OKAY. WELCOME BACK.

WE ARE ROLLING NOW.

LAST WEEK WAS OUR
"GET IT TOGETHER".

THIS IS IT,
WE ARE...

HOW DID YOU PROGRAM THIS AND THE
OTHER INTO THIS SCREENING.

DID YOU DO THAT ON PURPOSE?

- I ALREADY PUT MY CAMERA ON.
YOU DIDN'T KNOW?

- WE DIDN'T EVEN KNOW HOW WE
DID IT.

- I WONDER HOW WE DID THAT.

- THAT IS INTERESTING.

- THAT'S A DIFFERENT CAMERA.
IT'S THAT LITTLE ONE OVER THERE.

- OH, IT'S A PROJECTOR.

THAT IS HYSTERICAL.
I DIDN'T KNOW.

[ALL TALKING AT ONCE]

WOW. THAT'S WILD.

IS HE OVERHEAD?
- IS HE OVERHEAD?

- UH-HUH.
COS IT'S A DOCUMENT CAMERA.

BUT INSTEAD OF LOOKING DOWN,
IT'S FACING US.

I THOUGHT IT WAS YOU.

- AND WE ARE ALL BACKWARD.
- YES.

ALRIGHT. WE ARE STARTING A NEW
MODULE. WE ARE GIVING SHOTS.

BUT BEFORE WE START A NEW
MODULE I ALWAYS LIKE TO,

KIND OF, BRIEF ON THE
MODULE WE JUST PASSED

JUST TO HIGHLIGHT SOME
OBSERVATIONS AND SO FORTH,

SO YOU'LL BE ALL READY TO GO.
YOU GUYS DID A GREAT JOB.

IN FACT, THIS COURSE ON STERILE
GLOVING WORKED JUST INCREDIBLE.

YOU GUYS DID REALLY WONDERFUL
ON THAT.

SO DON'T GET COCKY AND
THINK YOU ARE PERFECT

BECAUSE THE THING ABOUT STERILE
TECHNIQUE IS THERE ARE SO MANY
WAYS TO CONTAMINATE YOURSELF.

SO JUST BE ANTICIPATING

AND REMEMBER HANDS UP AND OUT
AND LOOK AT A BIGGER PICTURE

THAN FOCUSING ON JUST THE EXACT
THING YOU ARE DOING AT THE TIME.

AND YOU CAN START LOOKING
AT A BRIGHT, BROADER SCOPE,
A BROADER AREA.

YOU WILL PICK UP THE FEEL BETTER
AND NOTICE CONTAMINATIONS

MORE THAN JUST GETTING
REAL FOCUSED ON THE THUMB

AND, YOU KNOW, NOT NOTICE
YOUR LITTLE FINGERS,
SOMETHING LIKE THAT.

DID YOU CATCH THE DISCREPANCY IN
THE READING FROM MY CHECKLIST?

- ABOUT THIS HAND WASHING ONE?

- NO. AND I'M STILL GLOVING
PRETTY MUCH THE SAME.

- THE HAND WASHING ONE?
- NO.

YEP.

OKAY, GARRETT, YOU CAN'T
GIVE THEM CLUES LIKE...

- BUT HE WAS WITH ME.

- OKAY. THE DRESSING ON
THE CENTRAL LINE.

IN THE BOOK AND ACTUALLY
IN MY ARTICLE, AND I
TOTALLY FORGOT ABOUT IT.

I MEAN, I JUST
FORGOT ABOUT IT.

I AM THE ONE THAT PUT
THE ARTICLE IN THERE.

WELL, THE NEW STANDARD FOR
CENTRAL LINE DRESSING CARE

IS THAT GAUZE DRESSINGS
ARE 24 TO 48 HOURS.

SO BE SURE AND FOLLOW WHAT
YOUR HOSPITAL PROTOCOL IS.

MOST OF THE TIME
YOU ARE GOING TO FIND 24
BECAUSE OF THE GAUZE.

BUT THE INTERESTING CHANGE HAS
BEEN IN THE TRANSPARENT DRESSING

FOR CENTRAL LINES AND IT'S SEVEN
DAYS AS OPPOSED TO EVERY THREE.

BUT AGAIN FOLLOW THE HOSPITAL
POLICY. IT'S SEVEN DAYS AND PRN.

SO IF IT'S ALL WRINKLY
AND WARTY AND LOOKING BAD,

THEN YOU'RE GOING TO GO AHEAD
AND CHANGE IT.

MOST OF OURS ARE WRINKLY, WARTY
AND LOOK BAD AND WHY WAS THAT?

- BECAUSE MANNEQUINS DON'T DRY.

- THEY WEREN'T DRY.
THEY WERE WET.

SO YOU GOT TO MAKE SURE
YOUR CLIENTS ARE REALLY DRY

AND WHEN THEY ARE, THEN THAT
TRANSPARENT DRESSING WILL STICK

TOTALLY TO THE SKIN
AND TO THAT LINE.

AND YOU SHOULD HAVE GOOD
ADHERENCE AND IT SHOULD LAST

AT LEAST FIVE DAYS,
FIVE TO SEVEN THEY ARE OKAY.

BUT IF IT'S PEELING IN ANY WAY,
GET RID OF IT.

SO, YOU GUYS HAVE NEW TEXTS
AND I AM IN THE PROCESS
OF READING ALONG WITH YOU

AS WE ARE DOING THIS SECTION
BECAUSE OF A NEW ADDITION
OF A TEXT BOOK.

SO HOPEFULLY THE ARTICLES
I'VE KEPT UP TO DATE

AS FAR AS KEEPING THE
CHECKLIST UP TO DATE.

BUT EVERY NOW AND THEN WE'RE
GOING TO FIND A DISCREPANCY,

SO DON'T HESITATE
TO LET ME KNOW.

"OH, I DIDN'T READ IT IN THE
BOOK. THIS IS DIFFERENT."

AND HOPEFULLY, WE'LL,
KIND OF, ALL CATCH UP.

I READ EVERYTHING LAST NIGHT
OF THE IM MED STUFF AND
WE ARE LOOKING PRETTY GOOD.

THEY JUST GAVE A FEW CRITERIA
THAT I WILL HIGHLIGHT TODAY
WHEN WE DO OUR SHOTS.

ALRIGHT. MOVING ON.

THIS IS A TWO-WEEK MODULE
SO ONE BLACKBOARD.

WE HAVE FIVE SHOTS
WE ARE GOING TO GIVE.

WE'RE GOING TO DO TWO
THIS WEEK AND THE IM,

WE ARE GOING TO DO 'EM
TO MANNEQUINS AND FOCUS
ON THE GLUTEAL MUSCLE.

SO BUTT THIS WEEK.

AND THEN NEXT WEEK WE'RE GOING
TO DO DELTOID, INTRADERMAL
AND WORK OUT OF AMPOULES.

I THINK THERE'S --
OH, VASTUS LATERALIS.

SO THREE SHOTS THE FOLLOWING
WEEK. THERE'S NO BLACKBOARD,

BUT YOU'RE GOING TO WANT TO READ
UP ON ALL THOSE SITE LOCATIONS

AND THE DIFFERENT TECHNIQUES.

OUR MAIN OBJECTIVE IS WE WANT
TO USE EVERY KIND OF SYRINGE

THAT'S OUT IN THE FIELD, EVERY
KIND OF NEEDLELESS DEVICE,

SO THAT YOU KNOW HOW TO
USE THE NEEDLELESS DEVICES
WHEN YOU ARE FACED WITH THEM

AND ANTICIPATE
A LITTLE BIT BETTER.

EVERY SINGLE MUSCLE,
EVERY SINGLE SITE
AND EVERY KIND OF NET.

SO WE'RE GOING TO REALLY BE
WORKING IT AS FAR
AS THAT GOES.

BUT, AGAIN, IT'S JUST, THE SHARP
PART IS REALLY THE EASY PART.

DART IN WHICH YOU'VE DONE WITH
YOUR SUBCUTANEOUS INJECTIONS.

SO THERE WON'T BE A LOT OF
CHANGE FROM THAT, THAT WE'RE
DOING INTRAMUSCULAR NOW.

SO, TO GET STARTED, WE WANT
TO FOCUS ON INJECTIONS.

THE FIRST SHOT WE'RE GOING TO DO
IS THE DEMEROL INJECTION.

WHEN YOU ARE LOOKING
AT YOUR CHECKLIST.

I THINK IT'S THE FIRST ONE THAT
SAYS USING Z-TRACK METHOD.

WE ARE GOING TO DO A DEMEROL
INJECTION, Z-TRACK METHOD.

AND --
LET ME SEE WHICH MUSCLE.

IN THE DORSAL GLUTEAL.

ALRIGHT. I WANTED TO READ
ONE MORE THING TO YOU BEFORE
WE GET GOING AS WELL.

LAST YEAR A STUDENT GAVE ME
THIS AT THE END OF THE SEMESTER
AND I THINK IT'S SO GOOD.

ONE OF THE THINGS ABOUT THE LAB
IS THAT YOU WANT IT
TO BE PERFECT,

BUT IT'S NOT ALWAYS
GOING TO BE PERFECT.

BUT THAT WOULD BE OUR GOAL
AND IT'S PRETTY --

WHAT'S THE WORD I WANT. THE
SIMULATIONS ARE SO SCRIPTED.

I MEAN, WE'RE GOING TO --
WE'RE DOING THINGS BY MEMORY.
BUT THINGS AREN'T PERFECT.

AND THAT'S THE WHOLE IDEA IS
THAT WE LEARN HOW TO ANTICIPATE,
BE FLEXIBLE,

AND TO ADJUST BECAUSE IN A
CLIENT SETTING, WE HAVE TO
MAKE ADJUSTMENTS.

SO WE'RE GOING TO HAVE
TO ANTICIPATE THAT.

AND SHE GAVE ME
THIS ARTICLE ON MISTAKES
"THE VALUE OF MISTAKES."

A MASTER CARPENTER IS LOOKING
TO TAKE ON A YOUNG APPRENTICE

TO HELP HIM WITH
THE WORK IN HIS SHOP.

ONE ABLE YOUNG MAN ENQUIRES
ABOUT THE POSITION.

THE MASTER CARPENTER ASKS
THE YOUNG STUDENT,

"TELL ME, WHAT MISTAKES
YOU'VE MADE."

"I NEVER MADE
A SINGLE ERROR.",

THE CONFIDENT, YOUNG STUDENT
REPLIES, CERTAIN THAT
THE JOB IS HIS.

THE MASTER CARPENTER
THEN RESPONDS,

"IN THAT CASE,
I WOULD NEVER HIRE YOU.

WHEN YOU MAKE A MISTAKE,
YOU WON'T KNOW HOW TO FIX IT."

ISN'T THAT THE TRUTH OF IT?

AND SO I AM HOPING --
I MEAN, WE WANT TO BE PERFECT,

BUT WE HAVE TO ALSO BE ABLE
TO ANTICIPATE AND TO FIX.

AND NOT ONLY FIX OUR MISTAKES,
BUT FIX THE MISTAKES
OF OTHERS.

YOU MAY BE PERFECT,
BUT OTHER PEOPLE AREN'T.

SO, WE WANT TO LEARN
HOW TO DO IT ALL,

TO DO IT RIGHT
AND TO FIX AS WELL.

SO, HOPEFULLY THAT WILL HELP
YOU GET SOME PERSPECTIVE.

ALRIGHT.

LET ME GO TO THE BOARD HERE.
I'M GOING TO SWITCH GEARS
A LITTLE BIT

SO WE CAN LOOK
AT THE ORDERS.

I CAN'T SEE WHO'S BACK THERE.
YOUR HEADS ARE ALL DOWN.

COULD SOMEONE GET THAT FIRST
LIGHT AND KNOCK THIS LIGHT OUT,
SO YOU CAN SEE A LITTLE BETTER.

- THIS LIGHT?
- WELL, I DON'T KNOW.

I THINK.
YEAH.

OKAY. YOU HAVE A DOCTOR'S
ORDER AND THE ORDER SAYS,

START AMPICILLIN
300 MG/IM/Q6 HOURS.

ALRIGHT?

THE ORDER HAS BEEN TRANSCRIBED
AND IT'S NOW ON THE MAR.

YOU SHOULD HAVE A MAR
IN YOUR...SYLLABUS.

AND THE MAR, AGAIN,
THAT JUST MY DOCTOR'S ORDERS.

I'VE CHECKED AND YOU
CAN SEE MY INITIALS.

AND IT SAYS, AMPICILLIN
300 MG/IM/Q6 HOURS.

I HAVEN'T PLUGGED IN THE TIME,

WHICH MOST OF YOUR MAR'S SHOULD
HAVE WHEN YOU'RE ON THE FLOOR,

BUT THE TIME WILL BE
THE TIME YOUR APPOINTMENT IS,

IF YOU ARE GOING TO
START IT THEN.

ALRIGHT. SO BECAUSE WE ARE DOING
ALL KINDS OF INJECTIONS,

ALL KINDS OF MUSCLES, ALL KINDS
OF SHOTS AND EVERYTHING.
I WAS CONFUSING MYSELF.

SO I WROTE UP ON THE TOP WHICH
SYRINGE I WANT YOU TO CHOOSE

AND WHICH MUSCLE I WANT YOU
TO PUT IT IN.

SO THAT WE HAVE SOME UNIFORMITY
THERE AND WE ARE GETTING IT
INTO THE RIGHT SPOT.

SO, WE'RE GOING TO GIVE
AMPICILLIN, 300 MG,
TO AN ADULT CLIENT

WITH THE SAFETY LOCK SYRINGE
IN THE VENTRAL GLUTEAL MUSCLE.

- DIANE, YOU ALREADY MENTIONED
WE'RE GOING TO DO
DEMEROL FIRST.

- OH, I'M SORRY THERE.
THANK YOU.

GOOD MAN, LARRY,
KEEP ME ON TRACK.

EDIT THAT, ALRIGHT?

DEMEROL, 60 MG/IM, NOW.

THIS HAS BEEN TRANSCRIBED.

THE DEMEROL, 60 MG/IM, NOW.

WE'RE GOING TO DO
AN ADULT CLIENT,

CARPUJECT, Z-TRACK,

DORSAL GLUTEAL.

ALRIGHT.

YOU DON'T NEED TO BRING YOUR MAR
WHEN YOU COME TO TEST,
WE'LL HAVE MARS FOR YOU.

BUT I WANTED YOU TO JUST
BE ABLE TO ANTICIPATE

AND PRACTICE WRITING AND
EVERYTHING, AS FAR AS I GO.

SO, RIGHT NOW, PICTURE ME
IN THE NURSING STATION.

- YOU DIDN'T REALLY
SAY LIKE NOW OR...

- YES. IF IT'S A NOW,
IT'S REALLY A PRN ORDER

AND IT WILL BE ON THE PINK SHEET
THAT WILL BE IN YOUR
PRN SECTION.

IF THEY'RE A PRE-OP,
THEY MAY HAVE IT.

IF THEY'RE SURGERY OR IF THEY'RE
MAYBE GOING TO GET A PATIENT
CONTROLLED ANALGESIA,

YOU MAY GIVE A SHOT NOW, UNTIL
YOU CAN GET IV THINGS GOING

OR TILL YOU CAN GET THEM
UNDER CONTROL OR SO FORTH.

SO, YES, IT WILL BE NOW.
- WOULDN'T IT BE STAT?

IT CAN BE STAT AND IT
CAN BE NOW, EITHER ONE.

"STAT" MEANS EMERGENCY, "NOW"
MEANS NOT QUITE SO EMERGENT.

- SO THEY ACTUALLY
DO HAVE "NOW"?

- YES.

- OH.
- YES.

THEY HAVE "NOW".
THEY HAVE "TODAY".

YEAH.
"BEFORE NOON".

THEY CAN WRITE IT ANYWHERE
THEY WANT.

AS LONG AS IT GETS DONE
AND WITHIN THEIR TIME FRAME.

SO. YES.

ALRIGHT.
I AM IN THE NURSING STATION

AND PICTURE YOURSELF IN
THE NURSING STATION, FIRST.

I'VE CHECKED MY
DOCTOR'S ORDERS.

I ALSO LOOK TO SEE IF
THERE IS ANY ALLERGIES,

BUT ON THIS PARTICULAR FORM,
IT DOESN'T SAY ALLERGIES.

SO I AM WANTING TO NOTE THAT
AND I WOULD CHECK THE CHART
IF POSSIBLE,

BUT I AM NOT GOING TO GET
A GOOD CUE UNTIL I GET
TO MY PATIENT'S ID BAND.

I DON'T KNOW WHICH PATIENT
YOU'RE GOING TO GO TO.

BECAUSE WE ARE GOING TO HAVE
YOU GO TO AVAILABLE STATIONS,

SO I AM NOT ABLE TO EXACTLY TELL
YOU WHAT THE ALLERGIES ARE.

SO I WANT YOU TO PUT ALL
OF OUR ALLERGIES THAT WE
HAVE IN THE LAB TO THE TEST.

AND THEY ARE PENICILLIN,
CODEINE, SULFA.

THAT'S ALL WE HAVE
OF OUR PATIENTS.

SO WHEN YOU ARE LOOKING
IN THE DRUG BOOK,

BECAUSE YOU ARE GOING TO
BE MAKING DRUG CARDS,

SEE, IS THERE ARE PROBLEM
WITH ANY OF THOSE DRUGS?

YOU KNOW THAT DEMEROL
IS WHAT KIND OF DRUG?

A NARCOTIC?

AND SO, OF ALL OF
THOSE THREE DRUGS,

WHICH WOULD BE THE ONE THAT
WE WOULD BE SUSPICIOUS OF?

CODEINE.

SO BE LOOKING TO SEE IF THERE'S
ANY PROBLEM. DEMEROL, CODEINE.

ALRIGHT. IT APPEARS THAT MY
CLIENT HAS NO ALLERGIES

AND I AM GOOD TO GO.

PRIOR TO DOING ANY MED PREP,
I'M GOING TO WASH MY HANDS

AND THAT'S SOMETHING
THAT HAPPENS IN THE
NURSING STATION TOO.

OKAY. DEMEROL,
BECAUSE IT'S A NARCOTIC,

AND THE GATHERING UP OF
EQUIPMENT STAGE IS GOING TO BE
IN THE NARCOTICS CABINET.

WE'VE ALREADY BEEN CHECKED UP
ON NARCOTICS CABINETS.

I'M NOT GOING TO GO THROUGH
THAT. BUT WHAT WE'RE GOING TO DO
IS GIVE YOU THESE CARPUJECTS.

THESE PRE-FILLED SYRINGES
THAT WOULD BE IN THE
NARCOTICS CABINET.

THEY'RE IN BOXES OF 10

AND THAT'S WHAT YOU'RE
GOING TO GET OUT OF
THE NARCOTICS CABINET.

ALRIGHT, LET'S
THINK FOR A MINUTE.
YOUR GATHERING EQUIPMENT.

THE DOCTOR'S ORDER
IS DEMEROL 60 MG.

THIS IS HOW DEMEROL IS SUPPLIED,
IN CARPUJECTS.

LIKE THIS AND THEY ARE
PRE-FILLED WITH 50 MG/ML,

75 MG/ML,

AND 100 MG/ML.

THERE ARE ALSO 25 MG, BUT THAT
SEEMS PRETTY OFF FROM OUR 60.

SO, IF YOU ARE
CHOOSING A CARTRIDGE

TO GIVE TO YOUR CLIENT,
WHICH WOULD YOU CHOOSE THE 50,

THE 75 OR THE 100?

- 75
- 50.

- I HEARD ONE 50
AND A LOT OF 75'S.

SOMEONE WHO HAS PICKED 75
TELL ME WHY?

- BECAUSE IF YOU PICK 50,
IT'S TOO LESS.

BUT IF YOU PICK 75,
YOU CAN JUST PUSH IT IN UNTIL
IT GETS TO THE 50 MILS.

- OKAY. ANYONE WANT 100?

- IN FACT, IT'S EASIER
TO SEE WHERE YOU'RE GOING.

- YES. I AM PICKING 100.

MATH'S EASIER.
THAT'S THE ONLY REASON.

MOST OF THE TIME PEOPLE WANT TO
PICK 75 COS THEY'LL WASTE LESS,

BUT THE CHARGE IS THE SAME.

SO WHEN YOU'RE PICKING,
PICK WHAT'S GOING TO MAKE
EASIER MATH.

IF I WANTED TO GIVE
LESS THAN 1 ML.

MAYBE SOMEONE DIDN'T
HAVE GOOD MUSCLES

AND I HAVE THE CHOICE BETWEEN
50 AND 75 AND I WANTED
TO GIVE LESS,

I MIGHT PICK 75 JUST BECAUSE
IT'S AN EASY INCREMENT
TO FIGURE MATH.

BUT DO IT ON YOUR MATH.

THE THING HERE IS
IF I NEED TO GIVE 60 MG

AND A 100 MG IS IN 1 ML,
HOW MAY MILLILITERS FOR 60 MG?

- 0.6.

- 0.6. RIGHT?

BECAUSE 90 MG WOULD BE
0.9 AND SO FORTH.
AND SO IT'S AN EASY MATH.

WHEREAS, IF YOU WANTED TO GIVE
60 MG AND 75 MG/ML?

WHAT IS IT? I CAN'T MUSCLE IT
OUT OF MY BRAIN.

I AM GOING TO HAVE TO
GET A CALCULATOR.

SO, EITHER ONE IS FINE,

BUT YOU CAN CHOOSE AND
YOU HAVE THE FREEDOM.

SO, I SUGGESTED IN YOUR SYLLABUS
THAT YOU LABEL YOUR CARTRIDGE
AS THE 100 MG/ML

SO THAT YOU CAN FIGURE
YOUR DOSE FROM THERE.

THESE CARTRIDGES ARE JUST
NORMAL SALINE THAT I PURCHASED
FOR PRACTICING,

AND SO MOST OF THEM ARE
PRE-FILLED TO 2 ML OF SOLUTION.

AND THEN ONCE YOU USE THEM UP WE
JUST PUT TAP WATER IN THEM AND
THEN KEEP USING THEM UNTIL --

WHATEVER, BUT THEY YOU GO.

OKAY. I'VE GONE TO
THE NARCOTICS CABINET,
I'VE CHECKED THIS OUT

LIKE I AM SUPPOSED TO
AND THIS IS HOW IT COMES.

I HAVE A 2 ML AND -- ACTUALLY IT
WILL ONLY COME IN 1 ML,

BUT I HAVE A 100 MG/ML
IN THIS CARTRIDGE.

THIS CARTRIDGE APPEARS TO
BE A NEEDLE, BUT IT'S NOT.

WHAT IT IS, IS AN ADAPTOR
AND THERE IS NO NEEDLE
ON IT WHATSOEVER.

AND THE REASON WE HAVE TO
HAVE AN ADAPTOR IS BECAUSE
THIS IS LIKE A VIAL.

REMEMBER WHEN YOU GOT THE
INSULIN OUT OF THE VIAL

AND YOU PUT THE STOPPER,
YOU PUT YOUR NEEDLE IN

AND THEN DREW YOUR MEDICATION
OUT, THIS IS SIMILAR TO THAT.

BUT WITH THIS ADAPTOR, WE CAN
HOOK OUR NEEDLE ONTO THAT.

THE NEEDLE IS HERE
IN THE ADAPTOR

AND IT JUST STICKS ON TO THE END
OF THIS CARTRIDGE LIKE THIS.

PRESENTLY, BECAUSE THERE IS
A GAP RIGHT HERE, AND I KNOW
IT'S REALLY HARD TO SEE,

BUT YOU WILL SEE IT WHEN
YOU ARE PRACTICING,

THE NEEDLE HASN'T YET
PUNCTURED THE VIAL TOP.

SO IT'S NOT OPEN YET. IT'S STILL
A CLOSED SYSTEM, A CLOSED VIAL.

BUT YOU HAVE YOUR ADAPTOR.

OKAY. THE OTHER THING ABOUT
THIS VIAL IS THAT AT THE END

THERE IS A RUBBER STOPPER, SO
THAT YOU CAN ATTACH A PLUNGER.

THIS IS IMPORTANT TO KNOW
BECAUSE THIS ISN'T A TRUE VIAL.

IF YOU WERE TO PUT AIR IN THIS
LIKE YOU DID YOUR INSULIN,

SO THAT YOU HAVE PRESSURE TO
PULL THE MEDICINE OUT OF HERE
LIKE THE VIAL,

YOU'LL SHOOT THE STOPPER
OUT THE OTHER END,
BECAUSE IT'S THE PLUNGER.

SO NEVER PUT AIR IN THESE,

IF YOU'RE GOING TO TAKE
THE MEDICINE OUT

AND PUT IT IN A DIFFERENT
KIND OF SYRINGE.

I'M GOING TO TEACH YOU
HOW TO USE THE HOLDER

THAT WAS CREATED FOR THE
CARPUJECT SYRINGE.

BUT IF YOU DON'T LIKE USING
THE HOLDER, YOU COULD GO GET
A REGULAR SYRINGE.

PUT THE NEEDLE ON IT,
DRAW THE MEDICINE OUT
AND USE THE OTHER SYRINGE.

AND THAT'S THE DIFFERENCE, COS
SOMETIMES THESE AREN'T AVAILABLE

OR THEY'RE AWKWARD AND PEOPLE
DON'T LIKE USING THEM.

ALRIGHT. WELL I'VE GOT MY
STOPPER...ON.

AND SO I PUT IT BACK TOGETHER.

OKAY, WHAT I WANT TO DO TO GET
READY. I FIGURED MY MATH.

I NEED TO GIVE 60 MG,
SO HOW MUCH AM I GOING TO
HAVE IN MY SYRINGE?

0.6.

SO I GOT MY HOLDER. AND YOUR
HOLDER LOOKS LIKE THIS.

YOU HAVE A PLUNGER
AND YOU HAVE -- I DON'T EVEN
KNOW WHAT YOU CALL THIS,

BUT YOU HAVE AN ADAPTOR
THAT SECURES THE CARTRIDGE IN.

YOU WANT TO LAY THE CARTRIDGE
INTO THE HOLDER

AND STABILIZE IT
WITH YOUR HAND

AND THEN TWIST THE PLUNGER
ONTO THE SCREW PIECE,
THE RUBBER STOPPER.

SO YOU CAN SCREW THE PLUNGER
ON TO THIS CARTRIDGE,

SO IT DOESN'T FALL OUT OF HERE.

BUT REMEMBER WE STILL DON'T
HAVE OUR NEEDLE INTO THAT
VIAL STOPPER YET.

WE DO THAT BY TWISTING
THIS BLUE PIECE IN

AND THAT SQUEEZES THESE
TWO PIECES TOGETHER

AND THAT'S WHAT PUNCTURES
THE VIAL.

SO WATCH HOW IT GOES RIGHT HERE.

SEE HOW I GO HERE AND...

IT PUSHED IT TOGETHER
AND NOW THE NEEDLE THAT
WAS IN THIS ADAPTOR PIECE

IS IN THE VIAL AND NOW
I CAN SQUIRT MY FLUID OUT.

IF YOU GO TO PLUNGE
AND SQUIRT YOUR FLUID OUT

AND IT WON'T GO
AND IT WON'T GO,

IT'S BECAUSE YOU DIDN'T PUSH
THE NEEDLE INTO THE VIAL.

ALRIGHT. BUT I STILL HAVE
NO NEEDLE, RIGHT?

THAT'S NOT A HUGE DEAL RIGHT
NOW. I CAN GO AHEAD
AND SET MY DOSE.

SO...

I GOT TO SEE THAT
IT DOESN'T SNAPPED.

HOLD YOUR SYRINGE STRAIGHT UP,
GET ALL THE AIR OUT.

AND BECAUSE THIS IS A NARCOTIC,
YOU NEED TO MAKE SURE

THAT YOU HAVE AN RN WATCHING YOU
TO CHECK YOUR WASTE, OKAY?

COS THEY HAVE TO
CO-SIGN THE SHEET,

THE NARCOTIC SHEET, THAT YOU'VE
WASTED 40 MG OR 0.4.

SO IN THE SINK OR IN THE
MED HOPPER OR SOMETHING,

YOU'RE GOING TO SQUIRT
THIS MED OUT.

MAKE SURE ALL MY AIR IS OUT
AND THEN YOU CAN SQUIRT THE --

ONCE ALL YOUR AIR IS OUT
AND YOU'RE SOLID FLUID,

THEN YOU CAN TURN
YOUR SYRINGE DOWN.

BUT IF YOU HAVEN'T DISPLACED
ALL THE AIR STRAIGHT UP,

THE AIR IS GOING TO STICK
TO THE SIDE AND YOU'LL
HAVE A WRONG DOSE.

GET ALL THE AIR OUT FIRST,
THEN SET YOUR DOSE.

OKAY, I HAVE 0.6.

I'M HAPPY,
BUT I STILL HAVE NO NEEDLE.

I'M GOING TO PUT THIS CAP ON,
WE GOT TO TALK ABOUT NEEDLES
A LITTLE BIT.

YOU'RE ALREADY FAMILIAR WITH THE
SYRINGE. JUST A BRIEF REVIEW.

YOU GOT THE PLUNGER,
THE FLANGE,

THE BARREL, THE HUB
AND NOW WE NEED A NEEDLE.

WHEN YOU'RE PICKING A NEEDLE,
YOU PICK IT BY THE SIZE
OF THE MUSCLE

RELATED TO YOUR CLIENT
AND THE VISCOSITY
OF THE SOLUTION

THAT YOU ARE GOING TO
PUT INTO THE CLIENT.

VISCOSITY BEING THE THICKNESS
OF THE SOLUTION.

DEMEROL, MORPHINE.
WATERY.

THEY'RE JUST WATER SOLUTIONS,
SO WE CAN HAVE A
RELATIVELY THIN NEEDLE.

BUT WE'RE GOING INTO MUSCLE,

SO WE DON'T WANT TO BE TOO THIN,
BECAUSE WE DON'T WANT IT
TO BEND.

IT NEEDS TO BE SOLID
TO GO THROUGH MUSCLE.

WHEREAS BEFORE, WHEN WE WERE
DOING SUBCUTANEOUS INJECTION,

REMEMBER HOW MICRO-THIN
THEY WERE?

DO YOU REMEMBER
THE GAUGE OF OURS?

27.
THAT WAS OUR INSULIN SYRINGE.

IT WAS JUST A LITTLE
THIN HAIR LIKE. 27.

AND WE DIDN'T REALLY WANT
TO GO MUCH BIGGER THAN 25.

SO WE'RE TALKING GAUGE.
REMEMBER GAUGE IS WIDTH.

THE BIGGER THEN NUMBER,
THE SMALLER THE WIDTH.

ALRIGHT. SO NOW WE'RE GOING TO
GO INTO A MUSCLE AND WE NEED
TO CONSIDER TWO THINGS,

THE GAUGE AND THE LENGTH OF
THE NEEDLE. LET'S TALK GAUGE.

WE KNOW IT'S A WATERY SOLUTION,
BUT WE KNOW IT'S MUSCLE.

SO YOU WANT TO BE CONSIDERING
A GAUGE OF 20 TO 23.

18 STARTS BEING PRETTY BIG.

I USE 18'S FOR FIXED SOLUTIONS.
LIKE THINGS LIKE A GOLD SHOT

WHICH IS REALLY FLECKS OF GOLD
AND THICK TYPE OF A SOLUTION.

SO SOMETHING THICK, YOU HAVE TO
HAVE A BIGGER GAUGE.

BUT FOR THE MOST PART, FOR AN
AVERAGE MUSCLE, 20 TO 23.

ALRIGHT. WE'RE ALSO GOING
INTO BUTTOCKS.

OUR FOCUS IS GLUTEAL MUSCLES
AND WE'RE GOING TO DO DORSAL
GLUTEAL AND VENTRAL GLUTEAL.

THIS SHOT I HAVE ASKED YOU
TO DO DORSAL GLUTEAL.

I WANT YOU TO KNOW THAT I KNOW

THAT THE DORSAL GLUTEAL MUSCLE
IS NOT RECOMMENDED ANY MORE.

IT'S NOT. WE'RE NOT TO DO
ANY SHOTS IN THE
DORSAL GLUTEAL MUSCLE.

WHY? BECAUSE THE DORSAL --
WHAT DOES DORSAL MEAN?

- THE BACK.
- BACK. SO IT'S BACK BUTT.

OKAY. SO IF ALL OF THIS
IS GLUTEUS AND THIS
IS MY FAVORITE LECTURE.

EVERYONE IS STARING
AT MY BUTT.

OKAY. BUT HERE WE GO.
BUT HERE WE GO.

WHEN YOU JOIN THE BUTTOCKS,

YOU'RE THINKING OF ONE SIDE,
RIGHT? SO DORSAL GLUTEAL
IS BACK BUTTOCKS.

NOW, I DON'T KNOW ABOUT YOU,
BUT WHEN I GOT SHOTS,

I ALWAYS THOUGHT THEY GAVE IT
INTO THAT BEEFY BOTTOM BUTTOCKS.

BUT YOU DON'T BECAUSE THAT'S
WHERE THE SCIATIC NERVE IS.

THIS YELLOW THING RIGHT HERE.

AND IF YOU HIT THE SCIATIC
NERVE, YOU CAN CAUSE NUMBNESS.

THIS IS NOT GOOD.

SO WHAT WE DO
FOR DORSAL GLUTEAL

IS REALLY, IT'S IN THE UPPER,
OUTER QUADRANT OF THE BUTTOCKS.

OKAY. THERE ARE SOME REAL
LANDMARKS THAT THEY
WANT YOU TO PICK.

AT LEAST WE CAN DO MINE.
I CAN POINT 'EM OUT OKAY.

FIND YOUR OWN ON YOUR HIPS.

YOU WANT TO FIND YOUR
GREATER TROCHANTER.

OKAY? JUST REMEMBER WHERE IT IS.
POINT AT IT.

IT'S THE TOP OF YOUR FEMUR BONE
AND THE TOP OF THAT BONE
IS YOUR GREATER TROCHANTER.

OKAY. YOUR ILIAC CREST
IS THE TOP OF YOUR HIP BONE.

THE HIGHEST PLACE.
THAT'S THE CREST, ILIAC.

OKAY. IF YOU FOLLOW
THE ILIAC SPINE DOWN

TO THE OTHER HIGHEST POINT
IN THE BACK,

THAT'S CALLED THE POSTERIOR,
RIGHT? WHICH IS BACK.

POSTERIOR, SUPERIOR
HIGHEST BACK POINT,

ILIAC SPINE.

IT CAN'T BE A CREST,
YOU CAN ONLY HAVE ONE CREST.

ONE HIGHEST POINT
AND THAT'S YOUR CREST.

OKAY. SO ONCE YOU'VE FOUND YOUR
POSTERIOR, SUPERIOR, ILIAC SPINE

AND YOUR GREATER TROCHANTER, YOU
DRAW AN IMAGINARY LINE...ACROSS

AND IT'S EVERYTHING ABOVE THE
LINE AND BELOW THE ILIAC CREST.

SO IT'S THAT MUSCLY PLACE
RIGHT HERE.

NOW WHEN I WENT TO SCHOOL,
AGES AGO, THEY DIDN'T TEACH US
THESE LANDMARKS.

THEY JUST SAID QUARTER OF THE
BUTT, THE UPPER, OUTER QUADRANT.

SO WE JUST TOOK THE BUTTOCKS
CHEEK, QUARTER.

IT'S THE SAME PLACE.

SO IN YOUR MIND, IT'S NOT LIKE
IT HAS TO BE THIS BULL'S-EYE,

THIS ONE LITTLE SPECK
OF A PLACE.

YOU GOT A LITTLE BIT OF A
TARGET THERE. UPPER, OUTER.

BUT WHAT THEY FOUND IN THE
RESEARCH IS AND BECAUSE
OF VARYING TECHNIQUES

AND VARIATIONS IN CLIENTS
IS THE SCIATIC NERVE IS
IN DIFFERENT PLACES IN PEOPLE.

IT'S NOT ALWAYS AS LOW
AS IT'S SUPPOSED TO BE.

SO BECAUSE OF THE
NERVE ENDING THERE,

THEY RECOMMENDED THAT
WE DON'T GIVE IT.

PEOPLE GIVE IT THERE
ALL THE TIME.

I WANT YOU TO KNOW
WHERE IT IS.

BECAUSE IF I WAS AN OLD NURSE
STILL WORKING AND I HADN'T
BEEN TO SCHOOL

AND I HADN'T HEARD THAT
YOU'RE NOT SUPPOSED
TO GIVE THEM THERE,

I'D STILL BE
GIVING THEM THERE.

SO I WANT YOU TO BE SEEING
WHAT THEY'RE DOING

AND KNOWING IF THEY'RE DOING
IT RIGHT OR WRONG,

IF THEY'RE IN GOOD LOCATION.
THEY GOT TO BE UPPER,
OUTER QUADRANT.

THE OTHER THING IS,
I'VE HAD CLIENTS
THAT HAD SICKLE-CELL

AND HE HAD NO MORE MUSCLE LEFT.
ANYWHERE.

HE HAD TAKEN DEMEROL SHOTS
FOR SO MANY YEARS.

YOU KNOW SICKLE CELL
CAUSES A LOT OF PAIN.

HE HAD BEEN ON DEMEROL
FOR A LONG, LONG TIME.

SOMETIMES YOU NEED AN
ALTERNATIVE PLACE

WHEN THERE ARE NO SOFT PLACES
LEFT OF ALL YOUR OPTIONS.

AND SO I WOULD STILL HAVE IT IN
THE BACK OF MY MIND
AS A LAST RESORT.

OKAY. SO, WE'RE STILL
GOING TO WORK ON IT.

I'M NOT READY TO
TOTALLY GIVE UP YET.

ALRIGHT. IF I AM GOING INTO THE
DORSAL GLUTEAL, BUTTOCKS MUSCLE,

THE RECOMMENDATION IS
THAT WE MINIMALLY,
ON AN AVERAGE ADULT,

I'M AN AVERAGE ADULT,

USE A ONE-AND-A-HALF INCH
NEEDLE, UP TO TWO INCHES.

ACCORDING TO NURSING 2002,

THEY GAVE A LITTLE BIT
CLEARER PARAMETER.

BECAUSE SOMETIMES IT'S LIKE,
"WELL, HOW DO YOU KNOW

WHAT'S AVERAGE
OR NOT AVERAGE?"

AND THEY SAID ANYONE OVER 100LB
CAN TAKE A ONE-AND-A-HALF
INCH NEEDLE.

AND ANYONE OVER 200LB,

YOU NEEDED TO AUTOMATICALLY
GO TO A TWO-INCH NEEDLE.

SO, OVER 200LBS, GIVES YOU
A LITTLE BETTER CRITERIA.

YOU'RE STILL GOING TO
PALPATE MUSCLE.

YOU'RE STILL GOING TO LOOK.

BUT IT HELPS YOU DECIDE,
WHEN DO I MOVE UP TO THAT.

I MEAN, THAT IS LONG,

A LONG, LONG NEEDLE AND YOU GOT
TO GET INTO THAT MUSCLE.

ALRIGHT.
KNOWING ALL OF THAT,

KNOWING THAT I AM GOING DORSAL
GLUTEAL, I'M GOING BUTTOCKS,

I HAVE CHOSEN A 21 GAUGE,

ONE-AND-A-HALF INCH
SAFETY GLIDE NEEDLE.

NOTICE THAT ON THIS CARTRIDGE
THERE IS NO SAFETY DEVICE

TO PROTECT ME FROM THAT NEEDLE
AFTER THE SHOT HAS BEEN GIVEN
AND I NEED SOMETHING.

SO, WE PRACTICE WITH
THE SAFETY GLIDE.

WAS IT ON OUR DEMO --
NO, OUR INSULIN?

DID WE HAVE IT ON THERE
AND IT JUST FLICKS IT DOWN.

AND SO THIS IS A NEEDLE
THAT'S SEPARATE,

BUT I'M GOING TO PEEL
OPEN FROM THE TOP.

TAKE THIS. ALWAYS HANDLE
FROM THE BOTTOM OF THE NEEDLE.

DON'T PULL IT OUT OF YOUR
PACKAGE AND START HANDLING IT

BECAUSE YOU'RE LIKELY TO
CONTAMINATE THIS TOP EDGE.

PUT THE TWO TOGETHER
AND SCREW IT ON.

THIS CARPUJECT ISN'T VERY,
VERY GOOD.

OKAY. I GOT MY NEEDLE ON,
SO I HAVE MY ONE-AND-A-HALF,

21-GUAGE, DEMEROL, O.6...

LONG NEEDLE.

YOU KNOW, I AM SO VISUAL.
I KNOW YOU'RE VISUAL TOO.

AND I WENT TO SURGERY THE FIRST
TIME AND THEY OPENED UP SOMEBODY

AND THEY WERE PEELING
AWAY THE LAYERS OF FAT.

WE GOT PLENTY.
PLENTY.

AND THE THING IS WE GOT TO
CLEAR THE OUTER POST TISSUE

AND GET TO MUSCLE SO THAT IT
WILL BE ABSORBED CORRECTLY.

WHICH ABSORBS FASTER?
SUBCUTANEOUS OR INTRAMUSCULAR?

- INTRAMUSCULAR.
- INTRAMUSCULAR.

SO WE WANT OUR CLIENT
TO GET THE MEDICATION.

IT TAKES 10 TO 30 MINUTES TO GET
INTRAMUSCULAR MEDICATION,

WHEREAS SUBCUTANEOUS
CAN TAKE UP TO AN HOUR.

THAT'S A BIG DIFFERENCE
WHEN YOU'RE IN PAIN

AND YOU'RE NEEDING YOUR
MEDICATION.

SO WE WANT TO GET TO MUSCLE,
THAT'S THE KEY.

ALRIGHT.
SO I HAVE A PLAN.

I KNOW HOW TO FIND MY MUSCLE.

I'VE GOT MY SYRINGE READY.

I HAVE A BAND-AID.

I HAVE A 2 BY 2
AND I HAVE AN ALCOHOL SWAB.

AND I DO HAVE
ANOTHER ADAPTOR HERE.

AND LET ME JUST SHOW YOU
THIS ADAPTOR.

CONNIE, ON THAT BACK SHELF,
YOU'LL SEE SOME MORE --

THERE'S A BLUE TRAY THAT'S
GOT MORE DEMEROL.

PASS THAT UP AND I'LL SHOW
YOU HOW TO DO THIS ONE.

SORRY, YOU SHOULD HAVE
GRABBED TWO. THANKS.

THIS IS ONE KIND OF HOLDER AND
THIS IS WHAT THE MANUFACTURER

USUALLY SENDS WHEN THEY
SEND THEIR DEMEROL,

THEIR NARCOTICS ORDERS
TO THE PHARMACY.

IF YOU CAN'T FIND THESE HOLDERS,
IT'S BECAUSE PHARMACY
HASN'T SENT ENOUGH

AND YOU JUST NEED TO CALL
THEM AND GET SOME MORE.

SOMETIMES NURSES WILL KEEP
A HOLDER IN THEIR POCKET,

AND IT'S THEIR PRECIOUS TREASURE
AND THEY WON'T SHARE.

BECAUSE THEY DON'T WANT TO LOSE
IT COS THEY KNOW HOW HARD
THEY ARE TO COME BY,

WHICH IS RIDICULOUS BECAUSE
PHARMACY HAS THEM BY THE CASE.

BY THE CASE.
SO YOU CAN GET THEM.

THE OTHER THING WE NEED
TO CONSIDER IS THAT

YOU DON'T WANT TO BE USING THE
SAME THING FOREVER ON SOMEONE.

IT NEEDS TO GET WIPED OFF
IF THIS IS TOUCHING ON THE SKIN
AND POSSIBLY BLOOD.

SO, IT SHOULDN'T BECAUSE OF THE
ADAPTOR AND THAT'S WHAT'S GOING
TO KEEP US FROM TOUCHING SKIN.

ALRIGHT. BUT THERE IS ANOTHER
ONE THAT'S MADE BY TUBEX.

AND IT LOOKS LIKE THIS, AND IT
SERVES THE SAME PURPOSE.

BUT YOU HOOK IT ON HERE.

YOU SCREW THIS ON AND THEN YOU
SCREW THIS PIECE ON TIGHT.

AND THEN YOU SCREW THIS
ON TO YOUR PLUNGER,

AND YOU GO TO GIVE IT,
AND YOU CAN'T, RIGHT?

BECAUSE WE HAVE A PUNCTURE.

AND THIS DOES NOT HAVE
THE HOLDER TO PUSH
THE TWO PIECES TOGETHER.

SO YOU'RE GOING TO HAVE TO
DO IT MANUALLY TO MAKE IT WORK
AND PUSH IT DOWN.

AND NOW IT'S GOING TO WORK,
OKAY?

AND THAT'S IT.
YOU GOT TO BE --

PUNCTURE IT YOURSELF AND THAT'S
HOW YOU KNOW THE DIFFERENCE.

SO THESE ARE NICE BECAUSE
THEN THE TUBEX DOESN'T
HAVE THIS BOTTOM PIECE

THAT MIGHT GET IN TOUCH
WITH THE CLIENT.

YOU'RE ALWAYS HANDLING
IT BY THE CARTRIDGE ITSELF

AND THIS STAYS RELATIVELY CLEAN
AND SO YOU'RE NOT PASSING
CONTAMINATION ON.

THESE ARE ALSO PRECIOUS AND
NURSES WON'T SPRING WITH THESE.

THEY HAVE THEM
IN THEIR POCKETS.

SO IF YOU CAN'T FIND
THEM ON THE MED CARTS,

START ASKING THE FLOOR NURSES,
"DO YOU HAVE A TUBEX HOLDER?"

THEY HAVE THEM.
THEY'RE IN THEIR POCKETS. OKAY?

ALRIGHT.

OKAY, WE'RE STILL IN
THE NURSING STATION,

WE'RE GETTING OURSELVES
CLEANED UP AND READY.

I AM A STICKLER ABOUT
CLEANLINESS.

DON'T LEAVE ALL YOUR TRASH
AND YOUR MESS AT THE STATION

BECAUSE SOMEONE ELSE IS GOING TO
BE BEHIND YOU GETTING
THEIR STUFF READY.

AND THE MORE CLUTTER THERE IS,
THE MORE DISTRACTION THERE IS

AND THE MORE POTENTIAL OF
CREATING A WRONG DRUG DOSE.

AND YOU DON'T WANT TO CREATE
SOMEONE ELSE'S ERROR.

ALRIGHT. SO I'VE CLEANED UP MY
STATION, AND I NEED TO TALK --

WELL, I WILL TALK ABOUT THAT
WHEN I GIVE THE SHOT.

I'M READY TO GO.
SO, I HAVE MY MAR.

I HAVE MY MEDS, MY PENS,
I HAVE CLEARED MY TRASH
AND I AM GOOD TO GO.

SO WE'LL COME OVER HERE
TO OUR CLIENT AND SAY,

GOOD MORNING MR. SPADE.
HOW ARE YOU?

ARE YOU READY FOR THAT SHOT?

ALRIGHT, IT NEEDS TO
GO INTO YOUR BOTTOM.

DO YOU REMEMBER WHICH ONE
YOU HAD THE LAST ONE ON?

ON THE RIGHT?
OR YOU HAVEN'T HAD ONE?

OKAY. WELL, WHY DON'T WE PUT IT
IN THE RIGHT THIS TIME

AND THEN WE'LL KIND OF ROTATE.

COS IT CAN MAKE YOUR BOTTOM
SORE, AND YOU NEED TO
KEEP MOVING IT.

ALRIGHT. BUT I DO WANT
TO CHECK YOUR ID BAND.

I NEED A TABLE.

"CAN YOU TELL ME YOUR NAME?

SAM SPADE?

ALRIGHT, LET ME CHECK
YOUR ID BAND.

I'VE ALREADY WASHED MY HANDS
SO I AM GOOD TO GO ON THAT.

SO, YOU'RE SAM SPADE
DR. FEEL GOOD 001010001.

AND, OH, YOU'RE ALLERGIC
TO SULFA.

THAT'S NOT A PROBLEM
WITH DEMEROL.

HAVE YOU EVER TAKEN DEMEROL
BEFORE? ARE YOU AWARE
OF AN ALLERGY?

OKAY. SO I CHECKED MY ALLERGIES,

I'VE CHECKED BANDS,
I'VE CHECKED MAR'S.

PRIVACY. THEY'VE GOT THIS WHOLE
HIGH FIVE DEAL.

ALRIGHT, I AM GOING TO
PUT YOU UP,

AND THE THING ABOUT DOING
THE DORSAL GLUTEAL IS

YOU HAVE TO GET HIM IN POSITION
TO DO THE DORSAL GLUTEAL.

YOU WANT TO GET TO
THE BACK BUTTOCKS.

WHERE WHEN WE DO THE VENTRAL
GLUTEAL, THEY CAN ACTUALLY
LAY ON THEIR BACK.

THEY DON'T HAVE TO MOVE AND THAT
ALLOWS THE PAIN MEDICATION
TO WORK, SO THEY CAN MOVE.

BUT I GOT TO MOVE THEM SO...

LET'S SEE. I GOT MORE PEOPLE
ON THAT SIDE,

SO I PROBABLY SHOULD DO IT
THE OTHER WAY, BUT HERE WE GO.

MAKE THEM TURN ALL THE WAY ON
THEIR STOMACH AND BE PRONE.

I'M GOING TO START USING A LOT
MORE TECHNICAL TERMS THIS TIME

AND MAKE SURE THAT YOU ARE
COMFORTABLE WITH POSITIONS,

BECAUSE ON THE INCLEX,

THEY'LL DESCRIBE WHAT PRONE IS
AND MAKE YOU PICK PRONE.

THEY'LL DESCRIBE POSITIONS AND
MAKE YOU DECIDE WHAT IT IS OR
WHAT DIAGNOSIS SHOULD BE THAT.

AND SO PRONE IS FACE DOWN,
WHEREAS SUPINE IS FLAT, FACE UP.

ALRIGHT. THIS IS AN ADULT
MANNEQUIN HERE.

THIS ABOUT JUST ROLLING OVER.

SO ON THE MANNEQUIN'S, ON THE
RIGHT SIDE OF THEIR BOTTOM

THEY HAVE A PAD AND THAT'S
THE DORSAL GLUTEAL.

ON THE LEFT OF THEIR BOTTOM
IS THE VENTRAL GLUTEAL PAD.

SO THAT, MAYBE, WILL HELP
YOU FIND YOUR LANDMARKS

AND LET YOU KNOW YOU ARE
IN THE RIGHT PLACE.

ALRIGHT.

HANG ON THERE, MR. SPADE,
I NEED SOME GLOVES,

BUT EVERYTHING IS ON
THE OTHER SIDE.

OKAY.

I AM ALREADY, KIND OF,
EYEBALLING MY TARGET.

BECAUSE I AM LOOKING TO SEE
IF THERE IS ANY REDNESS,

ANY ABRASIONS, ANY NECROSIS,
ANY SWELLING,

ANYTHING THAT MIGHT MAKE THIS
NOT A GOOD LOCATION
TO GIVE A SHOT.

BUT I AM ALSO GOING TO PALPATE.
I KNOW IT'S IN THAT
UPPER QUADRANT.

AND I WANT YOU TO KNOW THAT
AS A KIND OF DOUBLE CHECK,

BUT YOUR INSTRUCTORS ARE GOING
TO INSIST THAT YOU
IDENTIFY LANDMARKS.

IN ALL OF THE WRITTEN EXAMS THAT
I GIVE IN THE INCLEX WILL GIVE,

WILL DESCRIBE LANDMARKS WITHOUT
SAYING DORSAL GLUTEAL.

SO YOU GOT TO BE CLEAR
ON THOSE LANDMARKS.

SO I KNOW THAT FOUND THE
POSTERIOR, ILIAC ANTERIOR --
LET ME START OVER.

POSTERIOR SUPERIOR
ILIAC SPINE.

I FOUND THE GREATER TROCHANTER
AND I'VE DRAWN AN
IMAGINARY LINE.

AND IT'S ABOVE THE LINE.

BELOW THE ILIAC CREST.

I AM GOING THE PALPATE THE SIDE
AND MAKE SURE THERE'S
NO PAIN OR TENDERNESS.

I AM PALPATING FOR SOFTNESS,
FOR FIRMNESS, FOR BONE

BECAUSE YOU WANT TO BE OFF
OF THAT ILIAC CREST.

OKAY. SO I'M PRETTY COMFORTABLE
WITH MY SITE LOCATION THERE.

I AM GOING TO MAKE MY THIRD
CHECK OF MY MEDICATION
AT THE BEDSIDE.

LOOKING TO SEE THAT
IT IS DEMEROL.

ONE OF THE THINGS
I DIDN'T MENTION IS,

WHEN YOU ROTATE YOUR CARTRIDGE,
MAKE SURE THAT YOU PUT

THE NUMBERS HERE WHERE
YOU CAN SEE THEM.

NOTICE I DIDN'T
LABEL THIS ONE.

THERE'S REALLY NO NEED TO
BECAUSE IT ALREADY SAYS DEMEROL,

IT ALREADY SAYS O.6

IT WOULD JUST BE A DOUBLE DO
AND WASTE MY TIME.

AND ALL THE INFORMATION I NEED
IS ALREADY ON THE CARTRIDGE.

SO, O.6.
IT SAYS 100 PER MIL, 60 MG.

OKAY, I AM HAPPY.

OKAY, THAT'S GOOD.

NORMALLY YOU WOULD GIVE IT ON
A CLIENT, BUT I NEED TO SEE
WHAT I AM DOING.

SO WE ARE GOING TO COME
UP HERE WITH THE PADS.

YOU HAVE TWO PADS UP HERE
FOR YOU TO PRACTICE WITH.

WE HAVE ONE THAT'S
INJECT AIR ONLY AND WE
WOULD APPRECIATE JUST AIR.

IT WILL HELP OUR PADS
LAST LONGER.

AND THEN IF THEY
DON'T SAY ANYTHING,

YOU CAN PUT FLUID IN THEM.
THAT'S ALL.

ALRIGHT.

ONCE I FIND THE MUSCLE,
WE ARE GOING TO INTRODUCE

A DIFFERENT TECHNIQUE AS WELL
AND WE ARE GOING TO Z-TRACK.

Z-TRACK CAN ACTUALLY
BE DONE WITH ALL
INTRAMUSCULAR INJECTIONS.

DOESN'T HAVE TO BE,
BUT IT CAN BE.

AND WHAT A Z-TRACK IS, IS YOU
STRETCH THE SKIN OVER AN INCH
TO AN INCH AND A HALF,

YOU GIVE THE INJECTION
AND THEN WHEN YOU ARE
PULLING OUT THE NEEDLE,

YOU RELEASE THE SKIN AND RATHER
THAN THERE BEING A TRACK IN
AND OUT OF MEDICATION.

YOU PUT THE NEEDLE IN
AND YOU SQUIRT IT

AND THEN THE LIQUID COMES
RIGHT OUT OF THAT TRACK.

THE SKIN SWITCHES OVER
AND IT SHUTS OFF THE TRACK.

SO YOU DON'T LOSE THE
MEDICATION. SO A Z-TRACK.

THEY HAVE A GOOD PICTURE
OF IT IN YOUR BOOK.

SO WE ARE GOING TO
Z-TRACK THIS.

I AM GOING TO GO AHEAD
AND CLEAN THE SKIN

BECAUSE I CAN'T PULL AND CLEAN
AND GET ALL MY STUFF READY.

SO IT CAN BE CLEANED
WITH ALCOHOL AND DRY.

AFTER I AM DONE
WITH MY Z-TRACK,

I RECOMMEND THAT YOU USE
A 2 BY 2 AND JUST DAB,

RATHER THAN USE
AN ALCOHOL SWAB.

BECAUSE THE MOISTURE
WIPES AWAY ANY CLOT

AND CAUSES A LITTLE BLEEDING
AND SOMETIMES SOME BURNING.

SO ON A Z-TRACK, A DRY 2 BY 2
AND YOU JUST DAB, NO MASSAGING.

YOU CAN GO AHEAD AND HAVE
YOUR BAND-AID READY.

AND WE DON'T REALLY
NEED ONE ON A PAD,

SO MY BAND-AID'S
READY TO GO.

OKAY.

THIS IS REAL IMPORTANT AGAIN,
I JUST WANT TO REITERATE
ON NEEDLE SAFETY.

WHEN YOU PULL THE CAPS OFF YOUR
NEEDLES, HOLD IT BY THE BARREL,

HOLD IT BY THE END OF THE CAP
AND PULL AWAY FROM YOU,
BECAUSE IT'S LONG.

OKAY. SO PULL FAR AWAY.

BECAUSE IT'S MUSCLE YOU ARE
GOING TO HAVE TO GIVE IT
SOME UMPH THIS TIME.

WHEN YOU GIVE SUBCU,
I TALKED ABOUT GOING SLOW

AND PUSHING AND IT'S NOT A BIG
DEAL, BECAUSE IT'S SOFT TISSUE.

BUT WE GOT TO GET INTO MUSCLE.
SO YOU'RE GOING TO DART
THIS THING IN,

GIVE IT A LITTLE UMPH.

I'LL TALK TO YOU ABOUT
SOME VARIATIONS ON THAT.

OKAY. I'VE CHECKED MY CLIENT,
I'M GOING TO PULL MY SKIN ACROSS

AND I AM GOING TO WARN HIM,
LITTLE STICK.

MAKE SURE THAT YOUR BEVEL IS UP
AND YOU ARE GOING TO DART IN.

SO...
OH! I HIT BONE.

DID YOU HEAR?

ALRIGHT. NOW, I AM GOING TO
HAVE TO WALK UP THIS SYRINGE

BECAUSE THIS IS A
ONE-HANDED TECHNIQUE.

I HAVE TO KEEP HOLDING
THE SKIN IN Z-TRACK MODE,

BUT WE ARE GOING TO
ASPIRATE NOW.

WE ASPIRATE WITH ALL
INTRAMUSCULAR INJECTIONS

BECAUSE WE WANT TO MAKE SURE
WE ARE NOT IN A BLOOD VESSEL.

SO YOU ARE GOING TO PULL
BACK ON THE PLUNGER

AND SEE IF YOU GET ANY BLOOD.

AND YOU'RE GOING TO PULL BACK,
IT SAYS FOR FIVE TO TEN SECONDS.

I THINK THAT'S A WHOLE LOT. BUT
THIS IS WHAT THE RESEARCH SAYS.

THAT IF IT'S A SMALL VESSEL
AND A SMALL NEEDLE,

IT MIGHT TAKE A LITTLE BIT TO
PULL THE BLOOD INTO THE SYRINGE.

I HIT A BLOOD VESSEL
ONCE IN MY CAREER.

IT'S BLIND.
YOU DON'T KNOW.

YOU ARE STICKING IN
AND SO YOU DON'T KNOW,

AND IT'S POSSIBLE ON ANYBODY
TO HIT BLOOD.

I HAD NO RESISTANCE
WHATSOEVER.

I PULLED THE PLUNGER UP
AND WHISK, BLOOD.

WHEREAS IF YOU ARE NOT IN
A VESSEL, YOU'RE IN TISSUE,

AND THERE'S RESISTANCE
AT THE PLUNGER SIDE,

AND IT'S KIND OF STIFF.
YOU WILL FEEL THE DIFFERENCE.

SO ANYWAYS, YOU ARE GOING TO
PULL BACK, LOOK FOR BLOOD.

IF YOU GET BLOOD, YOU JUST PULL
THE NEEDLE OUT AND START OVER.

YOU JUST START OVER,
YOU CAN'T JUST READJUST.

- DO YOU PULL BACK AND HOLD?
- I PULL BACK ON THE PLUNGER.

YOU CAN SEE I AM JUST
DOING IT EVER SO SLIGHTLY.
DON'T JUST PULL REAL HARD.

IT HURTS IF YOU ARE
SUCKING ON TISSUE.

SO YOU JUST PUSH UP LIKE I AM
WITH MY THUMB HERE
A LITTLE BIT.

I'M FEELING RESISTANCE IN THE
PAD AND THAT FEELS
JUST LIKE A PERSON.

AND THEN IF I SEE
THERE'S NOTHING,

THEN I'M GOING TO INJECT MY
MEDICATION EVER SO SLOWLY.

THEN I'M GOING TO PULL
THE NEEDLE OUT

AS I RELEASE THE SKIN.

AND IT SHOULD -- WELL,
MY PAD'S LOST ITS RESILIENCY,

BUT SKIN WILL SHIFT,
KIND OF, OVER.

OKAY. I AM JUST NOT
COORDINATED ENOUGH

TO PULL, SWITCH AND FLIP
ALL AT THE SAME TIME.

THAT'S JUST MORE THAN
ANYBODY TO HAVE TO DO.

SO IN NEEDLE SAFETY,
AS LONG AS YOU KEEP
YOUR HAND BEHIND THE NEEDLE,

YOU CAN FLICK THIS DOWN AFTER.

BUT YOUR HAND HAS TO STAY.
YOU DON'T DO ANY OF THIS
KIND OF STUFF.

NO SWIMMING AROUND.

YOU STAY BACK HERE AND YOU FLIP
IT DOWN AND THEN IT'S PROTECTED.

ALRIGHT. BUT I DON'T WANT
TO FORGET MY CLIENT HERE,

SO I DO WANT TO LOOK AND SEE
IF THERE IS ANY OOZING.

AND YOU CAN SEE AN EVER
SO SLIGHT LITTLE DAB HERE

SO I CAN JUST KIND OF PAT IT.

BUT NO MASSAGING WHATSOEVER

BECAUSE IF YOU MASSAGE YOU
DEFEAT THE POINT OF THE Z-TRACK.

DAB, THAT'S GOING TO GO
IN THE TRASH,

AND THEN A BAND-AID
IF NECESSARY.

ALRIGHT. SO MY CLIENT HAS HAD
THEIR SHOT AND I WOULD SAY,

DO YOU WANT TO STAY ON
THE SIDE FOR A WHILE
OR YOU WANT TO MOVE BACK.

AND HE'S JUST SO HAPPY
RIGHT THERE. OKAY.

AND I AM GOING TO PUT THE BED
DOWN BECAUSE I WOULD HAVE BEEN
OVER THERE, RIGHT?

AND THE SHARPS CONTAINER
IS OVER HERE, SO TAKE CARE
OF YOUR PERSON FIRST.

THE RULE OF NURSING,
THE RULE OF TESTING IS
PATIENT BEFORE EQUIPMENT ALWAYS.

DON'T BE SO WORRIED
ABOUT THIS NEEDLE THAT
YOUR PATIENT GETS LEFT,

YOU KNOW, WITH THEIR
BUTT SHINING UP THERE.

ALRIGHT. NOW YOU NEED TO
DISPOSE OFF THIS THING.

YOU ALREADY CAN APPRECIATE
THAT THIS IS A REUSABLE
CARTRIDGE, RIGHT?

SO WHAT I WANT YOU TO
DO IS PUT ONE HAND HERE

AND STABILIZE THE CARTRIDGE.

YOU NEED TO RELEASE THE
CARTRIDGE WITH THE BLUE PIECE,

AND THEN YOU'VE GOT TO
RELEASE THE PLUNGER

WITH THE PLUNGER PIECE AND GET
OFF THE SCREW AND PULL IT OUT,

OTHERWISE IT WILL HOLD
ON TO YOUR CARTRIDGE

AND IT WON'T GO INTO
THE SHARPS CONTAINER.

AND THEN WITH ONE HAND, YOU JUST
COME UP HERE AND YOU DROP IT
INTO THE SHARPS CONTAINER.

KEEP THIS.

IF YOU ARE FUSSING
AND FUSSING AND FUSSING
AND YOU CAN'T GET IT,

JUST THROW IT ALL
INTO THE SHARPS.

THERE ARE MORE OF THESE
IN THE PHARMACY.
I'M TELLING YOU, OKAY?

BUT TRY. ESPECIALLY IF YOU GOT A
NEEDLE, A GUARD ON THAT NEEDLE,

YOU'RE NOT GOING TO GET STUCK,
BUT TRY TO GET IT OUT.

ALRIGHT.
THEN I WOULD CLEAN UP MY MESS,

TAKE MY GLOVES OFF,
WASH MY HANDS AND DOCUMENT.

BEFORE I FORGET, I DO WANT TO
MENTION THAT CONNIE AND I

DON'T WANT YOU TO THROW
YOUR CARTRIDGES INTO
THE SHARPS CONTAINER.

THESE CARTRIDGES COST ME
50 BUCKS A BOX.

IT'S RIDICULOUS, WHEN I PAY
FOR SALINE IN A CARTRIDGE
THAT'S FAKE.

SO WE'RE GOING TO PUT OUT
SOME JUST PLAIN EMPTY BOXES

AND THEN YOU CAN DUMP THEM
IN THERE LIKE YOUR SHARPS
AND PRACTICE.

AND THEN WHEN YOU TEST, I'LL
EVEN HAVE YOU DUMP THEM INTO
THIS LIKE IT'S YOUR SHARPS.

EVERYTHING ELSE, ALL YOUR
OTHER SYRINGES WHEN YOU TEST

YOU'LL ACTUALLY PUT INTO SHARPS
BECAUSE I CAN GET MORE OF THEM.

OKAY. LET'S DOCUMENT.

BECAUSE DOCUMENT IS ASTERISKED
AND IT WILL BE ASTERISKED
ALL SEMESTER.

OKAY.

IT IS 1:45, SO WE'RE GOING TO
THE SEVEN TO THREE SLOT.

SO -- OH, BROTHER,
I HAVE ALREADY ERRORED.

ERROR DB.

13:45 AND THEN I GOT THE TIME,
THE SITE AND MY INITIALS.

SO I HAVE TO GO DOWN HERE
TO THE KEY HERE.

IT'S NOT VERY EASY TO SEE.

YOU CAN SEE PROBABLY BETTER
ON YOUR OWN SHEET.

BUT I'M LOOKING FOR A DORSAL
GLUTEAL.

AND IT IS NOT VERY SPECIFIC ON
THIS.

AND THIS HAPPENS TO BE, I
BELIEVE ST. AGNES' SHEET, YES.

AND ALL THEY SAY IS LEFT GLUTEAL
OR RIGHT GLUTEAL.

WELL, I WANT TO BE
A LITTLE MORE SPECIFIC

COS WE'RE NOT GOING TO BE DOING
ANY DORSAL GLUTEAL FOR
THE MAIN THING,

AND WE WANT TO BE
MORE SPECIFIC.

SO I WROTE MY OWN
KEY CODE DOWN HERE

AND I WROTE LDG
FOR LEFT DORSAL GLUTEAL.

WELL, I HAPPENED TO DO
THIS ONE IN THE RIGHT,

SO I AM GOING TO SAY RDG
FOR RIGHT DORSAL GLUTEAL.

THIS PEN IS JUST TOO BIG,
BUT YOU GET THE IDEA.

SO UP HERE,
I'M GOING TO WRITE...

RDG AND THEN MY INITIALS DB.

SO I HAVE THE TIME,
THE SITE, MY INITIALS

AND I SIGN BELOW
MY INITIALS, DB RN.

AND REMEMBER YOUR SN CSUF.

AND YOU WILL LOSE ALL YOUR
POINTS FOR CREDENTIALS.

I KNOW IT'S HARD, BUT WE JUST
GOT TO FINISH OFF THE SHEET.

YOU GOT TO DO ALL OF PIECES OF
IT, SO MAKE SURE YOU SIGN.

YOU CAN SIGN YOUR NAME ON YOUR
MAR BEFORE YOU GO INTO THE ROOM.

YOU JUST CAN'T SIGN THE MED
GIVEN UNTIL YOU GIVE IT.

ALRIGHT. SO THAT'S
YOUR FIRST SHOT.

WHEN YOU GET PREPARED,

NEXT WEEK WHEN YOU COME IN
WE'LL HAVE THE CARTRIDGES

AND THE SYRINGES ALREADY
READY FOR YOU.

SO YOU CAN GO AHEAD
AND PREPARE YOUR DEMEROL.

WE ARE NOT GOING TO
WATCH YOU, OKAY?

SO HAVE YOUR CARPUJECT SET IN
THE HOLDER AND YOUR DOSE SET.

AND THEN YOU'LL COME IN AND
YOU'LL JUST GO TO THAT STATION

AND GIVE THAT SHOT
AND IT WILL GO PRETTY FAST.

ANY QUESTIONS ON THAT ONE?

EVERYTHING IS AGAIN,
UP IN THIS UPPER CORNER.

ALRIGHT. NOW WE ARE GOING
TO MOVE TO AMPICILLIN.

WE'VE REVIEWED THIS ORDER.
YOU KNOW, IT'S GOOD TO GO.

AMPICILLIN 300 MG HAS BEEN
ORDERED FOR YOUR CLIENT, IM.

Q6 HOURS.
YOU HAVE IT ON THE MAR.

300 MG.
WONDERFUL.

I HAPPEN TO KNOW HOW
AMPICILLIN COMES

AND SO WE NEED
TO BE LOOKING AT --

AND IF YOU BROUGHT YOUR
SYLLABUS, FIND THE LABEL
FOR YOUR AMPICILLIN.

OKAY.

I'M IN THE NURSING STATION.
DRAMA CLASS. HERE WE ARE.

WHAT WE'RE GOING TO HAVE YOU DO
ON THIS ONE IS YOU'LL
GATHER UP YOUR SUPPLIES,

BUT YOU'RE GOING TO GO TO A
STATION AND DRAW UP FOR SOMEONE,

AND THEY'LL CHECK YOU OFF
AT THE STATION.

MAKING, DOING YOUR AMPICILLIN,
DILUTING IT,

RECONSTITUTING IN THE VIAL AND
THEN GETTING THE RIGHT DOSE.

SO THAT'S ONE STATION
AND THEN YOU'LL GO GIVE IT
AT ANOTHER STATION.

YOU'LL HAVE THREE STATIONS
THAT YOU'LL BE GOING BETWEEN

AND ROTATING TO NEXT WEEK.

ALRIGHT. FROM THE TOP.

I'VE CHECKED MY DOCTOR'S ORDERS,
AMPICILLIN 300 MG/IM/Q6.

I CHECKED ALLERGIES.
AGAIN, MY CHART DOESN'T SAY,

BUT I'M PRETTY SURE IF IT'S THE
SAME CLIENT, I HAVE SULFA.

SO SULFA AND AMPICILLIN
AREN'T A PROBLEM.

WHAT DO YOU THINK ABOUT
PENICILLIN OR CODEINE?

- PENICILLIN IS A PROBLEM.
- PENICILLIN IS A PROBLEM.

SO, IF YOU GET TO THE BED
AND THE NAME TAG SAYS,

"OH! PENICILLIN,
CAN'T GIVE THIS."

WE'LL SAY, "YEP, YOU'RE RIGHT.
NOW, GO AHEAD AND GIVE IT."

SO YOU STILL GOT TO NOTE IT.

WE WANT YOU TO BE AWARE
OF THE ID BAND,

BECAUSE THAT'S YOUR LAST CHECK
IN ANY CLINICAL SITUATION.

BUT LIKE I SAID, I DON'T KNOW
WHICH BED YOU'RE
GOING TO SO...

AND WE NEED TO GIVE THE SHOT.

ALRIGHT. SO I KNOW MY SHOT,

I KNOW ALLERGIES ARE PROBABLY
NOT AN ISSUE AND MY DOSE
IS OKAY.

NOW I NEED TO GATHER
MY EQUIPMENT.

I'M GOING TO NEED
A SAFETY LOCK SYRINGE

TO GIVE IN THE
VENTRAL GLUTEAL MUSCLE,

AND I'M GOING TO GIVE
AMPICILLIN.

SO WHEN I GO TO THE DRAWER
TO GET MY MED OUT,

WHAT I FIND IS AMPICILLIN
AND A VIAL.

BECAUSE YOU HAVE TO
CREATE AMPICILLIN.

AMPICILLIN IS ONLY GOOD
FOR ONE HOUR, ONCE IT'S
BEEN RECONSTITUTED.

SO PHARMACY CAN'T MIX IT UP

AND EXPECT YOU TO DO IT WITHIN
THAT SHORT PERIOD OF TIME.

SO THEY SEND THE POWDER UP
AND THEY SEND THE SOLUTION
AND YOU GET TO MIX.

THIS IS A TEST
ON YOUR MED MATH EXAM.

THERE WILL BE A LABEL OF HOW
TO RECONSTITUTE YOUR DRUG.

I GAVE YOU THE LABEL SAMPLE
AND THEN YOU COME UP
WITH THE INFORMATION.

THE LABEL ALWAYS HAS EVERYTHING
YOU NEED TO KNOW ON THE LABEL.

SO IT'S JUST AN
EXERCISE IN READING

AND MAKING SURE THAT YOU
KNOW WHAT MEANS WHAT.

I TOLD YOU IN YOUR SYLLABUS,
WHEN IT TELLS YOU WHAT YOU ARE
GOING TO BE DOING FOR THE DAY,

TO LABEL YOUR PRACTOR POWDER
VIAL AS A 500 MG AMPICILLIN.

SO I PUT A PIECE OF TAPE ON
MINE. AMPICILLIN, 500 MG.

ALRIGHT. AND ALSO, BEFORE I'M
GOING TO GET INTO THE LABEL,

I WANT TO TALK A LITTLE BIT
ABOUT MY SYRINGE THAT I PICKED.

WELL, YOU CAN'T REALLY
PICK YOUR SYRINGE TILL YOU
KNOW WHAT YOU GOT GOING.

SO LET'S GO TO OUR LABEL.

LET'S SEE WHAT WE NEED TO DO.

I HAVE THINGS I NEED TO
NOT FORGET TO TELL YOU.

OKAY. NO POST-IT NOTE.

NO, EVERY SEMESTER THERE'S
ONE MORE POST-IT NOTE.

WHEN YOU LOOK ON THE LABEL,
IT TELLS YOU THE ORDER

AND IT TELLS YOU HOW IT'S
STOPPED.

AND THESE FIVE QUESTIONS
ARE THE FIVE QUESTIONS

THAT I'M GOING TO ASK YOU ON THE
MED MATH EXAM IN A FEW WEEKS.

YOUR BOOK DOESN'T ALWAYS ASK
ALL OF THESE QUESTIONS.

IT MAY ASK YOU ONE QUESTION.

LIKE, HOW MAY MILLILITERS WILL
YOU USE TO RECONSTITUTE?

OR, HOW MANY MILLILITERS
TO GIVE THIS DOSE?

OR SOMETHING LIKE THAT.
SO THEY'LL PICK PIECES OF IT.

I NEED YOU TO APPRECIATE
ALL OF IT EVERY TIME.

SO THESE WILL BE
THE FIVE QUESTIONS

AND ALL THE INFORMATION WILL
ALWAYS BE ON YOUR LABEL.

SO THE FIRST THING THAT
I NEED TO KNOW IS ACCORDING
TO THIS LABEL,

WHAT DILUTING FLUID AND HOW
MANY MILLILITERS WILL I USE

TO RECONSTITUTE THIS,
TO MAKE THIS POWDER LIQUID.

THAT'S WHAT
RECONSTITUTE MEANS.

SO WHEN YOU LOOK AT THE LABEL,

THE FIRST THING I DO
IS LOOK AT INTRAMUSCULAR.
"USE A 125 MG VIAL."

THAT'S NOT ME.
MOVE ALONG.

"250 MG VIAL."
THAT'S NOT ME. MOVE ALONG.

"FOR DILUTION OF 500 MG..."
THAT'S ME. ONE GRAM
OR TWO GRAM VIAL.

SO NOW I'M IN THE
RIGHT SECTION.

IN SOME WAYS YOU HAVE TO,
KIND OF, PERUSE THROUGH.

MAKE SURE TO PAY ATTENTION
TO IM AND IV,

BECAUSE THOSE WILL BE
DISTINGUISHED OFF AND ON A LABEL

AND YOU DON'T WANT TO GET
IN THE WRONG SECTION.

OKAY. ACCORDING TO THIS LABEL,
500 MG,

I WOULD SAY ON ANY LABEL THAT
YOU PUT A LINE STRAIGHT ACROSS

SO THAT YOU DON'T GET
OFF WHEN YOUR READING.

SO I PUT MINE STRAIGHT ACROSS
HERE ON MY 500 MG VIAL

TO SEE WHAT I AM
SUPPOSED TO DO.

AND IT SAYS, "THE RECOMMENDED
AMOUNT OF DILUTANT IS 1.8 ML."

OKAY, WELL, THAT TELLS ME
THE NUMBER OF MILLILITERS,

THOUGH I STILL HAVEN'T FIGURED
OUT WHAT IS THE DILUTANT?

WHAT'S THE LIQUID?

IT'S UP THERE IN THAT PARAGRAPH.
WHAT DOES IT SAY?

STERILE WATER, USP
OR BACTERIAL STATIC,

WHICH IS JUST A UNIT OF DILUTION
OR THE BACTERIAL STATIC FORM.

SO I HAVE STERILE WATER VIAL
AND IF YOU GUYS --

I CAN'T REMEMBER IF I GAVE YOU
STERILE WATER OR NORMAL SALINE,

BUT IF IT IS NORMAL SALINE
JUST MAKE IT STERILE WATER
FOR THE DRILL.

WE MAKE EVERYTHING WHAT
WE NEED IT TO BE FOR
THE TIME.

OKAY, SO I HAVE
MY STERILE WATER

AND I KNOW I NEED 1.8 ML
TO DILUTE THIS.

WHEN I PUT IN 1.8 ML, HOW MUCH
SOLUTION WILL BE IN THAT VIAL?

- 2 MILLILITERS.

- 2 ML, BECAUSE THE POWDER PLUS
THE LIQUID IS GOING TO MAKE TWO.

THEN MY NEW CONCENTRATION
IS GOING TO BE 250 MG/ML.

SO THAT ANSWERS
MY NEXT QUESTION,

WHAT IS MY SOLUTION
AND NEW STOCK?

I HAVE NOW CREATED
AMPICILLIN, 250 MG/ML.

HOW MUCH THEN WILL YOU GIVE?

WHAT DOES THAT MEAN?

WHAT AM I SUPPOSED TO GIVE?
- THE DOSE.

- A DOSE. 300 MG.

AND I HAVE 250 MG/ML.

SO I WOULD SET UP
A SIMPLE PROPORTION.

IF 250 MG EQUALS 1 ML,

300 MG IS GOING TO EQUAL X ML.

CROSS MULTIPLY.

I KNOW 300 IS MORE THAN 250, SO
IT'S GOING TO BE MORE THAN ONE.

OKAY, SO MAKE THAT
VISUAL CONNECTION.

AND I HAVE DONE MY MATH,
AND I KNOW IT IS 1.2.

I THINK I HEARD
SOME PEOPLE SAY THAT.

OKAY, 1.2 ML IS MY DOSE.

SO THE ANSWER IS AMOUNT
TO GIVE 1.2 ML.

SO IT'S ALWAYS REFERRING
TO THE DOSE.

ON "D" IT SAYS, WHAT DO YOU
WRITE ON THE LABEL?

WHENEVER YOU POP THE LID OFF
AND YOU RECONSTITUTE YOU ARE
GOING TO LABEL THIS,

SO IF THE NEXT GUY USES IT
THEY WILL KNOW HOW OLD IT IS
AND IF IT'S OKAY.

SO YOU WOULD PUT THE DATE,
THE TIME,

YOUR INITIALS AND THE
CONCENTRATION THAT YOU
HAVE CREATED.

SO I WOULD NEED TO
PUT ON HERE...

1/28/04,

13:50, DB,

250 MG/ML...

IF I WAS SAVING THIS.
BUT WHAT DID I TELL YOU?

IT'S ONLY GOOD FOR AN HOUR.
SO I AM GOING TO WRITE
NOTHING AND SAY,

"NOTHING, IT'S ONLY GOOD
FOR AN HOUR."

BUT THERE ARE MANY AND YOU WILL
SEE AS YOU LOOK AT YOUR LABELS.
GET INTO YOUR MED BOOKS.

I AM GOING TO GIVE YOU AN
ASSIGNMENT NEXT WEEK AND HAVE
YOU TURN IN SOME OF YOUR LABELS,

SO I CAN MAKE SURE YOU'RE
READING IT AND YOU'RE OKAY.

BUT IF YOU'RE SAVING IT, YOU
NEED TO PUT THAT INFORMATION.

BECAUSE SOME DRUGS ARE GOOD,
REFRIGERATED FOR THREE DAYS

OR SOME ARE GOOD FOR SEVEN DAYS
AND SOME ARE, YOU KNOW,

WHATEVER THE LABEL SAYS.
WE'RE GOING TO LOOK AT A FEW.

AND THEN STORAGE.
HOW WOULD WE STORE IT?

WE'RE NOT. WE'RE GOING TO
THROW IT AWAY ON THIS ONE.

BUT SOME WILL SAY REFRIGERATE,
ROOM TEMPERATURE AND SO FORTH.

ALL THE INFORMATION IS ALWAYS
GOING TO BE ON YOUR LABEL.

IT'S NEVER A TRICK,
IT'S NEVER A --
THEY WANT YOU TO KNOW,

BUT YOU NEED TO BE ABLE
TO FIND THAT INFORMATION.

ALRIGHT. I NEEDED TO KNOW HOW
MUCH SOLUTION I WAS GOING TO

DROP INTO MY SYRINGE SO I COULD
PICK THE RIGHT SYRINGE.

WE TALKED A LITTLE BIT ABOUT
SYRINGE SIZES THE LAST TIME.

IF YOUR DOSE IS 0.5 OR LESS,
WHAT SIZE SYRINGE DO YOU
HAVE TO PICK?

OKAY, YOU GUYS,
YOU GOT TO REMEMBER THIS,

BECAUSE WE ARE TESTING ON
ALL OF THESE AT THE END.

CRITICAL THING AND FOR
THE REST OF YOUR LIFE.

0.5 AND BELOW HAS TO BE
IN A 1 ML SYRINGE
FOR ACCURATE DOSING.

BECAUSE REMEMBER THE TB SYRINGE,
THE 1 ML SYRINGE,

GOES TO THE HUNDREDTH.

BUT ANYTHING OVER 0.5 CAN BE
IN A THREE, FIVE OR TEN.

BECAUSE OUR DOSE IS 1.2 ML,

A 3 ML SYRINGE WILL WORK
PERFECTLY FINE.

SO I PICKED A 3 ML SYRINGE.

IT HAPPENS TO BE THE SAFETY
LOCK BRAND. REMEMBER THEM.

THAT'S SHEATH ON THE OUTSIDE
THAT SLIDES DOWN WHEN
YOU PULL IT OUT.

AND I NEED A NEEDLE ON HERE.

OKAY. MY NEEDLE, I'M GOING TO
GO VENTRAL GLUTEAL.

AGAIN VENTRO --
GLUTEAL, BUTTOCKS,

BUT VENTRO, WHAT DOES THAT MEAN?
- SIDE.

- SIDE. SO NOW, WE'RE GOING TO
GO SIDE BUTTOCKS, SIDE GLUTEAL.

THE RULES ARE THE SAME FOR
ALL THE GLUTEAL MUSCLES.

ON AN AVERAGE ADULT
100 TO 200 POUNDS, HOW LONG?

- ONE AND A HALF INCHES.
- ONE AND A HALF INCHES.

CLOSER TO 200LB YOU MAY
WANT TO CONSIDER A 2 INCH,

BUT OVER 200LB,
A 2-INCH NEEDLE.

SO I PICKED OUR AVERAGE
MANNEQUIN OVER HERE.

AN AVERAGE ADULT,
A ONE-AND-A-HALF INCH NEEDLE.

WHAT GAUGE WOULD I PICK?
WHAT'S THE RANGE?

BECAUSE THIS IS WATERY.
- 20.

- 20 TO 23.
WE'RE GOING INTO MUSCLE.

SO I HAVE A 22 GAUGE,
ONE-AND-A-HALF INCH NEEDLE

ON MY 3 CC SYRINGE.

STILL GATHERING MY EQUIPMENT.
CAN YOU BELIEVE IT,
HERE WE ARE.

NOW THERE IS ONE OTHER THING
I KNOW ABOUT MIXING A POWDER.

AND THAT IS ANY TIME YOU MIX
A SOLUTION YOU'RE GOING TO
HAVE TO FILTER IT

BECAUSE THERE IS A RISK OF
PARTICLES BEING IN THE SOLUTION.

WE'RE GOING TO BREAK THEM
INTO AN AMPOULE.

THERE IS A RISK OF GLASS
BEING IN THE AMPOULE.

SO ANY TIME THERE IS
A MIXING GOING ON,
UNLESS THEY TELL YOU NOT TO,

YOU NEED TO PUT A FILTER
NEEDLE ON TO FILTER OUT
ALL OF THE PARTICLES.

SO I HAVE GOTTEN A FILTER NEEDLE
TO DO MY MIXING.

ALRIGHT. SO YOU ARE GOING TO
HAVE A FILTER NEEDLE,
YOUR SYRINGE.

I HAVE MY ALCOHOL SWAB,
TAPE TO LABEL THINGS.
I AM READY TO GO HERE.

REMEMBER WHAT ALL GOOD NURSES
HAVE IN THEIR POCKETS?

ALCOHOL SWABS AND?

- CARPUJECTS?
- I THOUGHT IT WAS BAND-AIDS.

- BAND-AID.
BAND-AIDS, YEAH.

CARPUJECTS. THAT, YOU ARE JUST
LUCKY IF YOU HAVE ONE OF THOSE.

AND THAT'S WONDERFUL.
BUT ALCOHOL SWABS
AND BAND-AIDS FOR SURE.

YOU WANT TO HAVE IN YOUR
POCKETS AT ALL TIMES.

BUT I HAVE THEM ON MY TRAY,
READY TO GO.

OKAY, MY HANDS ARE WASHED.

I HAVE GATHERED MY EQUIPMENT,
I'VE DONE THE TOP THREE
OF THE HIGH FIVE.

I AM GOING TO GO AHEAD NOW
AND GET INTO MY STUFF.

WHEN I OPEN MY BACTERIAL STATIC
WATER, I AM GOING TO MAKE SURE
THAT IT HASN'T EXPIRED.

SO CHECK YOUR EXPIRATION DATE
ON YOUR VIAL.

AND MINE'S VERY EXPIRED.

BUT IT'S FOR PRETEND,
SO IT DOESN'T MATTER.

BUT MAKE SURE THAT YOU'RE
NOTING THE DATE.

YOUR STUFF'S NEW,
YOU JUST BOUGHT IT,
SO IT SHOULD BE GOOD TO GO.

CHECK THE DATE.

IF THIS IS A MULTIDOSE VIAL,
THEN AFTER I POP THE LID OFF
IT'S GOOD FOR 30 DAYS.

HOW WOULD YOU KNOW WHEN
30 DAYS HAS PASSED?

- CHECK THE LABEL.

- DATE, TIME, INITIALS,
IT GOES ON EVERYTHING.

SO I WOULD --
I'M GOING THE POP THE LID OFF,

AND I AM GOING TO GO AHEAD

BECAUSE I ALWAYS HAVE INK PENS
IN MY POCKET AS WELL.

AND ON THOSE LABELS,
I'M GOING TO WRITE 1/28/04,

13:55, DB.

AND NOW SOMEBODY KNOWS
HOW LONG IT'S BEEN OPEN.

HOWEVER MOST OF THE INSTITUTIONS
HAVE GOTTEN AWAY FROM
MULTIDOSE VIALS.

HOW COMFORTABLE WOULD YOU BE
USING A MULTIDOSE VIAL
ON DAY 25?

I WOULDN'T.
I WOULD THROW IT AWAY.

THEY'RE CHEAP
AND I WOULD GET A NEW ONE.

SO MOST EVERYTHING IN YOUR
INSTITUTIONS IS NOW
A SINGLE DOSE.

YOU USE A VIAL
AND YOU THROW IT AWAY

AND IT WILL SAY AT THE BOTTOM,
"SINGLE DOSE ONLY."

SO YOU'LL MIX AND TRASH

BECAUSE WE DON'T KNOW
WHAT PEOPLE ARE DOING
WITH THIS STUFF.

OKAY. AND THEN I WANT
ALSO ON MY MEDICATION,
CHECK THE EXPIRATION DATE

AND BECAUSE THIS IS A PRACTICE
THING, THERE'S NOTHING
WRITTEN ON IT,

BUT ALWAYS LOOK FOR
MANUFACTURE DATES ON HERE.

COS ONCE IT'S RECONSTITUTED,
THEN WE GO BY WHAT IT SAYS
AS FAR AS HOW LONG IT'S GOOD.

SO IF THIS IS GOOD UNTIL 2005

AND I RECONSTITUTE IT TODAY
AND THEY SAY IT'S ONLY
GOOD FOR 24 HOURS,

I GO WITH THE 24 HOURS,
NOT THE 2005.

THAT JUST MEANT SEAL.
IT WAS GOOD FOR TWO YEARS.

ALRIGHT, POP THAT OPEN.

AND NOW A VIAL IS A VIAL,
JUST LIKE IT WAS WHEN
YOU DID YOUR INSULIN.

BUT WE'RE GOING TO ADD
TO OUR STUFF.

SO, OPEN UP.

THESE ARE LUER LOCK SYRINGES.
DID YOU GUYS DO
THE LUER LOCK...?

NO, YOURS WERE ALL CONNECTED..

THE NEEDLE WAS CONNECTED TO
THE END...THE 1 ML.

THIS IS A LUER LOCK SYRINGE.

LUER LOCK MEANS THAT
IT HAS GOT THE THREADS
LIKE YOU WOULD SEE ON A JAR.

SO THAT YOU CAN SCREW THE NEEDLE
ON AND THAT KEEPS IT
FROM SLIPPING OFF.

WE'RE GOING TO USE A SYRINGE
NEXT WEEK THAT IS A
NON LUER LOCK SYRINGE.

BUT LUER LOCKS ARE WONDERFUL

BECAUSE YOU CAN SCREW THEM
AND GET THEM TIGHT.

SO YOU WANT TO CHECK WHEN
YOU OPEN UP THE PACKAGE

COS THEY DON'T ALWAYS
SCREW THEM TIGHTLY.

AND WHEN YOU GO TO PULL UP
STUFF, YOU'RE NOT GETTING
YOUR SOLUTION IN

AND YOU CAN'T FIGURE OUT WHY.

IT'S BECAUSE IT'S LEAKING
AIR OUT OF YOUR SYRINGE.

ALRIGHT.
SO TIGHTEN IT UP.

AND I'M GOING TO DRAWING UP --
OH, I GOT TO GO BACK
TO MY PAPER.

NEVER WORK OUT OF YOUR MEMORY,
IT'S A SCARY PLACE.

MY 1.8 ML.

AND DO I NEED TO CLEAN
THIS TOP AGAIN?

INDECISION OUT THERE.

I AM NOT GOING TO.
I POPPED THE LID OFF OF IT,
I HAVEN'T DONE ANYTHING,

I HAVEN'T TOUCHED IT
AND I KNOW IT'S STERILE.

IF I TURNED MY BACK AWAY FROM IT
OR IT'S BEEN USED,

IT MUST BE WIPED WITH ALCOHOL.

SHAKY-HAND SYNDROME.
PULL THOSE HANDS IN.

GET THAT NORMAL --
OH, I DON'T WANT THIS NEEDLE.

I GOT TO TAKE THIS NEEDLE OFF.

SHOOT, I DIDN'T MEAN
TO DO THAT EITHER.

I GOT TO SAVE THIS, SO I AM
GOING TO PUT IT IN HERE

AND WHAT I WOULD RECOMMEND IS
THAT YOU JUST TWIST IT OFF

AND LEAVE IT IN HERE
AND NEVER TOUCH IT.

BECAUSE WE'VE GOT TO PUT
OUR FILTER NEEDLE ON.

WHICH THERE IS REALLY
NOTHING TO FILTER.

EVEN IF I HAD FORGOTTEN AT THAT
POINT AND PULLED UP THE WATER,
THAT'S OKAY.

THERE'S NOTHING THAT'S AN ISSUE
THERE, BUT IT'S JUST SIMPLER.

YOU CAN GET YOUR FILTER NEEDLE
ON AND PULL THAT OFF.

SO SCREW THAT ON GOOD.
THIS THING IS HUGE.

IT'S ONE-AND-A-HALF INCHES
AND IT'S A 19 GAUGE,

IT'S A BIG, OLD FAT THING.

OKAY, I AM GOING TO PUT THAT IN,
PUT MY AIR IN,

TURN IT UPSIDE DOWN,
PULL UP MY 1.8.

BUT I'M ACTUALLY GOING TO PULL
UP LIKE TWO AND A HALF.

PULL UP A LOT,
GET ALL YOUR AIR TO THE TOP,

TAP IT AND THEN SQUIRT THE AIR
OUT.

MAKE SURE THAT THE AIR PASSES
THROUGH THE HUB OF THE SYRINGE

BECAUSE YOU'LL FIND THAT YOU
GET SOME TRAPPED IN THERE

AND THAT WILL AFFECT
YOUR DOSE.

SO I KNOW I PASSED
ALL THE AIR.

I'M STILL A LITTLE SHORT
OF THIS FLUID,

BUT SEE ONCE I'VE SET IT, THEN
NO AIR COMES BACK AND FORTH.

ONCE I'VE HAVE GOTTEN RID
OF ALL THE AIR.

AND I AM GOING TO SET
MY DOSE AT 1.8.

YOU DON'T HAVE TO HAVE
IN THE NURSING WORLD
SOMEONE RECHECK YOU,

BUT IN OUR ENVIRONMENT YOU DO.

BECAUSE HOW WOULD I KNOW
YOU HAD IT RIGHT.

SO YOU ARE GOING TO SHOW YOUR
INSTRUCTOR, "I HAVE 1.8. 1.8."

AND THEY WILL BLESS IT AND YOU
CAN TAKE IT OUT. WHOOPS.

ALRIGHT. I TOOK MY EYE OFF THIS
AND WALKED AWAY,

ALTHOUGH I AM PRETTY CONFIDENT
NO ONE MESSED WITH IT.

BUT I AM GOING TO GO AHEAD
AND WIPE THIS OFF.

NOTICE THAT I HANDLED MY NEEDLES
OUT AWAY FROM ME

BETWEEN MY FINGERS AND I
KEEP MY CAP IN MY HAND.

I DON'T LIKE TO SET IT DOWN
BECAUSE I DON'T LIKE THEM TO
GET CONTAMINATED.

IF YOU DO SET IT DOWN,
IT'S BEST IF YOU CAN SET IT DOWN
ON YOUR STERILE SURFACE

RATHER THAN ON THESE DIRTY,
OLD TRAYS.

ALRIGHT, I AM GOING
TO PUT MY NEEDLE IN.

REMEMBER THESE SAFETY LOCKS.

THAT OUTSIDE SHEATH SLIDES,

SO YOU'RE GOING TO BE BETTER
SERVED TO HANDLE IT
BY THE FLANGE,

SO YOU DON'T GET
A LOT OF SLIPPAGE.

AND NOW YOU WANT TO
SQUIRT IN THAT 1.8.

AND I TRY TO SQUIRT IT ALL OVER
THE EDGES TO GET ALL THE POWDER.

LEAVE YOUR SYRINGE IN, HOLD THE
TWO OF THEM AND SHAKE IT UP.

THIS ISN'T INSULIN AND YOU GOT
TO GET IT ALL OFF OF THERE.

THIS IS SOME SUGAR CRYSTALS
OR SOMETHING, SO IT'S
GOT TO DISSOLVE.

SO SHAKE, SHAKE, SHAKE.

SOMETIMES I HAVE HAD POWDERS
GET LIKE STUCK ON THE SIDE
OF THE VIALS

AND YOU ARE SHAKING FOR
EVER TO GET THAT LOOSE.

I'VE TRIED TO GET NEEDLES
DOWN THERE TO SCRAPE IT OFF
AND JUST GET IT LOOSE,

BUT YOU NEED ALL OF IT DISSOLVED
OR YOU WON'T HAVE
THE RIGHT DOSE.

OKAY. SO I HAD IT ALL DILUTED.
IT LOOKS GOOD.

I DON'T SEE ANY PARTICLES
IN THERE.

SO NOW I WANT TO REVISIT MY DOSE
WHICH IS...1.2 ML.

1.2 YOU GET 300. OKAY.

SO YOU CAN BARELY SEE THROUGH
THIS LITTLE LABEL,
TO PEER THROUGH.

BUT CAN YOU SEE THAT MY NEEDLE
IS WAY OUT OF THE SOLUTION.

SO YOU'RE GOING TO HAVE TO
COME DOWN AND STABILIZE.

PULL YOUR NEEDLE ALL THE WAY
DOWN HERE INTO THE SOLUTION,

HOLD IT STEADY AND THEN
PULL YOUR SOLUTION OUT.

IT'S KIND OF THICK.

YOU GUYS CAN PUT MORE IN
TO TRAP THIS FLUID.

I WANT TO SET IT AT 1.2.

AND IT'S AT THIS POINT AGAIN,
THAT YOU'LL LOOK
AT YOUR INSTRUCTOR,

ONCE YOU ARE SET
AND YOU ARE HAPPY.

ONCE YOU SHOW IT TO HIM,
THAT'S IT.

YOU CAN FUSS ALL
YOU WANT OVER THERE.

BUT ONCE YOU GO LIKE THIS,
THAT'S WHEN WE DECIDE
IF IT'S A MED ERROR OR NOT.

1.2, 1.2
AND IT'S GOOD TO GO.

WAIT TO SEE IF I COULD
FIND THE BRAND.

OKAY.

YOU ARE GOING TO CAP IT.

BECAUSE YOU WANT THE CAP COS
YOU'RE GOING TO HAVE TO TAKE

THE FILTER NEEDLE OFF.
VERY CAREFUL.

PUT YOUR HANDS DOWN HERE.
OOPS, I AM DRIBBLING
ALL OVER MY MED SHEET.

PUT IT DOWN, GET IT IN HERE,
HANDLING IT BY THE FLANGE

AND THEN ONCE IT'S ON
DOWN HERE AT THE END,

I AM HANDLING THE FLANGE
AND I AM TWISTING HERE

AND I AM GOING TO TWIST
MY FILTER NEEDLE OFF,

AND THEN THIS IS GOING TO GO
INTO THE SHARPS CONTAINER.

FOR NOW I AM JUST GOING TO
SAVE IT BECAUSE WE'RE GOING TO
REUSE THEM FOR A WHILE.

THEN I'M GOING TO COME
IN TO MY PACKAGE.

AND AGAIN, TRY NOT TO
EVER TOUCH THESE ENDS.

AND I AM GOING TO TWIST
ON MY ONE-AND-A-HALF INCH
CLEAN, BEAUTIFUL NEEDLE,

BUT NOT A FILTER NEEDLE.

YOU DO NOT EVER WANT TO GIVE A
SHOT WITH THE FILTER NEEDLE ON.

THAT WOULD BE MISERABLE.

OKAY. NOW BECAUSE THERE ARE
NO MARKINGS WHATSOEVER
ON THIS SYRINGE,

I AM GOING TO LABEL THIS ONE
BECAUSE I DON'T KNOW WHAT IT IS.

SO YOU ARE GOING TO
GET YOUR PAPER TAPE.

YOU CAN ALREADY HAVE
THESE PRE-LABELED

BEFORE YOU COME TO THE TESTING
AREA TO SAVE A LITTLE TIME.

THIS IS AMPICILLIN, 300 MG.

AND I ALREADY KNOW HOW MANY
MILLILITERS IT IS.

I CAN SEE THAT ON THE SYRINGE,
SO I DON'T WANT TO
WASTE MY TIME.

AND I AM GOING TO PUT
MY LABEL ON MY CAP.

DON'T PUT IT ON HERE,
BECAUSE IF THIS SHIFTS THEN
YOU CAN'T SEE YOUR DOSE

AND YOU DON'T WANT TO PUT ON
YOUR PLUNGER BECAUSE THEN
YOU CAN'T PLUNGE.

OKAY. MY DOSE IS SET.

I AM GOING TO DO
MY SECOND CHECK.

1.2 AMPICILLIN.
AMPICILLIN 500. I AM HAPPY.

I'M NOT GOING TO THROW THIS AWAY
UNTIL I AM ABSOLUTELY DONE

BECAUSE WHAT IF I'M
WALKING DOWN THE HALL

AND HAVE A SPAS
AND SHOOT OUT A LITTLE.

AT LEAST I COULD GO BACK TO THIS
AND RESET MY DOSE.

SO I'M GOING TO SAVE IT UNTIL I
REALLY NEED TO THROW IT AWAY,

BUT EVERYTHING ELSE. YOU WANT
TO CLEAN UP ALL OF YOUR TRASH,

GET IT OFF OF YOUR CART
IN THE MED ROOM,

AND GET READY TO GO.

OKAY.

I HAVE MY TRAY. I KNOW I'M GOING
TO GO VENTRAL GLUTEAL.

I HAVE A BAND-AID.
I HAVE ALCOHOL SWABS
I DON'T REALLY NEED.

I AM NOT GOING TO
Z-TRACK THIS ONE,

JUST SO YOU CAN USE
A DIFFERENT TECHNIQUE.

SO I DON'T NEED THE 2 BY 2,
ALCOHOL SWAB WILL WORK,

AND I HAVE EVERYTHING I NEED.

ALRIGHT, THE LAST THING I DO
NEED, HOWEVER, IS A PLAN
AND YOU NEED A PLAN.

YOU NEED TO KNOW WHERE THE
VENTRAL GLUTEAL MUSCLE IS.

AND THIS IS WHERE I NEED
A VOLUNTEER. SOMEBODY.
SIDE BOTTOM.

OKAY, YOU GUYS,
I'LL JUST GOING TO CALL YOU.

YOU'RE IN A UNIFORM.
YOU DON'T LOOK TOO...

AND THE REASON I HAVE TO
DO IT ON YOU IS BECAUSE
I CAN'T DO IT ON ME,

BECAUSE YOU HAVE TO USE
THE OPPOSITE HAND
OF THE HIP YOU'RE DOING.

SO I WILL HAVE TO USE THE
LEFT HAND ON THE RIGHT HIP

OR THE RIGHT HAND ON THE
LEFT HIP AND IT HAS TO FACE
THE RIGHT WAY.

AND YOU TEND TO... SO COME UP
HERE AND JUST STAND SIDEWAYS.

FIRST THING IS OUR GOAL,

JUST A LITTLE MEMO HERE THAT
WE'RE GOING TO BE TURNING OFF
THOSE CELL PHONES AND PAGERS

BECAUSE NOW IT'S ALL ON
OUR VIDEO TAPE.

WE'RE GOING TO TAKE A LITTLE
PAUSE FOR EDITING.

WHEN YOU FIND THE VENTRAL
GLUTEAL MUSCLE, BOTTOM-LINE,
JUST FROM THE EASE OF IT,

APPRECIATE THAT IT IS SIMPLY
BETWEEN YOUR ILIAC CREST
AND YOUR GREATER TROCHANTER.

IT'S THE MUSCLE
SMACK IN THE MIDDLE.

BUT THEY'RE GOING TO SHOW YOU IN
YOUR TEXT BOOK HOW TO FIND IT,

AND THIS IS HOW THEY DESCRIBE IT
ALL THE TIME.

WHEN A CLIENT'S IN BED,
YOU WANT THEM, IF THEY CAN,

TO BE SIDELINED AND THEY CAN PUT
THEIR LEG OVER A LITTLE BIT

SO THAT THERE IS A LITTLE BIT
OF A BEND.

SO THAT YOU CAN START FINDING
YOUR ANATOMICAL SPOTS.

HOWEVER, I TOLD YOU THEY CAN
BE LAYING FLAT ON THEIR BACK

BECAUSE YOU CAN GET TO THE SIDE
FROM...FOR THE VENTRAL GLUTEAL.

WHAT YOU WANT TO DO IS
LOCATE THE GREATER TROCHANTER.

FIND YOUR OWN AND THEN YOU ARE
GOING TO FOLLOW THAT SPINE DOWN

TO THE ANTERIOR
SUPERIOR ILIAC SPINE.

OKAY, THEY ARE BOTH SUPERIORS,

BUT THIS IS ANTERIOR
AND THIS IS POSTERIOR.

ANTERIOR SUPERIOR ILIAC SPINE,
NOT A CREST.

THIS IS THE CREST.

THIS IS THE SPINE.

AND THEN THE GREATER
TROCHANTER. OKAY?

SO ONCE YOU'VE FOUND
THOSE THREE,

WHAT YOU HAVE TO DO IS
TAKE THE OPPOSITE HAND
OF THE HIP YOU'RE ON.

SO I AM TAKING MY LEFT HAND
FROM HER RIGHT HIP

AND I AM GOING TO PUT MY PALM
ON HER GREATER TROCHANTER.

I AM GOING TO POINT MY
THUMB TOWARDS GROIN

AND I AM GOING TO PUT MY INDEX
FINGER ON ILIAC SPINE.

THEN I'M GOING TO STRETCH MY
FINGERS AS FAR AS THEY'LL GO

AND IT'S SUPPOSED
TO BE RIGHT THERE.

AND I'M FEELING
AND I AM HAPPY.

BECAUSE IT HER, KIND OF,
A LITTLE POOCHY MUSCLE THERE.

EVERYONE. I MEAN, FEEL.
IT SHOULD HAVE A LITTLE GIB.

THERE SHOULD BE MUSCLE AS
OPPOSED TO, IF YOU WERE UP
HERE ON THE CREST,

THERE IS NO GIB THERE,
THAT'S BONE.

AND TROCHANTER IS BONE.
YOU CAN FEEL THE DIFFERENCE.

SO FEEL THE BONE
AND THEN FEEL THE MUSCLE.

PALPATE FOR BRUISING,
SOFTNESS, ALL RIGHT THERE.

THANK YOU.
THAT'S ALL I NEEDED.

AND IT LOOKS LIKE
THIS ON HERE.

IF THIS WERE THE HIP,
THE GREATER TROCHANTER,

MY PALM, INDEX TOWARDS GROIN,
FINGER ON THAT SPINE

AND SPREAD BACK AS FAR
AS YOU CAN GO AND THEN
RIGHT HERE IN THE MIDDLE.

NOW, YOU DON'T HOLD YOUR HAND
LIKE THAT AND GIVE THE
SHOT LIKE THIS.

YOU WILL BE SURPRISED.

AND ACTUALLY IN THE TEXT BEFORE
AND I LOOKED TO SEE IF THEY
HAVE THAT PICTURE

AND THAT'S HOW THEY SHOWED IT
IN THE PICTURE,

IN THE SECOND EDITION
OF YOUR TEXT, LIKE THIS.

THERE IS NO WAY UNDER THIS EARTH
I WOULD GIVE A SHOT BETWEEN
THOSE TWO FINGERS.

THERE IS NOT ENOUGH SPREAD.
AND I'M SUCH A SPAS.

YOU KNOW MY HANDS SHAKE.

AFTER YOU FIND THE SPOT,
YOU PALPATE IT AND THEN
YOU GO LIKE THIS.

GIVE YOURSELF A WIDE GIRTH WITH
WHICH YOU WILL BE STABBING,
OKAY?

ALRIGHT. WE HAVE A PLAN,
WE HAVE A SHOT,

WE HAVE A CLIENT AND WE ARE
GOING TO DO IT FROM THIS SIDE.

HELLO, MR. SPADE, I'M DIANE YOUR
NURSE AND I HAVE A SHOT FOR YOU.

WE'RE GOING TO START YOU ON AN
ANTIBIOTIC FOR YOUR CELLULITIS.

CAN YOU TELL ME
YOUR FULL NAME?

SAM SPADE?
GREAT. CAN YOU ROLL OVER?

WELL, HOW NICE THEY PUT NAME
BANDS ON BOTH YOUR ARMS
THAT WAS HELPFUL?

SAM SPADE, LET ME JUST CHECK
YOUR NAME BAND.

DR. FEEL GOOD 001010001,
GREAT.

AND I SEE YOU'RE
ALLERGIC TO SULFA.

HAVE YOU EVER TAKEN A PENICILLIN
DRUG BEFORE? AMPICILLIN?

YOU HAVE NO PROBLEM WITH IT.

NO RASH,
NO DIFFICULTY BREATHING. GREAT.

SO I'VE CHECKED ALLERGIES.

AND I ALREADY DID THE WASH
HANDS WHEN I DID MY MED, SO
NOW PROVIDE PRIVACY.

OKAY, WE GAVE YOU YOUR DEMEROL
SHOT ON YOUR RIGHT HIP.

SO I WOULD LIKE TO GIVE YOUR
AMPICILLIN ON YOUR LEFT HIP.

WE ARE GOING TO ROTATE.
ALWAYS BE THINKING.

YOU DON'T WANT TO JUST KEEP
PLOUGHING THE SHOT INTO
THE SAME PLACE ALL THE TIME

OR THEY WILL GET NECROSIS
INTO THAT SPOT.

YOU KNOW, GET HARD.

SO I THINK IT WOULD BE EASIER
IF YOU COULD ROLL
ON YOUR SIDE FOR ME.

GREAT. AND HE'LL JUST ROLL ON
RIGHT OVER.

I WILL PUT THE BED UP...

TO A GOOD WORKING HEIGHT.

ALRIGHT MR. SPADE, YOU GOT
A FOLEY CATHETER THERE, HUH?

SO IF THEY CAN,
ROLL OVER IS THE BEST.

AND I WILL SHOW YOU
HOW IT LOOKS.

YOU TAKE AND PUT ONE LEG OVER.

THAT'S THE POSITION YOU WANT.

THAT'S KIND OF A RIGHT SIMS'
POSITION.

SIDE-LYING POSITION.

AND NOW WE'VE GOT TO SEE HIS
BOTTOM, SO THERE YOU GO.

I KNOW IT'S HIS SIDE.

SO AGAIN -- IT'S ACTUALLY,
MAYBE, EVEN EASIER TO SEE IT

IF I WENT TO
THIS SIDE OF THE BED,
INSTEAD OF STANDING BEHIND HIM.

AS FAR AS SITE LOCATION GOES.

BECAUSE I CAN PUT MY HAND HERE
ON HIS GREATER TROCHANTER,

THUMB TOWARDS GROIN, INDEX
FINGER ON SPINE AND SPREAD.

AND IT'S HERE. IT'S MUCH
EASIER THAN IT WAS FOR ME
TO REACH OVER THAT WAY.

SO EITHER SIDE OF THE BED
MAY WORK BETTER FOR YOU.

AND I AM GOING TO PALPATE.
ALWAYS PALPATE.

ONE OF THE THINGS THAT I HAVE
NOTICED WITH AS MANY PEOPLE
AS I SEE CHECKING PEOPLE

IS SOME OF YOU HAVE LITTLE,
TINY HANDS, SOME OF YOU
HAVE TALLER TORSOS.

SOME OF YOU HAVE BIG, OLD
HANDS, SHORTER TORSOS.

AND SO I HAVEN'T FOUND THIS TO
BE THE MOST ACCURATE TECHNIQUE

BECAUSE OF THE VARIATIONS
FROM PERSON TO PERSON.

SO EVEN THOUGH YOU HAVE DONE
EVERYTHING LIKE YOU'RE
SUPPOSED TO,

MAKE SURE THAT YOU
PALPATE THAT SITE

OVER AND ABOVE EVERYTHING
ELSE YOU'VE DONE.

AND VISUALLY LOOK FROM THE SIDE
LINE, IS IT IN THE RIGHT PLACE.

OKAY, I'M HAPPY
WITH MY SITE LOCATION.

I AM GOING TO DO MY THIRD CHECK.
AMPICILLIN. I HAVE 1.2 MG,

300 MG AND IT IS AMPICILLIN.

I'M HAPPY WITH MY DOSE.
I'M GOING TO GO AHEAD
AND GET MY BAND-AID READY.

AND I GET THEM READY.
I PUT BAND-AIDS ON EVERYBODY,

COS ALMOST ALWAYS WITH
MOVEMENT THERE'S A LITTLE BIT OF
BLOOD THAT COMES OUT.

SO I TAKE A BAND-AID AND
JUST PEEL ONE HALF OFF.

GET MY ALCOHOL READY

AND I WOULD EITHER STAND
LIKE THIS OR IF I WAS ON
THE OTHER SIDE,

STAND AND FACE THAT WAY.

ONCE I'VE FOUND MY
SITE LOCATION, AGAIN,
I AM GOING TO PALPATE.

AND ON THIS ONE,
I'M GOING TO CLEAN

AND I'M GOING TO PUT
MY ALCOHOL SWAB EITHER IN
MY FINGERS READY TO USE

OR I LIKE TO TELL STUDENTS
JUST TO LAY ON THE SKIN

AND POINT IT TOWARDS
WHERE YOU WANT TO AIM.

AND IT KIND OF GIVES YOU
A LITTLE TARGET AND IT WILL
STICK RIGHT TO THE SKIN.

OKAY, PULL THE CAP OFF.

I GOT MY NEEDLE I AM PLEASED
WITH, ONE AND A HALF INCHES.

I AM GOING TO SQUEEZE
THE SKIN ON THE SQUEEZER.

YOU CAN ALSO SPREAD IT TAUT.

BUT THE WHOLE POINT IS THAT
YOU WANT THE SKIN TO BE
A LITTLE BIT TAUT,

SO THAT WHEN YOU
PUT THAT NEEDLE THROUGH,

YOU DON'T GET A PUCKER
OF LOOSE SKIN, RIGHT?

SO, I SQUEEZE.

I AM GOING TO MAKE SURE THAT
I GO IN AT 90 DEGREE ANGLE.

SO THAT'S GOING TO BE
STRAIGHT DOWN.

I AM GOING TO WARN THE CLIENT.
A LITTLE POKE.

POKE. I AM GOING TO ASPIRATE
RIGHT BY TO 10 SECONDS.

IF THERE IS ANY BLOOD,
I AM GOING TO PULL
MY NEEDLE STRAIGHT OUT.

IF THERE'S NOT,
I AM GOING TO PUT IT IN

AND I AM GOING TO GO SLOWLY
HOLDING ON THE FLANGE.

YOU ACTUALLY ARE SUPPOSED TO PUT
IN 1 ML OVER ABOUT 10 SECONDS.

SO THAT'S WHAT SLOW
TRANSLATES.

AND THAT'S A NEW CRITERIA THAT
THEY PUT IN THIS TEXT BOOK.

WE'VE ALWAYS SAID SLOW, BUT NO
ONE EVER SAID HOW SLOW SLOW WAS.

AND THAT'S WHAT THEY SAID.

ALRIGHT. I FORGOT TO HOLD
MY OTHER SHOT 10 SECONDS
SO I'LL TAKE ONE OUT.

I'M GOING TO STABILIZE THIS,
BECAUSE I CAN. YOU CAN RELEASE.

IN FACT, I COULD HAVE RELEASED
TO PLUNGE IF I WANT,

BUT YOU WANT TO STABILIZE
THIS SYRINGE.

NONE OF THIS STUFF.
NONE OF THIS, OKAY?

STABILIZE AND THEN I AM GOING TO
HOLD THAT OUTER SHEET

AND PULL STRAIGHT UP.
AND PULL FAST.

DON'T JUST GIGGLE AND TRY
TO TUG, COS THAT HURTS.

I'D RATHER YOU PULL OUT,
KEEP YOUR HANDS BEHIND
AND THEN SHOVE IT DOWN.

BUT PULL IT DOWN AND BLOCK.

I'M GOOD TO GO AND THEN
I CAN MASSAGE THIS ONE.

BECAUSE IT'S NOT A Z-TRACK AND I
CAN DO IT WITH MY ALCOHOL SWAB.

MASSAGE. HOW ARE YOU DOING?
GREAT.

PUT THE BAND-AID ON, WHICH YOU
REALLY DON'T HAVE TO BECAUSE
IT'S NOT REALLY A PERSON.

AND THEN REPOSITION THEM FOR
COMFORT.

I DON'T HAVE A THRASH CAN
ON THE SIDE.

THESE SYRINGES YOU CAN LAY DOWN
ON YOUR TRAY COS THERE'S
NO NEEDLE EXPOSURE.

AND SO YOU DON'T HAVE TO
WORRY ABOUT BLOOD GETTING
ON TO THE TRAY.

I DON'T LIKE LAYING THOSE
SAFETY GLIDES DOWN

BECAUSE ONE SIDE OF THE NEEDLE
YOU CAN GET ON TO THE TRAY

AND THE OTHER SIDE
HAS THE GLIDE PROTECTOR,

SO YOU SHOULD HOLD THOSE RATHER
THAN SET THEM DOWN.

ONCE THOSE ARE LOCKED,
THEY'RE NO GOOD.

TAKE MY GLOVES OFF,
PUT THEM IN MY AREA.

REPOSITION MY CLIENT. ARE YOU
HAPPY ON THAT SIDE? GOOD.

PUT HIM DOWN.

- SO DIANE, WE'RE HOLDING THE
INJECTION 10 SECONDS AFTER.

- NO, NOT ON THIS ONE.
- NOT ON THIS ONE.

- WE SHOULD HAVE ON THE Z-TRACK.
I'M SORRY, I FORGOT
THE 10 SECONDS.

SO YOU PUT THE NEEDLE IN,
YOU ASPIRATE FOR --

I MEAN, DO YOU EVER REMEMBER
YOUR SHOTS BEING FAST
IN YOUR LIFE?

BUT THEY'VE MADE US BE SLOW
AND I JUST THINK IT WOULD
HELP THE CLIENT

TO KNOW THAT THIS TAKES
A FEW SECONDS TO DO.

I'M USING A DIFFERENT TECHNIQUE
SO THE MEDICATION STAYS
IN YOUR MUSCLES,

SO I AM GOING TO HOLD IT THERE.
YOU SHOULDN'T FEEL THE NEEDLE.

YOU MIGHT FEEL A LITTLE
BIT OF THE MEDICATION,

BUT HOLD STILL SO THAT THE
MEDICINE WILL ABSORB BEFORE
I TAKE THE NEEDLE OUT.

AND I'LL TELL YOU.
SO POKE, PULL UP.

ONE, TWO, THREE, FOUR, FIVE.
THAT'S FOREVER TO ME.

I'M HAVING A HARD TIME
BUYING INTO THAT ONE.

PUT THE MEDICATION IN SLOWLY
ON THE Z-TRACK AND THEN
HOLD 10 SECONDS.

ONE, TWO, THREE,
FOUR, FIVE, SIX,

SEVEN, EIGHT, NINE, TEN.

FLICK.

DAB.

ALRIGHT. YOU'LL GET ALL THAT.
THE SEQUENCING ISN'T THAT BAD.

WE'LL DOCUMENT HERE IN A MINUTE.
I JUST NEED TO TELL YOU A STORY.

MY VERY FIRST SHOT.

MOST OF YOU WON'T FORGET
ANY OF YOUR VERY FIRST THINGS
AND THIS IS MY VERY FIRST.

AND THIS VERY FIRST SHOT,

I'LL NEVER FORGET THIS LADY'S
BOTTOM UNTIL THE DAY I DIE.

SHE WASN'T MY CLIENT,
BUT THEY CALLED ME IN.

SHE HAD JUST COME OUT FROM
SURGERY AND THEY SAID,

"WHOEVER. SHE HAD JUST HAD
AN HYSTERECTOMY AND SHE
NEEDS A SHOT.

DIANE, YOU HAVEN'T GIVEN ONE
YET, DO YOU WANT TO GIVE THIS?"

BUT YOU KNOW IN YOUR HEART
YOU KIND OF WANT TO,
BUT YOU'RE SCARED TO DEATH.

I WAS TERRIFIED,
ABSOLUTELY TERRIFIED.

AND SO I SAID OKAY. SO I GOT MY
LITTLE DEMEROL SHOT READY
AND I WENT INTO THE ROOM.

AND YOU KNOW MY HANDS SHAKE
NORMAL.

BUT WHEN I AM SCARED,
OH, MY GOODNESS. SPASTIC.

MY LITTLE HANDS ARE JUST
SHAKING. I'M SHAKING.

I AM SO SCARED. I DON'T KNOW
WHY I AM SO SCARED,
BUT I WAS SO SCARED.

THE LADY'S JUST KIND OF MOANING
AND SHE ROLLED OVER.

SHE NEVER EVEN LOOKED AT MY
FACE. I'VE NEVER SEEN HER FACE,
ALL I SAW WAS HER BOTTOM.

THERE WAS JUST HER BOTTOM
IN FRONT OF ME.

AND WE HAD IT EASY THOSE DAYS.

WE DON'T HAVE TO DO
THE LANDMARK THING, RIGHT?
JUST QUARTER OF THAT BUTT.

AND I LOOKED AT MY INSTRUCTOR
AND WENT. AND SHE WENT.

OKAY. SO I TOOK THE CAP OFF.

AND I WENT TO GIVE IT.

AND I BOUNCED OFF HER BUTT.
THE NEEDLE COULDN'T GO IN.

ARGH!
WHAM!

AND THEN, I MEAN, MY HANDS
WERE REALLY SHAKING.

OH, MY GOSH.
AND I DIDN'T THINK.

I DON'T KNOW IF
I ASPIRATED OR NOT.

I COULD HARDLY HOLD ON AND I PUT
IT IN AND I PULLED IT OUT.

AND WE WERE OF
THE NON-RECAP PEOPLE.

AND SO WE HAD TO RECAP
AND I WAS TRYING TO RECAP
AND MY HANDS WERE LIKE THIS.

AND MY INSTRUCTOR PUT HER LITTLE
HAND ON MY BACK AND SAID,

"WHY DON'T WE STEP OUT?"

OKAY. OKAY! SO I STEP OUT
AND I SAY,

"DID YOU SEE IT BOUNCE OFF
HER BUTT. OH, MY GOD!
IT BOUNCED OFF HER BUTT."

AND SHE GOES,
"YES." AND I SAID,
"THAT SCARED ME SO BAD."

SO...THE MORAL OF THE STORY IS

IF IT BOUNCES OFF,

PUSH IT IN!

YOU MIGHT GET SCARED
BECAUSE IT TAKES A LITTLE
MORE UMPH FOR THAT IM.

YOU GOT TO PUT IT IN.

NOW SINCE THEN, I'VE GIVEN
HUNDREDS AND MAYBE
THOUSANDS OF SHOTS,

BUT NEVERTHELESS,

I ONLY HAVE DONE IT MY WAY
AND I WAS TAUGHT TO DART

AND I HAVE DARTED
FROM THAT DAY ON.

WHAM! WHAM! WHAM!

BUT I STARTED DOING STUDENTS
AND STUDENTS ARE SOMETIMES
A LITTLE TENTATIVE.

SO I WATCH STUDENTS
DO THEIR SHOT

AND PUSH THE NEEDLE AND ONLY GO
IN A QUARTER OF AN INCH,

AND THEY MAY HAVE
AN INCH NEEDLE.

AND THEY'LL TAKE IT
AND THEY'LL JUST GO, WHOOP!

NOW, I SEE YOU GOING --
I DID THE SAME THING.

AND THE STUDENT WOULD GO,
COS WE WERE GIVING TO EACH OTHER
AND THEY WOULD SAY,

"I DIDN'T FEEL A THING."

"NO WAY."

BUT SEE THE NEEDLES ARE SO MUCH
SHARPER THAN THEY USED TO BE

AND THEY'RE SILICON-COATED
THAT THEY SLIDE RIGHT IN.

SO DON'T BAIL OUT.
IF YOU'VE GOT IT IN,

JUST GIVE IT A LITTLE MORE UMPH
AND GO STRAIGHT.

- I DID THE SAME THING ONCE
TO THIS GIRL WITH A GUARDIAN.

AND SOMETHING WITH HER SKIN.
I WAS GIVING HER A SUBCU
BEHIND THE ARM.

AND I WENT TO PUSH THE NEEDLE IN
AND IT JUST GOT STUCK.

AND I WAS LIKE, "OH, MY GOD!"

I'M LIKE, "I WANT TO TRY
THAT ONE MORE TIME."

SHE WAS LIKE, "YOU POKED ME
ALREADY."

AND I FELT SO BAD.

YOU DO, BECAUSE IT'S A NEEDLE,
YOU KNOW?

BUT THE THING IS
IT'S THEIR FLORA

AND SO YOU'RE NOT CONTAMINATING
THEM WITH ANYTHING BUT THEM.

SO THAT'S NOT A PROBLEM.
AND WHERE I HIT

AND PROBABLY WHERE YOU HIT
WAS THE CLEANED PLACE.

SO YOU CAN.
AND HIT AGAIN.

OKAY. MY SECOND SHOT.

MY SECOND SHOT.
I AM DETERMINED NOW.

YOU KNOW, BECAUSE OF MY FIRST
SHOT, I BOUNCED OFF.

SO I AM GOING TO GET
THIS ONE IN.

AND THEY GAVE ME A MAN.
I'LL NEVER FORGET THESE TWO.

I CAN'T REMEMBER ANY OTHER
SHOTS, BUT THESE TWO.

MY SECOND ONE AND HE --
A NICE, NICE GENTLEMAN,

WHO HAD HAD SICKLE-CELL
FOR YEARS AND YEARS AND YEARS.
HE HAD NO MUSCLES LEFT.

AND RIGHT GLUTEAL,
THAT'S WHERE YOU GIVE SHOTS,
OR MAYBE VASTUS LATERALIS.

BUT HE HAD NOTHING LEFT
AND SO WE WERE GIVING DEMEROL
IN HIS DELTOIDS WHICH IS LIKE,

OH, YOU KNOW?
IT'S JUST THE LAST RESORT.

SO I WENT TO HIS DELTOID
AND I FELT AND FELT AND IT WAS
AS HARD AS A ROCK.

HIS MUSCLES --
THERE WAS NOTHING LEFT.

HE HAD HAD SO MUCH,
SO MANY SHOTS.

I FOUND THIS ONE, EVER SO SOFT
PLACE RIGHT THERE.

IT WAS ABOUT THAT BIG.

I'M GOING TO DO IT.
AND I WASN'T SCARED THIS TIME,
BUT I WAS DETERMINED.

SO, I FOUND MY SPOT AND I WENT
TO SART IT IN AND WHAM!

HE WAS SO TOUGH,
THAT THING WOULD NOT GO IN.

AND I PUSHED IT IN,
GAVE MY SHOT.

YOU CAN PUSH THEM.
DON'T FREAK OUT.

THEY WILL PUSH RIGHT IN,
EVEN ON THE TOUGHEST OF SKIN.

ANOTHER SCENARIO, NOT MINE,
JUST THINGS YOU NEED TO KNOW.

SOMETIMES YOU UNDER
OR OVER ESTIMATE

THE BUTTOCKS AND YOUR NEEDLE
AND YOU MAY HIT BONE.

IF YOU HIT BONE. THEN YOU HIT
BONE, PULL BACK A LITTLE BIT.

IT'S ALL YOU CAN DO.

YOU DON'T KNOW,
IT'S BLIND.

YOU'RE MAKING YOUR BEST GUESS.

AND THAT'S WHY I AM KIND OF
A PINCHER BECAUSE I JUST
DON'T WANT TO.

I'VE HIT BONE ONCE
AND THAT'S A FUNNY FEELING.

AND I JUST PULL BACK, AND GAVE
MY SHOT AND THE SAME THING.

- WHAT WOULD HAPPEN IF YOU WOULD
INJECT THE BONE WITHOUT KNOWING?

IT WOULDN'T BE IN THE MUSCLE,
IT WOULD JUST BE AT BONE LEVEL,

AND YOU WANT IT TO BE
ABSORBED IN MUSCLE SO
YOU'RE GOING TO PULL BACK.

THERE ARE SHOTS CALLED
INTRAOSSEOUS AND WE DON'T
WANT TO GIVE THOSE.

WE DON'T WANT TO GIVE
A BONE INJECTION.

- BUT NOTHING WILL HAPPEN TO THE
PATIENT IF THEY WERE TO GET --

- I DON'T REALLY KNOW THE
ANSWER TO THAT QUESTION.

WHAT THEY MIGHT GET?
IT MIGHT DEPEND ON WHAT
YOUR PUTTING IN THEM.

- WHEN YOU HIT THE BONE,
CAN THE PATIENT FEEL THAT?

- SOMETIMES AND SOMETIMES NOT.

THE ONE I DID SAID
THEY DIDN'T FEEL IT,

BUT I'VE HAD OTHER PEOPLE
SAY THAT THEY'VE FELT
THE BONE BE HIT.

AND THEY FEEL LIKE A LITTLE --

WELL, PAIN IS RELATIVE. I MEAN,
TO HOWEVER THEY DESCRIBE IT.

BUT THEY FELT THE PRESSURE
OR TINGLING OR A HIT.

- COULD YOU BREAK THE NEEDLE?

- YOU COULD, AND THAT WOULD BE
A RISK IF YOU WERE REALLY
LIKE WHAMMING IT.

BUT I DON'T KNOW OF ANYONE
WHO DOES IT THAT HARD.

SO, DID YOU EVER HIT
A BONE, TOM?

- NO, I'VE HAD SOMEBODY
HIT BONE ON ME ONCE.

AND YOU COULD FEEL IT.
- HOW DID IT FEEL?

- IT WAS LIKE SOMEBODY
SCRATCHING.

- SO ASK THEM.
HOW DID THAT FEEL, YOU KNOW?

- DO YOU THINK THE SHOT HURTS
MORE, THE BIGGER IT IS...

- IT VARIES AND WE'RE GOING TO
GIVE SHOTS TO EACH OTHER
NEXT WEEK.

WE'RE JUST GOING TO GIVE
A LITTLE SALINE WITH A NICE,
LITTLE THIN NEEDLE DOWN TO IT.

YOU'VE ALL HAD YOUR HEPATITIS,
SO COME ON.

AND WHAT WE'RE GOING TO DO
IS WE CAN TALK TO EACH OTHER.

AND THAT'S A NICE THING.

YOU CAN GO, "WHAT DID YOU FEEL?
WHAT DID YOU THINK?"

AND ALMOST ALL THE TIME,
PEOPLE DON'T FEEL THE NEEDLE,

IT'S THE MEDICATION
THAT THEY FEEL.

AND IF YOU ASPIRATE TO HARD.

THAT'S WHERE, YOU KNOW,
JUST ANALYZING IT OVER
THE LAST FEW YEARS.

I MEAN, SERIOUSLY, I DO HOW MANY
SHOT WITH ALL THESE STUDENTS

AND THEN I DO CLINICS
AND WHAT NOT.

AND FOR THE MOST PART THOSE
ARE THE TWO COMPLAINT PLACES.

MED'S LIKE COMPAZINE,
THEY BURN LIKE FIRE GOING IN.

SO CERTAIN MEDICATIONS DO BURN
AND HURT AND FAR MORE THAN
THE NEEDLE IS.

THE FEAR USUALLY
IS OVER THE NEEDLE

AND THE NEEDLE IS USUALLY
THE LEAST OF THE PROBLEM,

IT'S THE MEDICATION.

OKAY. SO JUST TO
KIND OF HELP YOU.

A LITTLE MORE DART THIS TIME,
LONGER NEEDLES,

YOU'RE GOING IN MUSCLE,
BUT HANDLE THOSE NEEDLES
EVER SO CAREFULLY.

WE TRY TO KEEP THE NEEDLES,
WE KEEP RECYCLING THEM,

BUT FOR THE DAY
WE USUALLY USE NEEDLES

OVER AND OVER AND OVER,
IN AND OUT OF THE PADS.

SO IF YOU WERE TO STICK
YOURSELF, PLEASE LET US KNOW,

WE NEED TO DISCARD
THAT NEEDLE,

YOU NEED TO SCRUB WITH BETADINE
AND THEN WE NEED TO SEND YOU
OVER TO THE HEALTH CENTER,

SO THAT YOU CAN FILL OUT A
REPORT AND THEN THEY'LL ASK YOU
ABOUT YOUR TETANUS SHOT

TO MAKE SURE THAT YOU'RE
CLEAR ON THAT.

SO JUST BE VERY, VERY CAREFUL.
WATCH EACH OTHER, YOU KNOW?

AND MAKE SURE THAT EVERYONE
IS USING GOOD TECHNIQUE.

NONE OF THIS STUFF.
IT'S NO GOOD.

ALRIGHT. LET'S DOCUMENT THIS
AND THEN I JUST HAVE

ONE OTHER LITTLE THING
WE NEED TO DO.

ALRIGHT.
WE GAVE OUR AMPICILLIN.

300 MG AND WE PROBABLY
GAVE IT AT 2:15.

AND WE GAVE IT IN THE...

LEFT VENTROGLUTEAL.

SO WE'RE GOING TO GO DOWN HERE
AND I HAVE CREATED A T-CODE.

I OBVIOUSLY DID IT
OPPOSITE LAST SEMESTER.

SO RIGHT VENTROGLUTEAL.
SO I HOGGED UP ALL MY SPACE.

I NEED A LEFT VENTROGLUTEAL AND
I WOULD WRITE IT ALL OUT THERE.

SO LEFT VENTROGLUTEAL
AND MY INITIALS, DB,

AND I HAVE SIGNED DOWN HERE.

SO MAKE SURE YOU HAVE
ALL YOU SIGNATURE.

AND DO IT IN THIS ORDER,
TIME, SITE, INITIALS.

IT REALLY HELPS COS IT STARTS
LOOKING LIKE THE ALPHABET SOUP
THERE AFTER A WHILE

AND IT'S LIKE WHAT'S
WHAT IN THERE, YOU KNOW?

ESPECIALLY IF YOU HAVE INITIALS
LIKE LG OR SOMETHING.

LG, LG.

OKAY, I WANTED TO DO JUST ONE --
A COUPLE OF LABELS WITH YOU

AND THEN I WANT TO SHOW YOU
HOW TO USE THE CATH SIMULATOR
FOR IV THERAPY

COS YOU GUYS NEED TO START DOING
SOME IV STUFF, ALREADY.

AND YOU'LL LIKE THAT.

BUT LET'S JUST DO A COUPLE
OF MATH THINGS SO THAT
YOU CAN APPRECIATE...

WELL, MAYBE YOU CAN'T
APPRECIATE TO WELL.

CAN YOU SEE IT AT ALL?

WHAT WE NEED IS ACTUALLY THIS.

YOU CAN'T SEE IT, HUH?