods of sedation and the precautions required, brief introduction to benzodiazepines, induction agents etc). 5) Sampling: Blood Taking and Cultures. Various points of venous access, including cephalic and brachiocephalic veins, anatomy of femoral triangle. Guide to various types of blood bottles and what they contain. Indications, step by step practical guide and potential complications. Particular reference to taking of cultures - indications and how to. 6) Sampling: Arterial Blood Gas. Anatomy of radial, ulnar, brachial artery, revisit femoral triangle. Hoffmans test. Indications, step by step practical guide and potential complications. Interpretation of arterial blood gases + examples. 7) Sampling: Lumbar Puncture. Indications, step by step practical guide and potential complications. Anatomy, importance of checking INR. Various tests and their indications. 8) Sampling: Asitic Tap. Indications, step by step practical guide and potential complications. Interpretation of results - difference between transudate and exudates etc, causes of ascites. 9) Sampling: Pleural Tap. Indications, step by step practical guide and potential complications. Causes of pleural effusion, implications of result. Chest xrays of unilateral and bilateral asictes. 10) Access: Intravenous Cannulae. Revisit venous anatomy. Explanation of Poiseuille's law, colour coding of cannulae. 72hr rule of cannulae. Indications, step by step practical guide and potential complications. 11) Access: Central Line. Anatomy of int jugular vein, subclavian vein + revisit femoral triangle. Explanation of central line. Indications, step by step practical guide and potential complications. Appropriate setting for insertion. Need for post procedure chest x-ray and examples. 12) Access: Emergency - Intraosseous, Sternal + Venous Cutdown. Brief indications, step by step practical guide and potential complications (need for senior support!!!). 13) Therapeutic: Airway - Manoeuvers + adjuncts. Head tilt, chin lift, and jaw thrust. Anatomy of oropharynx. Nasopharyngeal and oropharyngeal airways. Indications, step by step practical guide and potential complications. 14) Therapeutic: Airway - Endotracheal intubation. Equipment required + anatomy, need for senior/specialist support, brief introduction to emergency airway procedures and rapid sequence induction. Indications, step by step practical guide and potential complications. 15) Therapeutic: Chest Drain (thoracocentesis): Seldinger and surgical techniques. Indications, step by step practical guide and potential complications. Pre and post procedure chest X rays. Special mention of tension pneumothorax + decompression. 16) Therapeutic: Ascitic drain. Indications, step by step practical guide and potential complications. Use of albumin and control of BP. 17) Monitoring: Urinary Catheterisation. Indications, step by step practical guide and potential complications. Relation between BP and urine output. Extra information on suprapubic catheterization. 18) Monitoring: Central Line. Anatomy regarding position of central line to right atrium - relevant physiology. Specific indications for monitoring as opposed to access. Setting up flush line and calibrating. Mention of Schwann Ganz catheters. 19) Monitoring: Arterial line. Indications, step by step practical guide and potential complications. Arterial waveform analysis. 20) Emergency Medicine procedures - Suturing: Equipment, basic stitches, skin glue, do's and don'ts; Joint Aspiration:. required for Emergency Medicine trainees and Orthopods: Anatomy, indications. 21) Use of Speculum: A standard skill for OBGY and GP trainees (and one much worried about). Anatomy, pathology, performing a smear etc. 22) Paediatric: Capillary blood tubes, bleeding skills, variations in anatomy etc