Module 6 Introduction

Module 6: Procedures, Emergencies, and Prescribing

Module 6: Practical Procedures, Emergency Stations & Prescribing

Module 6 covers the hands-on stations in PLAB 2 — venepuncture, cannulation, catheterisation, BLS, ABCDE emergency assessment, prescribing, inhaler teaching, and suturing. For procedures, the examiner awards marks for safe technique, communication throughout, and professionalism, not just whether you complete the task. For emergencies, they want to see a calm, systematic FY2 who escalates early and acts decisively.

Module Summary

Lesson	What to Remember
6.1 — Venepuncture	Communicate throughout. Order of draw: gold → green → purple → blue → grey → pink. Release tourniquet before withdrawal. Safety device before disposal.
6.2 — Cannulation	Match gauge to clinical need. Flashback → advance 2 mm → advance cannula off needle. Flush with 10 mL NaCl. Document. Tissuing: stop, remove, elevate, reassess.
6.3 — Catheterisation	Strict aseptic technique throughout. Male: perpendicular then 45 degrees. Female: front to back, advance 5–6 cm. Never inflate if pain or resistance. Absolute contraindication: suspected urethral trauma.
6.4 — BLS	30:2. Depth 5–6 cm, rate 100–120/min. Full recoil. AED: stand clear before shock. Choking: 5 back blows then 5 abdominal thrusts. Never blind finger sweep.
6.5 — ABCDE	Systematic. Manage at each step before moving to the next. ACVPU (not AVPU). NEWS2 ≥7 = high risk. Fluid bolus for sepsis: 250 mL over 10–15 min (NICE NG253). SBAR when escalating.
6.6 — Prescribing	Check allergies first. Micrograms in full, units in full. Generic names. Methotrexate is weekly. Concentrated KCl never as IV bolus. Sick day rules: hold ACEi/ARBs, NSAIDs, metformin in acute illness.
6.7 — Inhaler Teaching & Suturing	Demonstrate, observe, correct. MDI + spacer eliminates coordination problem. DPI needs deep fast inhalation. Suture timing: face 3–5 days; joints 10–14 days. Tetanus: tetanus-prone wound + incomplete vaccination → TIG.
6.8 — Ready for Cases	You have the framework. Cases add the clinical content. Structure first, every time. Apply the correct module framework before layering in condition-specific knowledge.

Universal Principles for Every Procedure Station

Principle	What This Means in Practice
Communication	Introduce. Explain in plain language. Obtain consent. Keep talking throughout. Warn before any discomfort.
Aseptic technique	Wash or gel hands. Use correct gloves. Maintain sterile field. Do not contaminate sterile equipment.
Equipment check	State aloud that you are checking expiry date, integrity of packaging, and correct equipment.
Sharps safety	Never resheath needles without a safety device. Dispose directly into sharps bin. Yellow bin for sharps; clinical waste bag for contaminated material.
Communication during the procedure	Do not go silent once you start. Update the patient at every step — it is an assessed skill.
Two-attempt rule	As an FY2, never attempt a procedure more than twice. After two attempts: explain to the patient, apply appropriate care, and seek a more experienced colleague. This is not failure, it is safe practice.
Documentation	State that you would document: date, time, site, gauge/size, batch numbers where relevant, and any complications.

What to Say During a Procedure — Communication Is Marked

The examiner is assessing how you communicate throughout, not just whether the technique is correct. Going silent mid-procedure loses IPS marks.

Moment	What to Say
Before touching	"I'm just going to clean the area now — you may feel the cold of the wipe."
Before the needle	"You'll feel a sharp scratch now — take a slow, deep breath for me."
During	"How are you doing? Everything okay?"
Partway through	"You're doing really well — nearly done."
On withdrawal	"All done — I'm going to apply a little pressure now to prevent any bruising."
On completion	"Thank you for your patience. How are you feeling?"

Module 6: Procedures, Emergencies, and Prescribing

Module 6: Practical Procedures, Emergency Stations & Prescribing

Module Summary

Lesson	What to Remember
6.1 — Venepuncture	Communicate throughout. Order of draw: gold → green → purple → blue → grey → pink. Release tourniquet before withdrawal. Safety device before disposal.
6.2 — Cannulation	Match gauge to clinical need. Flashback → advance 2 mm → advance cannula off needle. Flush with 10 mL NaCl. Document. Tissuing: stop, remove, elevate, reassess.
6.3 — Catheterisation	Strict aseptic technique throughout. Male: perpendicular then 45 degrees. Female: front to back, advance 5–6 cm. Never inflate if pain or resistance. Absolute contraindication: suspected urethral trauma.
6.4 — BLS	30:2. Depth 5–6 cm, rate 100–120/min. Full recoil. AED: stand clear before shock. Choking: 5 back blows then 5 abdominal thrusts. Never blind finger sweep.
6.5 — ABCDE	Systematic. Manage at each step before moving to the next. ACVPU (not AVPU). NEWS2 ≥7 = high risk. Fluid bolus for sepsis: 250 mL over 10–15 min (NICE NG253). SBAR when escalating.
6.6 — Prescribing	Check allergies first. Micrograms in full, units in full. Generic names. Methotrexate is weekly. Concentrated KCl never as IV bolus. Sick day rules: hold ACEi/ARBs, NSAIDs, metformin in acute illness.
6.7 — Inhaler Teaching & Suturing	Demonstrate, observe, correct. MDI + spacer eliminates coordination problem. DPI needs deep fast inhalation. Suture timing: face 3–5 days; joints 10–14 days. Tetanus: tetanus-prone wound + incomplete vaccination → TIG.
6.8 — Ready for Cases	You have the framework. Cases add the clinical content. Structure first, every time. Apply the correct module framework before layering in condition-specific knowledge.

Universal Principles for Every Procedure Station

Principle	What This Means in Practice
Communication	Introduce. Explain in plain language. Obtain consent. Keep talking throughout. Warn before any discomfort.
Aseptic technique	Wash or gel hands. Use correct gloves. Maintain sterile field. Do not contaminate sterile equipment.
Equipment check	State aloud that you are checking expiry date, integrity of packaging, and correct equipment.
Sharps safety	Never resheath needles without a safety device. Dispose directly into sharps bin. Yellow bin for sharps; clinical waste bag for contaminated material.
Communication during the procedure	Do not go silent once you start. Update the patient at every step — it is an assessed skill.
Two-attempt rule	As an FY2, never attempt a procedure more than twice. After two attempts: explain to the patient, apply appropriate care, and seek a more experienced colleague. This is not failure, it is safe practice.
Documentation	State that you would document: date, time, site, gauge/size, batch numbers where relevant, and any complications.

What to Say During a Procedure — Communication Is Marked

The examiner is assessing how you communicate throughout, not just whether the technique is correct. Going silent mid-procedure loses IPS marks.

Moment	What to Say
Before touching	"I'm just going to clean the area now — you may feel the cold of the wipe."
Before the needle	"You'll feel a sharp scratch now — take a slow, deep breath for me."
During	"How are you doing? Everything okay?"
Partway through	"You're doing really well — nearly done."
On withdrawal	"All done — I'm going to apply a little pressure now to prevent any bruising."
On completion	"Thank you for your patience. How are you feeling?"

Navigation

Module 6: Procedures, Emergencies, and Prescribing

Module 6: Practical Procedures, Emergency Stations & Prescribing

Module Summary

Universal Principles for Every Procedure Station

What to Say During a Procedure — Communication Is Marked

Module 6 Introduction

Module 6: Procedures, Emergencies, and Prescribing

Module 6: Practical Procedures, Emergency Stations & Prescribing

Module Summary

Universal Principles for Every Procedure Station

What to Say During a Procedure — Communication Is Marked