Clinical Practical Procedures for Junior Doctors

217 Pages·2009·9.109 MB·English

by  Nisha Patel, Daniel Knight, Mark Palazzo (ed.)

ChurChill’s PoCketbooks of
Clinical Practical Procedures
for Junior Doctors
Commissioning Editor: timothy horne
Development Editor: Ailsa laing
Project Manager: Anne Dickie/sukanthi sukumar
Designer: kirsteen Wright
Illustration Manager: Merlyn harvey
Illustrator: ethan Danielson
ChurChill’s PoCketbooks of
Clinical Practical
Procedures for
Junior Doctors
Nisha Patel
bsc(hons) Mbbs MrCP
specialist registrar in Gastroenterology,
Chelsea and Westminster hospital Nhs trust, london, uk
Daniel Knight
bsc(hons) Mbbs MrCP
specialist registrar in Cardiology,
royal free hampstead Nhs trust, london, uk
edited by
Mark Palazzo
Mb frCA frCP MD
Chief of service, Directorate of Critical Care Medicine
and Anaesthetics, imperial College healthcare Nhs trust,
Charing Cross hospital, london, uk
eDiNburGh loNDoN NeW York oxforD
PhilADelPhiA st louis sYDNeY toroNto 2009
first published 2009, © elsevier limited. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by
any means, electronic or mechanical, including photocopying, recording, or any
information storage and retrieval system, without permission in writing from the
publisher. Permissions may be sought directly from elsevier’s rights Department:
phone: [phone] (us) or ([phone] (uk); fax: [phone];
e-mail: [email protected]. You may also complete your request
online via the elsevier website at http://www.elsevier.com/permissions.
isbN 978-0-443-06806-5
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the british library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the library of Congress
Notice
knowledge and best practice in this field are constantly changing. As new
research and experience broaden our knowledge, changes in practice, treatment
and drug therapy may become necessary or appropriate. readers are advised
to check the most current information provided (i) on procedures featured
or (ii) by the manufacturer of each product to be administered, to verify the
recommended dose or formula, the method and duration of administration,
and contraindications. it is the responsibility of the practitioner, relying on their
own experience and knowledge of the patient, to make diagnoses, to determine
dosages and the best treatment for each individual patient, and to take all
appropriate safety precautions. to the fullest extent of the law, neither the
Publisher nor the Authors assume any liability for any injury and/or damage to
persons or property arising out of or related to any use of the material contained
in this book.
The Publisher
Printed in China
Contents
Section 1 Airway and breathing 1
1 Airway care with simple devices 1
2 Peak expiratory flow rate measurement and spirometry 15
3 Pleural aspiration (of fluid or air) 23
4 Chest drain insertion and management 33
5 Percutaneous pleural biopsy 45
Section 2 Circulation 53
6 Venepuncture (peripheral and femoral) 53
7 blood cultures 63
8 Peripheral venous cannulation 67
9 Preparing and setting up intravenous medications 75
10 intravenous fluids and commonly prescribed infusions 79
11 Central venous catheter insertion 89
12 Arterial blood gas sampling 105
13 Arterial cannulation 111
14 Performing an electrocardiogram (eCG) 119
Section 3 Abdomen/Genitourinary 123
15 Nasogastric tube placement 123
16 Abdominal paracentesis and ascitic drain insertion 129
17 rigid sigmoidoscopy 141
18 urethral catheterization 147
Section 4 Miscellaneous 155
19 lumbar puncture 155
20 Arthrocentesis of the knee 165
21 subcutaneous and intramuscular injections 171
22 local anaesthetics 179
23 suturing 185
Index 197
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PrefaCe
After the celebrations of graduating from medical school, the reality
of starting out as an inexperienced junior doctor can be particularly
stressful. As first year doctors ourselves not so long ago, being left on the
wards to do that ‘urgent lumbar puncture’ or ‘quick ascitic tap’ was
a dauntingly familiar story. Clinical practical procedures are widely taught
on models in medical schools. however, putting this theoretical training
into clinical practice in your junior years can be particularly disconcerting.
While providing a basic foundation upon which to learn procedures,
models can never translate to the reality of performing them on
a patient under difficult circumstances, for example, on an acutely unwell
patient in the middle of the night. of the multiple factors involved in
this stressful time, we hope this book alleviates those associated with
performing clinical practical procedures.
We aim to provide you with a valuable tool and reference point when
asked to perform these clinical procedures. As one of the Churchill’s
Pocketbooks series it can be conveniently carried in your bag or pocket.
related practical procedures are grouped under the relevant system
in a recognizable ‘AbC’ approach, making it easier to find a procedure
quickly. each chapter starts with the origins of the procedure, its
indications and potential complications to be aware of before you start.
After all, you must know what to explain to the patient pre-procedure
and what to prepare for should things go wrong. the procedures are
outlined in an easy-to-read manner using a step-by-step approach, with
abundant diagrams and clinical photographs to complement the text.
Chapters finish with post-procedure care, how to process investigations
and the basics of their interpretation. Performing the procedures
successfully is not the end-point of course; you must know what to do
with the cerebrospinal fluid or ascitic fluid you managed to obtain. tip
boxes are present throughout the chapters to highlight useful points
regarding the procedure, common pitfalls and improvements to your
delivery.
We hope you enjoy this book and use it to improve your clinical
procedural skills, giving you confidence to perform them on the wards
and on-call.
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aCknowledgements
We would like to express our gratitude to the patients who kindly agreed
to have their clinical procedures photographed. Without their willing-
ness to assist, this educational resource would not be possible. We thank
Dr Patrick Doyle for his help and expertise. thank you to Chris Priest, Nicola
Webster and Philippa hutton at Medical illustration uk ltd for their help
with the medical photography. We thank Christopher knight for his assis-
tance. We would also like to thank all the staff at elsevier for their help
with this project.
finally, we would like to thank our parents and partners, kinesh
and Amy, for their patience, understanding and support in completing
this book.