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February 2003
Contributed by readers • Edited by Donald B.
Middleton, MD
TOO TRICKY?
From Oxford, Iowa, Dr. Thomas Bloom questions a previously published
"Trick" (see EMERGENCY MEDICINE, October
2001, p. 8) suggesting that a foreign body, like a bug or a
pellet from a BB gun, can be suctioned from the external ear canal
with a cut-off pediatric feeding tube. Dr. Bloom maintains that
the noise is too scary for kids and that the small end of the tube
cannot form a suction seal with a hard foreign body. Furthermore,
he points out, if the suction tube seals with the inflamed auditory
canal instead of the foreign body, it could damage the tympanic
membrane (which suggests that it would be wise to limit the amount
of suction used). My experience is that this technique is benign
and occasionally works if the object is loosely entrapped or flaky
(like cereal), but it certainly is not foolproof. Any comments?
Send them in, and we'll tabulate a report.
ORAL PREDNISONE
Dr. Michael Jaeger in Tivoli, New York, suggests topical application
of a bit of crushed prednisone tablet to an aphthous ulcer. Most
suggestions to treat aphthous ulcers are disappointing, but this
one seems worth a try.
STOICAL STANCE
When collecting a urethral swab from a man, Dr. Jaeger directs
the patient to hold his own penis with both hands. He finds that
if the swab hurts, the patient holds the penis tighter but doesn't
pull away.
MAKING GOOD SENSE
To separate anxiety-induced sensory loss from a true neurologic
deficit, Dr. Brady Pregerson in Los Angeles uses the simultaneous
sensory extinction test. While the patient has the eyes closed during
a Romberg test, he touches each hand one after the other, then both
at once. If the patient cannot feel at all on one side, or can feel
the independent touches but consistently feels only one side with
the simultaneous touch, then Dr. Pregerson recommends a computed
tomography scan of the head to look for a stroke, tumor, or hemorrhage.
BENIGN BELLYACHE
From Lincoln Park, Michigan, Dr. Basil Rodansky suggests that overweight
patients with abdominal pain may be suffering from a very simple
problem: a belt (or perhaps a girdle) that is so tight as to inhibit
peristalsis. If the patient is otherwise normal, he advises eliminating
the belt and using suspenders instead. A controlled trial might
help to clarify this issue, which could apply to anyone who wears
a belt or garment too tight around the waist.
THIS SHOT HAS TEETH
Dental pain can be extremely difficult for patients to cope with—and
cope they must when the dentist's care is not immediately available.
When the pain cannot be relieved by the standard measures, Dr. Rodansky
opts for 80 mg of methylprednisolone IM, to be continued in oral
form if needed for pain control over a weekend. He also prescribes
an antibiotic if infection is a possibility. This use of methylprednisolone
is not advisable for a patient who is diabetic or hypertensive,
Dr. Rodansky notes, but for others, he swears by it.
TONGUE DEPRESSORS TO THE RESCUE
From Plattsburgh, New York, Dr. Paul Gill, Jr., relies on an old
tried-and-true assistive device for control of nosebleeds: the tongue-depressor
nose clip. Although we all tell patients to hold their nose tips
shut for at least 10 minutes by the clock, many relax their grips
after only a minute or two and a fresh torrent of blood results.
The nose clip consists of two tongue depressors taped together at
one end for about one-third of their length. The untaped end is
slipped over the lower nose and left in place for 10 to 20 minutes,
after which most nonpathological bleeding will stop. This device
makes things a bit easier on the patient and serves especially well
in the office or emergency department, where the patient can lie
still, but it can also work at home.
MIND THE EYES
Make certain that any antibiotic ointment you prescribe to cover
a wound near the eye is safe even if it gets into the eye. In New
York City, New York, Ms. Claudia Radist, RPA-C, always prescribes
an ophthalmic preparation such as bacitracin.
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