Practical Skills

Question 1

Manual blood pressure

Answer 1

Explain
Consent
Put cuff on patient
Find radial pulse
Pump up cuff and make a note of pressure when pulse can no longer be felt
Release pressure and feel for brachial pulse and place stethoscope
Pump up cuff to +30 pressure from before
Slowly release pressure making note of first and last audible beat
Systolic (big number)/ diastolic (small number)

Question 2

Peak flow

Answer 2

Explain
Consent
Show & explain to patient how to complete
Sit upright, deep breath, hands away from end and dial
Replace mouthpiece
Ask patient to demonstrate and correct technique if necessary
Gain total of 3 valid attempts, taking breaks if necessary
Check highest attempt on JRCALC

Question 3

ECG placement

Answer 3

Explain
Consent
Red lead I on right arm
Yellow lead II on left arm
Green lead III on left leg
Black lead IV on right leg
Lead V1 4th intercostal space right side
Lead V2 4th intercostal space left side
Lead V4 5th intercostal space mid clavicular line left side
Lead V3 Midway between V2 & V4
Lead V6 5th intercostal space mid axillary line
Lead V5 Midway between V4 and V6

Question 4

ECG rate interpretation

Answer 4

Check if regular
If regular, divide 300 by number of large squares between R waves (or 1500 by number of small squares)
If irregular, measure 6 seconds (30 large squares) and count number of R waves multiply by 10

Question 5

GCS

Answer 5

Eye response: (4 spontaneous, 3 to speech, 2 to pain, 1 no response)
Verbal response (Orientated 5, confused 4, innappropriate words 3, incomprehensible sounds 2, no response 1)
Motor response (follows commands 6, moves to pain 5, withdraws ffrom pain 4, abnormal flexion 3, abnormal extenson 2, no response 1)

Question 6

FAST test

Answer 6

Face - Ask patient to smile
Arms - Ask patient to hold arms palms up eyes closed for 5 seconds
Speech - Talk to patient and check for slurring of speech. Check if slurring is normal
Time - Confirm when symptoms started and consider transport to hospital

Question 7

Peak flow (asthma criteria)

Answer 7

Ask patient if they know their usual peak flow
Mild asthma over 75% predicted/ best
Moderate asthma 50-75% predicted/ best
Severe asthma 33-50% predicted/ best
Life threatening asthma under 33% predicted/ best

Question 8

Blood glucose

Answer 8

Explain
Consent
Ask patient to wash hands
Insert test strip to machine
Use lancet and collect blood using strip
Place gauze on patients finger

Question 9

Additional ECG spots

Answer 9

V4R - Fifth intercostal space, mid clavicular line on right side
V7 (using V4 lead) - 5th intercostal space posterior axillary line left side
V8 (using V5 lead) - 5th intercostal space tip of the scapula left side
V9 (using V6 lead) - 5th intercostal space left side midway between V8 and spine.

Question 10

Capillary refill

Answer 10

Explain
Consent
Put pressure on forehead or sternum for 5 seconds and release. Count time for skin to return to normal tone for central cap refill.
Use hands or feet for peripheral. Both should be 2 seconds or less, longer could indicate poor perfusion.

Question 11

Taking temperature

Answer 11

Explain
Consent
Take tympanic thermometer and caps
Turn on
Place in ear until beep heard
Record temperature
Dispose of cap