RMA cheat sheet

Standard precautions apply to every patient contact regardless of diagnosis: hand hygiene before and after contact, gloves for blood or body fluids, and eye/mask protection when splash is likely.

Order of draw for venipuncture (CLSI): blood cultures, light-blue sodium citrate, red/gold serum tubes, green heparin, lavender EDTA, gray glycolytic inhibitor.

A tourniquet is placed 3–4 inches above the antecubital site and released within 1 minute; prolonged occlusion causes hemoconcentration and falsely raises potassium, protein, and enzyme values.

Needle gauge and lumen size are inversely related: 21 G is standard for adult antecubital venipuncture, 23 G is used for small or fragile veins, and 25 G for fragile pediatric veins.

IM injection volumes: deltoid no more than 1 mL, vastus lateralis up to 3 mL in infants, ventrogluteal up to 3 mL and the safest adult site (no major nerves or vessels nearby).

Gravity-displacement autoclave: 121 °C (250 °F) at 15 psi for 15–20 minutes; sterilization is validated with a Geobacillus stearothermophilus spore test.

Normal adult vital signs: oral temperature 36.5–37.5 °C (97.7–99.5 °F), pulse 60–100 beats/min, respirations 12–20 breaths/min, blood pressure below 120/80 mmHg.

EKG standard calibration is 10 mm/mV at a paper speed of 25 mm/s; lead V1 is placed at the 4th intercostal space at the right sternal border.

The HIPAA Privacy Rule allows disclosure without authorization for treatment, payment, and health care operations (TPO); all other uses require a signed patient authorization.

Minimum necessary standard: only the protected health information needed to accomplish the purpose may be used or disclosed, except when the request is for treatment.

SOAP note structure: Subjective (patient's reported complaint), Objective (measurable findings), Assessment (provider impression or diagnosis), Plan (diagnostics, treatment, education, follow-up).

Chart errors are corrected with a single line through the error so it remains legible, plus the correction, initials, and date; erasures and correction fluid are prohibited.

ICD-10-CM codes diagnoses and reasons for the encounter; CPT codes procedures and services; HCPCS Level II codes supplies, drugs, and durable equipment.

Pegboard (write-it-once) bookkeeping: one handwritten entry simultaneously creates the day sheet, patient ledger, and receipt, reducing posting errors.

Scheduling types: fixed-interval (stream) assigns a set time to each patient, wave groups several patients at the hour in arrival order, clustering groups similar visits, double booking overlaps appointments.

Mail classes: first-class for routine correspondence, priority for 1–3 day delivery, certified with return receipt for legal, collection, and termination notices.

Body planes: sagittal divides right from left, coronal (frontal) divides anterior from posterior, transverse divides superior from inferior.

Adult skeleton totals 206 bones: 80 axial (skull, vertebral column, ribs, sternum) and 126 appendicular (limbs and girdles).

Vertebral counts: 7 cervical, 12 thoracic, 5 lumbar, 5 fused sacral, 3–5 coccygeal; C1 is the atlas and C2 the axis.

Ribs: 12 pairs - 7 true ribs attach directly to the sternum, 3 false ribs attach via costal cartilage, and 2 floating ribs have no anterior attachment.

Long bone regions: diaphysis (shaft), epiphyses (articular ends), metaphysis (growth plate region), periosteum (outer fibrous covering).

Cardiac output = heart rate × stroke volume; a resting adult value is about 5 L/min (70 beats/min × 70 mL).

Normal arterial blood pH is 7.35–7.45; below 7.35 is acidosis and above 7.45 is alkalosis.

Nephron processes are glomerular filtration, tubular reabsorption, and tubular secretion; normal GFR is approximately 125 mL/min.

Hemostasis sequence: vascular spasm, platelet plug formation, coagulation cascade, then clot retraction and fibrinolysis.

Word building order: prefix + word root + combining vowel + suffix; the suffix typically identifies the term as a condition, procedure, or specialty.

Incision-related suffixes: -otomy (cutting into), -ectomy (surgical removal), -ostomy (creating an opening), -plasty (surgical repair).

Condition suffixes: -itis (inflammation), -megaly (enlargement), -algia (pain), -emia (blood condition), -uria (urine condition), -pathy (disease).

Quantity prefixes: hyper- (above normal), hypo- (below normal), eu- (normal), oligo- (few or scanty), poly- (many or excessive).

Rate and position prefixes: tachy- (fast), brady- (slow), endo- (within), epi- (above or upon), sub- (below), inter- (between).

Common roots: cardi/o (heart), gastr/o (stomach), hepat/o (liver), nephr/o (kidney), pulmon/o (lung), oste/o (bone), dermat/o (skin), neur/o (nerve).

Plural endings: -a becomes -ae, -us becomes -i, -um becomes -a, -is becomes -es, -on becomes -a, as in vertebrae, bronchi, atria, anastomoses.

Negligence requires four elements: duty to the patient, dereliction (breach) of that duty, direct cause, and damages; all four must be proven.

Informed consent requires patient capacity, disclosure of risks, benefits, and alternatives, comprehension of the information, and voluntary authorization.

HIPAA breach notification: affected individuals must be notified without unreasonable delay and no later than 60 days after discovery of the breach.

Confidentiality exceptions without authorization include reportable communicable diseases, suspected abuse or neglect, certain wounds such as gunshot injuries, and court orders.

Emancipated minors (for example by marriage, military service, or court order, depending on state statute) may consent to their own medical care.

Respondeat superior holds an employer liable for negligent acts of employees committed within the scope of employment.

Advance directives: a living will states treatment wishes when the patient is terminally ill; a durable power of attorney for health care names a surrogate decision-maker.

OSHA Bloodborne Pathogens Standard requires the hepatitis B vaccination be offered free of charge within 10 working days of assignment to exposure-risk duties.