January 2004

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

CLAMPING DOWN ON EPISTAXIS

As previously reported here, a nosebleed can be stopped by taping together two tongue blades at one end so that the other ends can be opened and applied to the soft, anterior nostrils. From Greenwood, South Carolina, Dr. Jerett Tozzi adds two small twists: Use a strong rubber band rather than tape to hold the non-pinching ends together, and place a phenylephrine-soaked pledget in the hemorrhaging nostril prior to clamping on the tongue blades. Cautery can be used after the bleeding ceases.
 

SEEING YELLOW

To avoid the mess that results when fluorescein drips where it was not meant to, Dr. Bruce Lindsay in Middleton, Wisconsin, folds the fluorescein strip along its long axis prior to moistening to create a trough to channel the liquid where he wants it to go. The folded strip acts like a V-beam, keeping the paper from sagging and allowing control over where the drops land.
 

HOLES SHOO FUNGUS

For patients with tinea pedis, Dr. Basil Rodansky from Lincoln Park, Michigan, believes footwear that enhances air circulation, thereby reducing the accumulation of sweat, can promote healing. He says sandals are best but even goes so far as to recommend cutting several 1-cm holes in the patient's shoes. I have read previously that wearing white cotton socks is similarly helpful but wonder whether "ventilated" shoes have ever been studied.
 

COOLING WARMTH

As part of his strategy to reduce anxiety in patients with primary hyperventilation, Dr. Brady Pregerson in Los Angeles, California, gives a patient a warm blanket or two, an act that meets both physical and emotional needs and augments the benefit of breathing into a bag.
 

WHICH WAY DID THEY GO?

In an elderly patient with thin skin, to prevent dehiscence of a pretibial laceration previously closed with adhesive strips, one must remember to remove the strips starting at the base of the thin flap of overlying skin and moving toward the laceration. With that in mind, Dr. Khin Maung Aye in Yangon, Myanmar, pens an arrow on one of the strips. He removes them about seven days later, peeling in the direction of the arrow.
 

HOLDING PATTERN

Electronic records loom on the horizon for most physicians. If computers are already a presence in your exam rooms, Dr. Lawrence Gill from West Bend, Wisconsin, suggests setting up screen savers with images of artwork or nature to calm patients while they wait. He likes relaxing subjects better than educational materials, but I note that many movie theaters have begun using trivia questions to entertain while the audience waits for the film to start. Can it be long before patients will be given a choice of education, medical or other trivia, entertainment, or perhaps even e-mail access?
 

KEEP IT SHALLOW

To incise and drain an abscess in an area where the incision could go too deep—for example, a peritonsillar abscess near the carotid artery—Dr. Mark Silverberg in Brooklyn, New York, wraps a wide band of white tape around a #11 scalpel blade so that only 1 cm of the point is exposed. The tape stop prevents him from incising too deeply and regretting it later.
 

SPECULUM SHEATH SEQUEL

In response to my November 2002 request for more opinions on visualizing the cervix when the vaginal walls prolapse between the blades of the speculum, Pamela Moyers Scott, PA-C, from Williamsburg, West Virginia, wrote in that she covers the speculum blade not with a finger from a latex glove but with a condom that has the closed end cut off. A flexible clear condom should certainly do the trick.
 

SWEET SUCCESS

Liquid steroid medications that children may require are typically bitter or otherwise foul-tasting. Chocolate is the answer, according to Christa Castro, PA-C, from Taos, New Mexico, who adds a bit of chocolate syrup to each dose after measuring it out. She claims most children then take the medication without a fuss. Most studies show oral steroid effects equate to those of parenteral steroids. I just hope the medication doesn't ruin the chocolate.