Hints and tips for the exam

Sites that can be used are the:

Deltoid muscle
Lateral thigh muscle (vastus lateralis)
Gluteus muscle and the upper outer quadrant of the
buttock, in order to avoid the sciatic nerve

Table of drugs that can be administered

via the intramuscular route
Conditions

Indication for
injection

Example of drug

Pain

Analgesia

Nausea and
vomiting
Psychosis
Infection
Cardiac arrest

Antiemetic

Anaphylaxis

Rapid drug
administration if
intravenous access
difficult

Morphine, tramadol,
pethidine, diclofenac,
ketoprofen
Ondansetron, cyclizine,
metoclopramide
Haloperidol, olanzapine
Co-amoxiclav
Adrenaline (epinephrine),
atropine
Adrenaline,
chlorpheniramine

Antipsychotic
Antibiotic

Always aspirate before injecting. The importance of

this cannot be overemphasised as inadvertent intravascular injection may be fatal.
In the event of aspirating blood, abandon the procedure, apply pressure and try again at a different site
with a fresh set of equipment.
Never resheath a needle. As you change your needle,
immediately dispose of it in the sharps bin, ensuring
the examiner sees you do this.
Always have a sharps bin with you to minimise any
risk of injury.
It is very likely that you will receive a manikin or a
slab of modified sponge on which to perform the procedure. There may, however, be an actor-patient present
from whom you may be asked to obtain consent. If not,
it is wise to tell the examiner that these are the steps
you would take prior to performing your injection.
If you do get an actor-patient, being polite and courteous and using a suitable introduction will get you
some marks before you even start the procedure.
Ensure the examiner sees that you would wash your
hands before and after the procedure.

Sciatic nerve

Figure 60.1 Suitable sites for intramuscular injection: the deltoids and the upper outer quadrant of the buttock (as this position avoids the
path of the sciatic nerve)