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Leg ulcers — wound debridement and compression therapy

Procedurer Compression is the treatment that heals venous leg ulcers; everything else is supportive. But the same compression applied to a limb with arterial insufficiency…

Bone marrow aspiration and biopsy

…What usually ruins the examination is not the technique but the handling of the specimen — an aspirate that clots before the smears are made is…

Wound suturing

…contamination, not poor suture technique — and the commonest cause of permanent loss of function is a tendon injury that was sutured over without being found…

Central venous catheter

…serious error is dilating a vessel that turns out to be an artery — everything in the technique is designed to make sure that never happens…

Eye examination and corneal foreign body

…Sterile saline with a syringe for irrigation. An eye shield (never a pressure dressing when perforation is suspected). A tonometer: an applanation tonometer on the…

Ankle-brachial index (ABI)

…only in claudication, but before every compression treatment of a leg ulcer and as a risk marker in diabetes and known atherosclerotic disease. An ABI…

Abscess incision and drainage

…not treated away. Incision and drainage is the treatment; antibiotics are normally neither necessary nor sufficient in an uncomplicated cutaneous abscess in an otherwise healthy…

CPAP and non-invasive ventilation (NIV)

Procedurer CPAP and NIV are two different treatments with different physiology, and the commonest source of error is confusing them. CPAP delivers a constant pressure…

Joint aspiration

…always weighs more heavily). A joint prosthesis: the aspiration must be performed by an orthopaedic surgeon under strictly sterile conditions. For corticosteroid injection there is…

Nail procedures — paronychia, ingrown toenail and subungual haematoma

…nitrate. Electrocautery or a heated paper clip for trephination. Antibiotic ointment, a non adherent dressing, gauze. The digital block Anaesthetise from the dorsal aspect, one…

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