Foundations: the first 90 days of a new technician

Your trainer is with another patient, and a technician asks you to run a test your trainer has not yet walked you through. What is the expected response?

A brand new technician who asks a clarifying question before touching a patient is doing exactly what is expected, because a designated trainer walks each new skill through hands-on before it is performed independently. An attempt under pressure puts a patient in front of an unpracticed skill, a blanket refusal for the whole period would stop the hands-on check-offs Foundations runs on, and a coworker who is also new is not a substitute for the assigned trainer.

A few minutes after a drop goes in, a patient's lips start to swell and she says her throat feels tight. How is this handled?

Lip or tongue swelling with a tight throat after a drug is a possible severe allergic reaction that can close the airway, so it is an emergency: call for help and emergency services, and stay with the patient. Epinephrine is the treatment, given by trained staff under the clinic's plan. Rinsing the eye, charting it for later, and handing out a tablet all lose time the patient may not have.

A patient was grinding metal without safety glasses and now has a scratchy eye with only mild pain. What makes this an immediate call?

Metal on metal throws fragments fast enough to go through the wall of the eye and seal the entry point behind them, sometimes with little pain, so the patient is seen now and told not to rub the eye or remove anything. It is not a chemical burn, mild pain does not measure the damage, and billing plays no part in the tier.

With a penlight held at the temporal limbus and parallel to the iris, you see a shadow over the nasal half of the left iris. What does that suggest?

In the penlight shadow test, an iris bowed forward blocks light coming from the temporal side and leaves a shadow on the nasal iris, which suggests a shallow chamber and a possibly narrow angle. It is recorded for that eye and raised with the physician before any dilating drops. Pupil size, a weak battery and corneal scarring do not produce this pattern.

A colleague hands you a freshly disinfected tonometer tip that is still visibly wet. What do you do?

Residual disinfectant left on a tip that contacts the cornea can cause irritation or toxicity, so the tip air dries completely before it reaches the next patient's eye. A wet tip used immediately carries that chemical onto the cornea, a gauze wipe risks recontaminating a surface that was just disinfected, and a tap water rinse followed by immediate use still puts a wet tip on the eye. Where a clinic soaks its tips, protocol is a thorough clean-water rinse after the soak and then full air drying; a tip is never used wet.