Basic Medical Maneuvers- Patricias Choice Deltoid intramuscular injection: allows intramuscular injection of maximum 1ml of liquid medication.

It is often used in anti hepatitis B vaccine on adults. Main disadvantage: its a small muscle with a lot of blood vessels and nerves nearby. Steps to follow: 1. Quick evaluation of the vital functions: conscious , movements, breathing. Good morning! My name is Patricia Niculau and I am the doctor in charge with your medical examination today. 2. Could you tell me your name, please! And your birth date? Thank you! Asking these questions we ensure we talk to the right patient. We must ensure privacy to the patient and make the examination in a room with one bed only or we must drag some curtains around patients bed if there are many persons in the room. We also must evaluate patients blood pressure, oxygen saturation and body temperature(if the were not evaluated before). 3. We must wash our hands and put on medical gloves. (Standard precaution) 4. Do you agree with injections? We must evaluate patients belief according medical maneuvers. Next we must evaluate patients medical sheet considering existing diagnosis and medication. So we avoid the risk of bleeding if the patient takes anticoagulants. 5. We select the medication according patients medical sheet. First verification. 6. We check the time of administration. 7. We check the route of administration. 8. We check the period of validity of the medication. 9. Do you know yourself allergic to this medication? But rubber or plastic? 10. I will administrate your medication by injecting it in the muscle from your shoulder. Did you ever make a similar injection? We let the patient know what we are going to do. 11. This implies a sting in your shoulder until we reach to the muscle and inject the medication. You will feel a little pain for about a few seconds We tell the patient the procedure. 12. Its crucial that you stay still and calm during the injection. I would like you to uncover your arm and your shoulder I choose for injection. We tell the patient what he/she can do in order to help. 13. Muscular administration implies a very good spreading of the medication. 14. Now, please take of your shirt and turn your left shoulder if you are right handed. 15. First we evaluate the skin, the layer of fat and the muscular layer. 16. We must evaluate the ganglia around the axilla if there are local adenopathies we use other region. 17. We must decontaminate the medical table we use to put the medication and syringe.(standard precaution).

18. We change the gloves and before putting new one we wash our hand again. (standard precaution) 19. We check the period of validity of the syringe and the needles we use. 20. We extract the syringe from its pack respecting antiseptic rules and then we connect the filter needle to the syringe. (without removing the protecting cap) 21. We extract the liquid medication from the bottle. Second verification. Before that, we equalize the content by rolling the container in our palms. 22. We remove the cap of the bottle and disinfect the plug in of the container with alcohol. 23. We check a good connection between the needle and the syringe. 24. We remove the needle cap and we absorb the same amount of air in the syringe as the amount of medicine we wish to extract from the container. 25. We place the container on the table and we insert the needle in the center of the rubber plug. 26. We inject the air from the syringe in the container. 27. We place the container upside down holding it between the thumb and the second and third fingers and we extract the content holding the needle under the level of the medicine. ( this is important in order not to extract air) 28. We extract the needle from the container. 29. We un plumb the needle from the syringe by using a special recycling box which catches the needle without us touching it. 30. We extract a second needle that we use for the injection and connect it to the syringe. 31. We consult the medication sheet placing the container in the medication cabinet ( third verification) 32. Please remain calm. Your muscles must be relaxed 33. We prepare a buffer with alcohol in order to use it to disinfect the skin. 34. We identify the position of the acromion through palpation. 35. We place our hand on the patients shoulder and we form a triangle between the first two fingers.( We will punction in the center of the triangle.) 36. With the cubital border of the left hand we slide the skin. 37. We compress the region with our pointing finger for about 10 seconds. 38. We disinfect the region we chose for injection by using the buffer prepared before. 39. We threw the buffer to the special recycle bin for infectious items. 40. We remove the needle cap. 41. We hold the syringe in our dominant hand with the needle orientated downwards. 42. Holding the needle perpendicular to the tissue, we insert the needle with a firm move into the muscle.(A firm move in order to reduce a long time discomfort.) 43. We hold the syringe with the other hand and with the dominant hand we check for blood (aspirate) through retracting the syringe piston. ( We shall not retract blood because the needle has to be placed in the muscle). 44. We introduce the medicine with a rate of 1ml per 10 seconds

45. After we finish injecting we maintain the needle in the tissue for 10 seconds. .( It allows medication fusion to the tissue and not come out with the needle.) 46. We retract the needle from the tissue . 47. We retract the non dominant hand and we let the skin cover the puncture point.( This technique seals the puncture point and the medication remains under the skin.) 48. After that we throw the second needle to the recycle bin for infectious items. 49. Next we put on the injection point a buffer without alcohol.(Alcohol would produce pain.) 50. We throw the buffer to the yellow recycle bin. 51. Next we write down in patients medical sheet: the name of the medication, the dose we administrate , the route of administration, the area of administration, date-time-minute of administration, clinical parameters evaluated before the treatment. 52. If the patient refuses medication we will announce the specialist and we write it down into patients medical sheet. 53. I shall return in 30 minutes! ( Time supposed for the action of the medicine.) 54. We wash our hands and leave the room. 55. We return after 30 minutes and we wash our hands again : Good morning, again! How do you feel? 56. We evaluate clinical parameters after the medication and we write down in patients medical sheet the efficiency of the medicine and other impressions of the patient. 57. We sign the medical sheet , wash our hands and we offer further information to the patient if needed.

This is quite a long protocol but we must take it step by step. It is frightening to realize that we have to memorize it and 15 other protocols with the same importance. But it is not impossible. I did it and the deltoid intramuscular injection was one of my favorites and it also was one of my subjects at the exam and I did it perfectly. As Roxana said above, we came very enthusiastic to this University and we still have some enthusiasm even though we have huge amount of information to absorb and we still can not use this protocols we have memorized. I hope I wont forget it soon! But for sure I wont forget our first on call night. It happened after a large series of tries but it worth it. I was impressed by the calm of the doctors and their skills and to be honest it seemed easier than I expected and I know I may seem ignorant saying this. The doctors we watched were gifted and this is why it seemed easy to me because after all it wasnt such an easy surgery.

These are our first impressions from medical school. Im still glad that finally I got rid of that boring high school uniform to replace it with the shiny medical white coat. It is very difficult but it is also attracting so me and Roxana are very happy with our choices. Lets support Roxana for her Basic medical maneuvers exam next week!