Medicine and Science, that's me! My name is Giusy Davino and I'm just a 22-years-old medical student in University of Salerno (Italy) with internet access!
"Isn't it strange
That princes and kings
And clowns that caper
In sawdust rings
And common people
Like you and me
Are builders for eternity?
Each is given a bag of tools,
A shapeless mass,
A book of rules;
And each must make -
Ere life is flown -
A stumbling block
Or a stepping stone."

 

Violinist plays during brain surgery.
Musician Roger Frisch underwent deep brain stimulation to fix tremors in his hands and played the violin throughout the process. Deep brain stimulation is a technique used to aid people with Parkinson’s disease, dystonia (neurological movement disorder) and essential tremors, as well as people suffering from OCD, major depression or chronic pain.
During the procedure, surgeons place electrodes inside the deepest parts of the brain and use electric pulses to modify neurological responses. Surgeons implanted electrodes into Roger’s thalamus while he was still awake in an attempt to rectify his tremors.
There are no pain receptors in the brain so patients are always conscious during brain surgery so that the doctors can monitor their condition. In Roger’s case, the surgeons were concerned that the tremors were so small that they risked placing the electrodes in the wrong position and failing to fix the shaking. 
(To read more).

Violinist plays during brain surgery.

Musician Roger Frisch underwent deep brain stimulation to fix tremors in his hands and played the violin throughout the process. Deep brain stimulation is a technique used to aid people with Parkinson’s disease, dystonia (neurological movement disorder) and essential tremors, as well as people suffering from OCD, major depression or chronic pain.

During the procedure, surgeons place electrodes inside the deepest parts of the brain and use electric pulses to modify neurological responses. Surgeons implanted electrodes into Roger’s thalamus while he was still awake in an attempt to rectify his tremors.

There are no pain receptors in the brain so patients are always conscious during brain surgery so that the doctors can monitor their condition. In Roger’s case, the surgeons were concerned that the tremors were so small that they risked placing the electrodes in the wrong position and failing to fix the shaking. 

(To read more).

ozzies-world:

A map of referred pain, something nice to keep in mind when taking patient assessments.

ozzies-world:

A map of referred pain, something nice to keep in mind when taking patient assessments.

Human kidney proximal tubule.
This is a SEM picture of a human proximal tubule, showing the tubular structure and projections extending over the tissue surface. The proximal tubule is the portion of the duct system of the nephron of the kidney which leads from Bowman’s capsule to the loop of Henle.
The kidney participates in whole-body homeostasis, regulating acid-base balance, electrolyte concentrations, extracellular fluid volume, and blood pressure. It accomplishes these homeostatic functions both independently and in concert with other organs, particularly those of the endocrine system. Various endocrine hormones coordinate these endocrine functions
Many of the kidney’s functions are accomplished by relatively simple mechanisms of filtration, reabsorption, and secretion, which take place in the nephron. Filtration, which takes place at the renal corpuscle, is the process by which cells and large proteins are filtered from the blood to make an ultrafiltrate that eventually becomes urine. Reabsorption, which takes place at the proximal tube, is the transport of molecules from this ultrafiltrate and into the blood. Secretion is the reverse process, in which molecules are transported in the opposite direction, from the blood into the urine.
(Picture by The Cell: An Image Library).

Human kidney proximal tubule.

This is a SEM picture of a human proximal tubule, showing the tubular structure and projections extending over the tissue surface. The proximal tubule is the portion of the duct system of the nephron of the kidney which leads from Bowman’s capsule to the loop of Henle.

The kidney participates in whole-body homeostasis, regulating acid-base balance, electrolyte concentrations, extracellular fluid volume, and blood pressure. It accomplishes these homeostatic functions both independently and in concert with other organs, particularly those of the endocrine system. Various endocrine hormones coordinate these endocrine functions

Many of the kidney’s functions are accomplished by relatively simple mechanisms of filtration, reabsorption, and secretion, which take place in the nephron. Filtration, which takes place at the renal corpuscle, is the process by which cells and large proteins are filtered from the blood to make an ultrafiltrate that eventually becomes urine. Reabsorption, which takes place at the proximal tube, is the transport of molecules from this ultrafiltrate and into the blood. Secretion is the reverse process, in which molecules are transported in the opposite direction, from the blood into the urine.

(Picture by The Cell: An Image Library).

Edema.
This picture shows a 49-years-old woman with Elephantiasis nostras verrucosa (ENV), a rare form of chronic lymphedema that causes progressive cutaneous hypertrophy.
The edema is an abnormal accumulation of fluid in the interstitial tissue: beneath the skin or in one or more cavities of the body and it is clinically shown as swelling. 
Six factors can contribute to the formation of edema:
Increased hydrostatic pressure in the capillaries;
Reduced oncotic pressure within blood vessels; 
Increased tissue oncotic pressure; 
Increased blood vessel wall permeability (for example in anaphylaxis or in inflammation);
Obstruction of fluid clearance in the lymphatic system (lymphedema);
Changes in the water retaining properties of the tissues themselves. Raised hydrostatic pressure often reflects retention of water and sodium by the kidney.
Edema can be generalized (Anasarca, usually caused by liver failure, renal failure/disease, right-sided heart failure, as well as severe malnutrition/protein deficiency) or organ-specific, through tissue specific mechanisms:
Lymphedema, where abnormal accumulation of interstitial fluid is caused by failure of the lymphatic system. This may be due to obstruction, destruction of lymph vessels by radiotherapy, or infiltration of the lymphatics by infection (such as elephantiasis).
Myxedema, a cutaneous edema, which is caused by increased deposition of mucopolysaccharides, that hold water in the skin.
Cerebral edema, where there is an extracellular fluid accumulation in the brain. It causes drowsiness or loss of consciousness.
Pulmonary edema occurs when the pressure in blood vessels in the lung is raised because of obstruction to the removal of blood via the pulmonary veins. This is usually due to failure of the left ventricle of the heart. It can also occur in altitude sickness or on inhalation of toxic chemicals. Pulmonary edema produces shortness of breath. Pleural effusions may occur when fluid also accumulates in the pleural cavity.
Periorbital edema is the edema surrounding the eyes. The periorbital tissues are most noticeably swollen immediately after waking, perhaps as a result of the gravitational redistribution of fluid in the horizontal position.
(Picture by The New England Journal of Medicine).

Edema.

This picture shows a 49-years-old woman with Elephantiasis nostras verrucosa (ENV), a rare form of chronic lymphedema that causes progressive cutaneous hypertrophy.

The edema is an abnormal accumulation of fluid in the interstitial tissue: beneath the skin or in one or more cavities of the body and it is clinically shown as swelling

Six factors can contribute to the formation of edema:

  • Increased hydrostatic pressure in the capillaries;
  • Reduced oncotic pressure within blood vessels;
  • Increased tissue oncotic pressure;
  • Increased blood vessel wall permeability (for example in anaphylaxis or in inflammation);
  • Obstruction of fluid clearance in the lymphatic system (lymphedema);
  • Changes in the water retaining properties of the tissues themselves. Raised hydrostatic pressure often reflects retention of water and sodium by the kidney.

Edema can be generalized (Anasarca, usually caused by liver failure, renal failure/disease, right-sided heart failure, as well as severe malnutrition/protein deficiency) or organ-specific, through tissue specific mechanisms:

  • Lymphedema, where abnormal accumulation of interstitial fluid is caused by failure of the lymphatic system. This may be due to obstruction, destruction of lymph vessels by radiotherapy, or infiltration of the lymphatics by infection (such as elephantiasis).
  • Myxedema, a cutaneous edema, which is caused by increased deposition of mucopolysaccharides, that hold water in the skin.
  • Cerebral edema, where there is an extracellular fluid accumulation in the brain. It causes drowsiness or loss of consciousness.
  • Pulmonary edema occurs when the pressure in blood vessels in the lung is raised because of obstruction to the removal of blood via the pulmonary veins. This is usually due to failure of the left ventricle of the heart. It can also occur in altitude sickness or on inhalation of toxic chemicals. Pulmonary edema produces shortness of breath. Pleural effusions may occur when fluid also accumulates in the pleural cavity.
  • Periorbital edema is the edema surrounding the eyes. The periorbital tissues are most noticeably swollen immediately after waking, perhaps as a result of the gravitational redistribution of fluid in the horizontal position.

(Picture by The New England Journal of Medicine).

sixpenceee:

Schizophrenia: patients usually have less brain tissue
Major Depression: scans show less brain activity in depressed brain
Alzheimer’s: brain tissue significantly shrinks, hippocampus is usually the first region to go
ADHD: less brain activity in the frontal cortex (area associated with decision making) 
OCD: high brain activity 
Post Traumatic Stress Disorder (PTSD): hippocampal volume reduction (area involved in memory) and increased activation of the amygdala (area involved in emotional responses) 

sixpenceee:

  • Schizophrenia: patients usually have less brain tissue
  • Major Depression: scans show less brain activity in depressed brain
  • Alzheimer’s: brain tissue significantly shrinks, hippocampus is usually the first region to go
  • ADHD: less brain activity in the frontal cortex (area associated with decision making) 
  • OCD: high brain activity 
  • Post Traumatic Stress Disorder (PTSD): hippocampal volume reduction (area involved in memory) and increased activation of the amygdala (area involved in emotional responses) 
"You treat a disease, you win, you lose. You treat a person, I guarantee you, you’ll win, no matter what the outcome." - Robin Williams, Patch Adams.
Goodbye Mr. Williams.

"You treat a disease, you win, you lose. You treat a person, I guarantee you, you’ll win, no matter what the outcome." - Robin Williams, Patch Adams.

Goodbye Mr. Williams.

Where did HIV come from?
HIV, or human immunodeficiency virus, is the causative agent of AIDS (acquired immune deficiency syndrome). There are actually two types of HIV; HIV-1 and HIV-2. HIV-1 is the dominant virus worldwide, whereas HIV-2 is largely confined to West African countries and those with links to this area such as France and Portugal. 
According to a 2005 survey of African Americans living in the US, almost 50% of the respondents believed that HIV was manufactured in a lab. Furthermore, over 25% believed that this was done by the government. A significant number also believed that it was created in order to control the population of black people/homosexuals.
There is absolutely no evidence in support these theories and a lot of evidence to suggest they’re baloney. Some of the earliest documented cases of HIV were in the late 1950s; it’s absurd to think that scientists would have had the knowledge or technology to create viruses back then. We only identified the structure of DNA in 1953. We’ve only just managed to create the first synthetic bacterial genome, let alone create a virus from scratch. Creating a virus would require knowledge of genetic manipulation. We simply did not have the expertise to be able to achieve something like this at that time 
There are a few different theories about how these viruses got into the population. The simplest explanation is that humans came into contact with the blood or other secretions of infected primates which is perfectly plausible since, for example, sooty mangabeys were both kept as pets and slaughtered for bushmeat in West Africa, the same region that HIV-2 is most prevalent. It would be easy for infected bodily fluids to come into contact with broken skin during the bitchering process.
Given the fact that medical resources are costly, it is plausible that during immunization programs in Africa, healthcare professionals would have shared needles, providing ample opportunity to spread infection through the population. This, coupled with an increase in international travel alongside sexual promiscuity and intravenous drug use, seems a logical explanation for the emergence of HIV.
Another theory is that humans became infected from contaminated oral polio vaccines. The vaccine in question was called CHAT which required the use of living tissue for production. The idea was that the kidney cells used in the production line came from SIV infected chimps and thus a large number of people were exposed. However, this theory falls down because as we have seen, not all of the HIVs came from chimps. It’s also extremely unlikely that oral vaccines would result in transmission since, unless compromised, the mouth is a pretty good barrier to infection. Furthermore, researchers found stocks of the vaccine used and when it was tested, no traces of SIV were found. This theory has therefore largely been refuted.
In sum, while it is difficult to definitively prove where HIV came from, we can make assertions based on the best available evidence. This evidence points to a simian (monkey or ape) origin, not the government. Everyone loves to hear about a good conspiracy theory, but it really does not add up here.
(Source: I fucking love science).

Where did HIV come from?

HIV, or human immunodeficiency virus, is the causative agent of AIDS (acquired immune deficiency syndrome). There are actually two types of HIV; HIV-1 and HIV-2. HIV-1 is the dominant virus worldwide, whereas HIV-2 is largely confined to West African countries and those with links to this area such as France and Portugal. 

According to a 2005 survey of African Americans living in the US, almost 50% of the respondents believed that HIV was manufactured in a lab. Furthermore, over 25% believed that this was done by the government. A significant number also believed that it was created in order to control the population of black people/homosexuals.

There is absolutely no evidence in support these theories and a lot of evidence to suggest they’re baloney. Some of the earliest documented cases of HIV were in the late 1950s; it’s absurd to think that scientists would have had the knowledge or technology to create viruses back then. We only identified the structure of DNA in 1953. We’ve only just managed to create the first synthetic bacterial genome, let alone create a virus from scratch. Creating a virus would require knowledge of genetic manipulation. We simply did not have the expertise to be able to achieve something like this at that time 

There are a few different theories about how these viruses got into the population. The simplest explanation is that humans came into contact with the blood or other secretions of infected primates which is perfectly plausible since, for example, sooty mangabeys were both kept as pets and slaughtered for bushmeat in West Africa, the same region that HIV-2 is most prevalent. It would be easy for infected bodily fluids to come into contact with broken skin during the bitchering process.

Given the fact that medical resources are costly, it is plausible that during immunization programs in Africa, healthcare professionals would have shared needles, providing ample opportunity to spread infection through the population. This, coupled with an increase in international travel alongside sexual promiscuity and intravenous drug use, seems a logical explanation for the emergence of HIV.

Another theory is that humans became infected from contaminated oral polio vaccines. The vaccine in question was called CHAT which required the use of living tissue for production. The idea was that the kidney cells used in the production line came from SIV infected chimps and thus a large number of people were exposed. However, this theory falls down because as we have seen, not all of the HIVs came from chimps. It’s also extremely unlikely that oral vaccines would result in transmission since, unless compromised, the mouth is a pretty good barrier to infection. Furthermore, researchers found stocks of the vaccine used and when it was tested, no traces of SIV were found. This theory has therefore largely been refuted.

In sum, while it is difficult to definitively prove where HIV came from, we can make assertions based on the best available evidence. This evidence points to a simian (monkey or ape) origin, not the government. Everyone loves to hear about a good conspiracy theory, but it really does not add up here.

(Source: I fucking love science).

plannedparenthood:

The HPV vaccine is three shots. Anyone ages 9-26 can get it. The HPV vaccine helps prevent cancer it’s life-saving. Share this infographic and make sure you spread the word, not HPV.

asfgd asked
Hi! Your tumblr is interesting, i wonder if you could share some med books or basic bibliography. I'm going to start the major of medicine and i'm lost, i don't know which books are best & also of you could give some advices. Thak you so much.

Hello! Sorry if I reply now, but I hadn’t WiFi for a while.
Of course! I can write the books I studied from when I was at the first years of med school (it sounds like you’re at the beginning).
I used:
• For Biology: “Molecular Biology of the Cell”, 5th edition, by Bruce Alberts and “Molecular Biology of the Gene”, 7th edition, by James D. Watson.
• For Anatomy: “Gray’s Anatomy”, 40th edition, by Susan Standring (but I found it really hard as a first approach to anatomy, so I helped myself with easier books, such as Anatomy by Anastasi or Mezzogiorno, that are Italians); THIEME, “Atlas of Anatomy”, by Schünke, Schulte and Schumacher (I found it better than Netter); “Clinical Neuroanatomy and Neuroscience”, 6th edition, by M.J.T. Fitzgerald.
• For Genetics, I studied from my professor’s lessons.
• For Histology, I used a bad and difficult Italian book, but I had to because my professor wrote it.
• For Physiology: “Ganong’s Review of Medical Physiology”, 24th edition, but I helped myself with “Guyton and Hall Textbook of Medical Physiology”, 12th edition.
• For Pathology: “Robbins & Cotran Pathologic Basis of Disease” and “General Pathology” by Pontieri.
• For Immunology: “The Immune System” by Peter Parham.
I hope this could help you! Also, as advices, I suggest you to study day by day, following the lessons, and, before of an exam, I think it’s really helpful to divide the pages of the books for the days left. Try to do schemes too.
Good luck!!

An aspirin a day keeps the cancer away.

An aspirin a day could dramatically cut people’s chances of getting and dying from common cancers, according to the most detailed review yet of the cheap drug’s ability to stem disease.

More than 130,000 deaths would be avoided over a 20-year period if Britain’s 50- to 64-year-olds took a daily aspirin for 10 years, because the beneficial effects continue even when the aspirin is stopped, the authors say.

A research team led by Professor Jack Cuzick, head of the centre for cancer prevention at Queen Mary University of London, concluded that people between 50 and 65 should consider regularly taking the 75mg low-dosage tablets. Cuzick said that taking aspirin “looks to be the most important thing we can do to reduce cancer after stopping smoking and reducing obesity, and will probably be much easier to implement”.

Aspirin was originally developed as a painkiller and treatment for fever and inflammation, but more than a century after it was first synthesized from willow bark, researchers have found more medical uses for it. It has been demonstrated to reduce the risks of heart attacks and strokes as well as the chances of some cancers. But the big question has been whether the benefits outweigh the harms, because aspirin can cause stomach bleeds, which could be potentially fatal in some people.

(To read more).

cranquis:

diarymdstudent:

mymedlife:

Why do you think those two are hugging and crying? my resident asks as we watch our attending embrace a man about his age. It’s because one year ago that patient was given four months to live. I saw him then, he looked like he was on his deathbed.
No one knew what he had
But our attending figured it out. He diagnosed him.
It was a rare form of leukemia.
You know it’s rare when Google’s feeble attempts to help out only turns up a handful of journal articles.
Do you know how he knew?
He read an article about it a few weeks before. 
Everyone laughed at him, but he remembered that article and demanded we run the tests. 
Turns out, he was right.
Never forget, reading saves lives. 
To the first years, just staring out your med school journey, not sure why they signed up for this. To those who just finished boards, and never want to pick up a text book again. To the premeds, who just want to finish up their pre reqs and get to medical school already. To the spouses, who wonder if they will ever see their significant others without a textbook again.
This is why we do it.
This is why we stay up past our bedtimes.
And wake up before the sun.
This is why we memorize overly complicated pathways until we can do them in our sleep.
Why we can name every class of antibiotic, even those no one uses anymore.
This is why we push ourselves to be better every day than we were the last.
Why we put our lives on hold.
Not for more letters to put behind our name.
Not for some number on a score sheet.
Not because mom told us to.
We do it because one day, a day that will occur far faster than we are ready for, we’ll have our own patients.
One day someone will come in and ask you “so doc, what is it.” And you’ll say to yourself, I know this.
So when the tediousness of studying gets you down, don’t forget:
Reading saves lives.

This feels like it needs epic music to go with it. 

Compose the music and I’ll sing this from the rooftops.

(In all seriousness — this is an important reminder for all physicians and healthcare providers, before/during/after school/exams/residency/beyond!)

cranquis:

diarymdstudent:

mymedlife:

Why do you think those two are hugging and crying? my resident asks as we watch our attending embrace a man about his age. It’s because one year ago that patient was given four months to live. I saw him then, he looked like he was on his deathbed.

No one knew what he had

But our attending figured it out. He diagnosed him.

It was a rare form of leukemia.

You know it’s rare when Google’s feeble attempts to help out only turns up a handful of journal articles.

Do you know how he knew?

He read an article about it a few weeks before.

Everyone laughed at him, but he remembered that article and demanded we run the tests.

Turns out, he was right.

Never forget, reading saves lives.

To the first years, just staring out your med school journey, not sure why they signed up for this. To those who just finished boards, and never want to pick up a text book again. To the premeds, who just want to finish up their pre reqs and get to medical school already. To the spouses, who wonder if they will ever see their significant others without a textbook again.

This is why we do it.

This is why we stay up past our bedtimes.

And wake up before the sun.

This is why we memorize overly complicated pathways until we can do them in our sleep.

Why we can name every class of antibiotic, even those no one uses anymore.

This is why we push ourselves to be better every day than we were the last.

Why we put our lives on hold.

Not for more letters to put behind our name.

Not for some number on a score sheet.

Not because mom told us to.

We do it because one day, a day that will occur far faster than we are ready for, we’ll have our own patients.

One day someone will come in and ask you “so doc, what is it.” And you’ll say to yourself, I know this.

So when the tediousness of studying gets you down, don’t forget:

Reading saves lives.

This feels like it needs epic music to go with it. 

Compose the music and I’ll sing this from the rooftops.

(In all seriousness — this is an important reminder for all physicians and healthcare providers, before/during/after school/exams/residency/beyond!)

vorpalplatypus asked
Your blog is wonderful! I'm a med school hopeful from across the ocean in the US. :)

Hiiii! Thanks a lot! Big up to you and good luck! :)

Ebola outbreak.

An ongoing epidemic of the Ebola virus disease has spread throughout Guinea and beyond the nation’s borders in West Africa. The outbreak, which began in Guinea in February 2014 and has spread to Liberia, Sierra Leone and Nigeria, is the most severe in recorded history, both in the number of cases and fatalities. A suspected 1,323 cases with 729 deaths have been reported as of 27 July 2014, with 909 cases and 485 deaths confirmed to be Ebola.

But what is actually Ebola?

Ebola virus disease (EVD) or Ebola hemorrhagic fever (EHF) is the human disease caused by the ebola virus.

Ebola virus (formerly officially designated Zaire ebolavirus, or EBOV) is a virological taxon species included in the genus Ebolavirus, family Filoviridae. The Zaire ebolavirus is the most dangerous of the six species of Ebola viruses of the Ebolavirus genus which are the causative agents of Ebola virus disease and it is responsible of the outbreak.

Signs and symptoms: Manifestation begins with a sudden onset of an influenza-like stage characterized by general malaise, fever with chills, sore throat, severe headache, weakness, joint pain, muscle pain, and chest pain. The development of hemorrhagic symptoms is indicative of a negative prognosis. However, contrary to popular belief, hemorrhage does not lead to hypovolemia and is not the cause of death (total blood loss is low except during labor). Instead, death occurs due to multiple organ dysfunction syndrome (MODS) due to fluid redistribution, hypotension, disseminated intravascular coagulation, and focal tissue necroses. 

Transmission: Ebola virus is transmitted to a human index case via contact with an infected animal’s bodily fluids. Human-to-human transmission occurs via direct contact with blood or bodily fluids from an infected person (including embalming of an infected dead person) or by contact with contaminated medical equipment, particularly needles and syringes. Medical workers who do not wear protective clothing, such as gloves and surgical masks, may also contract the disease.

Treatment: No ebolavirus-specific treatment exists. Treatment is primarily supportive in nature and includes minimizing invasive procedures, balancing fluids and electrolytes to counter dehydration, administration of anticoagulants early in infection to prevent or control disseminated intravascular coagulation, administration of procoagulants late in infection to control hemorrhaging, maintaining oxygen levels, pain management, and administration of antibiotics or antimycotics to treat secondary infections.

Sterilization procedures, isolating patients and good hygienic practices are the only way to prevent transmission.

nurse-with-a-smile:

Intradermal:
This route is usually used for tuberculin testing or checking for medication/allergy sensitivities
It may be used for some cancer immunotherapy
Use small amounts of solution [0.01-0.1 mL] in a tuberculin syringe with a fine-gauge needle [26 to 27] in lightly pigmented, thin skinned, hairless sites [inner surface of mid-forearm or scapular area of back] at a 10-15 degree angle.
Subcutaneous:
This route is appropriate for small doses of nonirritating, water-soluble medications and is commonly used for insulin and heparin.
Use a 3/8- to 5/8-inch, 25- to 27-gauge needle, or an insulin syringe of 28- to 31- gauge. 
Inject no more than 1.5 mL solution. 
For an average size client, pinch up skin and inject at 45-90 degree angle. For an obese client, use a 90 degree angle.
Sites are selected for adequate fat-pad size [abdomen, upper hips, lateral upper arms, thighs]
Intramuscular:
This route is appropriate for irritating medications, solutions in oils, and aqueous suspensions.
Most common sites include ventrogluteal, dorsogluteal, deltoid, and vast us lateralis [pediatric]
Use needle size 18 to 27 [usually 22- to 25-gauge], 1 to 1.5 inches long, and inject at a 90 degree angle.
Volume injected is usually 1-3 mL.
If > 3 mL is required, divide into two syringes and use two sites.

nurse-with-a-smile:

Intradermal:

  • This route is usually used for tuberculin testing or checking for medication/allergy sensitivities
  • It may be used for some cancer immunotherapy
  • Use small amounts of solution [0.01-0.1 mL] in a tuberculin syringe with a fine-gauge needle [26 to 27] in lightly pigmented, thin skinned, hairless sites [inner surface of mid-forearm or scapular area of back] at a 10-15 degree angle.

Subcutaneous:

  • This route is appropriate for small doses of nonirritating, water-soluble medications and is commonly used for insulin and heparin.
  • Use a 3/8- to 5/8-inch, 25- to 27-gauge needle, or an insulin syringe of 28- to 31- gauge. 
  • Inject no more than 1.5 mL solution. 
  • For an average size client, pinch up skin and inject at 45-90 degree angle. For an obese client, use a 90 degree angle.
  • Sites are selected for adequate fat-pad size [abdomen, upper hips, lateral upper arms, thighs]

Intramuscular:

  • This route is appropriate for irritating medications, solutions in oils, and aqueous suspensions.
  • Most common sites include ventrogluteal, dorsogluteal, deltoid, and vast us lateralis [pediatric]
  • Use needle size 18 to 27 [usually 22- to 25-gauge], 1 to 1.5 inches long, and inject at a 90 degree angle.
  • Volume injected is usually 1-3 mL.
  • If > 3 mL is required, divide into two syringes and use two sites.