January 2003

Contributed by readers. Edited by Donald B. Middleton, MD

FROTHY FOG

The process of connecting an intravenous (IV) line to blood or packed cells for a transfusion can be complicated by froth that forms in the drip chamber when the bottle is inverted or the bag is squeezed to fill the line. With the clinician's view into the chamber obscured by froth, counting drops to determine transfusion rates becomes difficult. From Yangon, Myanmar, Dr. Khin Maung Aye recommends raising the needle end of the IV line to the level of the bottle or bag outlet so the line hangs down in a "U" shape. After filling the line, if froth occurs, simply lift the needle end higher than the bag or bottle. The resulting flow of blood back into the drip chamber will push any froth back into the container, allowing the droplet rate to be counted. With most automatic transfusion or IV machines, this problem is eliminated.

FINALLY, A GOOD USE FOR A CIGARETTE

When an ear wick is unavailable, especially for a patient with otitis externa, Dr. Michael Jaeger in Tivoli, New York, has found he can substitute a strip cut from the filter of a new filter cigarette. Voila! The perfect wick—and one less cigarette.

NO SWEAT

Another use for everyday materials that Dr. Jaeger has found is prevention of rashes like intertrigo under the breast. He recommends strips of old cotton pillowcases or sheets tucked under the breast to keep the area dry. These are, of course, easily laundered and readily replaced.

POSTERIOR PHARYNX POINTERS

When examining the posterior pharynx, Dr. Gus Garmel in Los Altos, California, puts two tongue blades together to get a stronger lever to depress the tongue, then tells the patient to say "Ay," as in a long "A" rather than "Ah." He says these modifications of standard technique give a much better view. I find telling the patient to breathe through the open mouth, and prompting with my own loud synchronized exhalations, helps to reduce gagging and opens up the throat.

A FLUID IDEA

Dr. D. Brady Pregerson in Los Angeles, California, suggests a simple formula for fluid replacement over the first eight hours for an adult burn victim of average (75 kg) weight: estimated total burn area as a percentage of total body surface multiplied by 2 L/h of lactated Ringer's or normal saline. The optimum number of liters per hour varies with body size, but this equation offers a starting point.

SHEATH THAT STETHOSCOPE

Recent data support the idea that the head of a stethoscope can serve as a transmitter of disease. To reduce that risk, and especially to avoid contaminating the stethoscope with blood, pus, vomitus, or other infectious substances, Dr. Chris Dutra of Berkeley, California, covers his stethoscope head with a nonsterile examination glove. This tightly fitting cover rarely interferes with auscultation and is easily discarded after the exam. Dr. Dutra also uses an isopropyl alcohol pad to wipe off the diaphragm and bell after all is complete.

GIVING BAD NEWS

From Lincoln Park, Michigan, Dr. Basil Rodansky sagely reminds us that when it comes time to give difficult, serious news to family members, perhaps of a loved one's death, or to patients, perhaps of serious illnesses like cancer, we should be certain that everyone is seated before we speak. Attention to this seemingly small detail will avoid multiple unnecessary headaches like fainting with resultant trauma.

BE APPRECIATIVE

Remember to praise the work your colleagues and staff do every day—both you and they will feel better for it. Thanks to Dr. Stephen Acosta in Portland, Oregon, for that good piece of advice.