Tuesday, June 29, 2004

Sticks, Triumphs and Failures

Yesterday I pumped myself full of saline via the following routes:

1 1cc of Saline Intramuscular injection (IM) to the vastus lateralis (outer thigh muscle).
2 .5cc Intradermal injections; one to the hairless part of the forearm and another to the top of my thigh.
2 .75 cc Subcutaneous injections of saline into my belly.
Total: 3.5 ccs (less than a teaspoon) in 4 limbs and ZERO mishaps! A triumph!

IM injections are the ones that go deep and are used for tetanus shots or demerol. When administering an IM, the good nurse must "aspirate," which involves pulling back on the plunger of the syringe to make sure you haven't hit a blood vessel. If you have hit a vessel, the barrel of the syringe will fill up with blood. I can't wait to explain that to a patient: "What blood? Oh, this blood? The red stuff filling up the needle I have jabbed deep into your muscles? That's perfectly normal. Let me just pull out of here and stick you somewhere else, shall I?" Intradermal injections are those little bubbles they put under your skin for allergy tests and are most commonly used for TB tests. They're surprisingly easy to perform. Subcutaneous shots are the easiest - the needles are small and sharp and go right in. The two shots on my belly didn't hurt a bit.

So the good news is that I am feeling fairly confident when it comes to giving injections. The bad news is that I blew my "sign off," where I was asked to identify breath sounds emanating from a plastic dummy. I am not good at identifying breath sounds emanating from plastic. I am very very bad at it. Luckily, the professor administering the sign-off was fairly patient and gently guided me to the correct answer. However, I felt extremely stupid. It was a Pass/Fail test but I can't help wondering if my name wasn't marked with a special little asterisk or something indicating I have severely limited capabilities. I suppose I will have to start riding the short bus to clinical placements.

On Thursday I will be at Johns Hopkins Hospital practicing taking complete health histories from patients admitted to the ER or a normal medical/surgical floor. It will be the first occasion where we have to deck ourselves our in full uniform: pants, shirt, lab coat AND the white shoes. V. exciting.

Thanks very much to Michael Green for linking me and the recommendation.

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