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ASHIA Clinical skills preparation Workshop

• 13:00 doors open / welcome• 13:30 – 14:00 – Approach to a patient in Africa

– History taking– Illnesses you may encounter

• 14:15-14:30 – Basics of suturing and vena puncture• 14:30-14:45 – Break• 14:45-16:45 – Suture skills lab / Vena puncture• 17:00-17:15 – Neonatal resuscitation project

Group 1 Group 2

14:45 Vena puncture Suture skills

15:45 Suture skills Vena puncture

Important resources• Where there is no doctor by David Werner• Sim-vivo online training guide on suturing

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Approach to a patient in Africa• Ask the person’s name and if needed, confirm this with identification • Age (remember that sometimes they do not know their exact date of births)

– Special care to elderly patients• Gender: Be sensitive of the patient’s wish to be referred to as a male or female. • Ask them why they are in hospital• Ask SOCRATES

– Site of pain (where is the pain the worse?)– Onset (when did it start?)– Character (how would you describe the pain? Dull, sharp, tightness ache?)– Radiation (does the pain move to another location?)– Associated factors (are there any other symptoms with the pain for example is there

fever, nausea, headache, vomit, yellow skin etc?)– Timing (how long does the pain last?)– Exacerbating/relieving factors (is there something that you know that makes the

pain worse or better?)– Severity (From a scale of 0-10 how bad is the pain? Do you want analgesia?)

• Other body parts; don’t forget to ask about their health in general; – Any ear, nose or throat symptoms? Any headache or visual problems?– Problems breathing– Chest pains or palpitations?– Gastrointestinal: any worries about stools?– Urogenital: Problems passing ‘water’?; pregnant? Menstruation cycle?– Skin: any itching, bumps?

• Use of medication– Ask if they are taking other medication even over the counter or what a family

member or friend may have given them– Many patients will not admit that they see a ‘medicine doctor’ but you should still

ask. Look for unexplainable ‘wounds’ or scars on patients body to guide you• Family history

– Ask what has happened recently to a family member– Any similar symptoms in those close to them

• Don’t forget to ask the patient what it is they would like– Sometimes patients want reassurance instead of medication so try to understand

their point of view before you propose a therapy• Remember to talk to the patient. Aim for an open dialogue so that the patient feels

comfortable talking to you • Don’t forget to discuss each patient with your supervisor.

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Serious illness you may encounter in Africa:

Airway problems IS an EMERGENCY!Signs that the airway is compromised:• Inability to talk• Choking, Drooling• Gurgling sound • Stridor • Coma/unconscious

When Airway is in danger – patient stops breathing!• Clear the airway (look for foreign objects• Chin lift / Jaw thrust• Give oxygen through re-breath mouth-to-mouth bags/mask (you can buy these online and take them with you!)

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Serious illness you may encounter in Africa

Circulation problems are life threatening if not treated immediately!•Dehydration due to D&V or severe burns•Blood loss due to road traffic accidents or internal bleeding.

Think about substituting the loss with- ORS- Intravenous fluids- Blood transfusion

Skill lab technique: IV cannulation for fluids/medication

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Serious illness you may encounter in Africa

There are many causes of loss or lowered level of consciousness. Think about these and try to reverse itALWAYS check the GLUCOSE – Hypoglycemia is an emergency and can be reserved!

A

B

C

D

Airway BreathingCirculationDisability

Step by step

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Serious illness you may encounter in Africa

Temperature is a sign of an infection. Give paracetamol, fluids and keep patient cool

Sepsis is life threatening!

There is a window of approximately 1 hour to start treatment with antibiotics to save a life!

If fever and low blood pressure low, high respiratory rate, low oxygen (difficulty breathing) and/or confusion high chance of sepsis • Oxygen• Fluids• Antibiotics

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Vena puncture / IV cannula

Procedure of entering a vein with a needleMain purpose is to • Obtain blood for diagnostics

Procedure when a vein is entered with a needle and a cannula is left behind has 2 main purposes• Blood collection for diagnosis• Therapy (fluids, medication etc)

1. Choose a vein 2. Confirm patient / date of birth3. Decontaminate hands/ gloves4. Inspect and palpate arm5. Clean skin6. Apply tourniquet7. Place hand8. Take needle with dominant hand and insert in vein9. Collect blood in appropriate tubes / remove needle for

cannulation10. Remove tourniquet as soon as blood appears in tube11. Use gauze to apply pressure on puncture site12. Handle specimens carefully

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Suture skills lab

Wound closure is important to• Decrease wound contamination• Stop the blood loss• Better tissue healing

Steps1. Assess the wound 2. Gather materials3. Local anaesthesia4. Clean the wound 5. Sterile environment 6. Suture7. Bandage 8. Discard 9. Give advise for follow up/care of wound

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Feedback form

Section I: Workshop Evaluation This section helps us understand how future training may need to be adjusted to best respond to participants’

needs. On a scale of 1-4 where 1 is strongly disagree and 4 is strongly agree, please circle the most appropriate answer: The workshop venue was:Comfortable 1 2 3 4 Well located 1 2 3 4 Food and refreshments were adequate 1 2 3 4

The workshop content was:Relevant 1 2 3 4 Comprehensive 1 2 3 4 Easy to understand 1 2 3 4

Workshop handouts: Supported presentation material 1 2 3 4 Provided useful additional information 1 2 3 4 Were clear and well-organized 1 2 3 4 The workshop was:Well paced 1 2 3 4 Breaks were sufficient 1 2 3 4 A good mix between listening and activities 1 2 3 4 The facilitator(s)were:Knowledgeable 1 2 3 4 Well-prepared 1 2 3 4 Responsive to participants’ questions 1 2 3 4 What did you like best about this workshop?

______________________________________________________What did you like least about this workshop?

______________________________________________________

How could this workshop be improved (use this space if you did not provide comments above)? Content: _Hand-outs: Activities:Facilitators:Other: Would you recommend this workshop to a colleague?Yes _____ No _____Why/why not: