February 2005

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

EYE FEEL SOMETHING...

To remove a corneal foreign body, Dr. Stephen Acosta of Portland, Oregon, recommends eye spuds or a moist cotton-tipped applicator to pop the foreign body off the cornea. The cotton will not scratch if moistened, says Dr. Acosta. Ersatz eye spuds can be made by bending the tip of a 27-gauge needle on an insulin syringe (or a TB syringe if necessary) to a 45- to 90-degree angle with the needle bevel facing away from the eye surface.

 

...AND EYE DISSENT

Rather than use a needle (too sharp) or a cotton swab (too floppy) to remove a foreign body from the cornea of an eye, Susan Creal, PA-C, in Lincoln, Nebraska, endorses a pediatric cerumen spoon or flexible loop. The spoon or loop is flexible enough to avoid further trauma yet rigid enough to get the job done.

 

A QUESTION OF COMPLIANCE

Compliance with prescribed medications is always an issue. Dr. Ashish Rana from Glen Mills, Pennsylvania, deals with it by calmly asking the patient whether he or she usually misses one or two doses of each drug per week, as if that were nothing unusual. A "yes" response opens the door to an in-depth investigation without any threat or guilt.

 

PERCUSSION POINTER

The reflex hammer is good for more than just reflexes, writes Dr. Mike Lemanski of Springfield, Massachusetts. Tapping on his finger with the reflex hammer augments the percussion note from the chest, heart, or abdominal exam, and the soft, round tip leaves his finger feeling fine.

 

COOL TOOL

Dr. Regina Gomez from Arlington Heights, Illinois, keeps a few endometrial biopsy pipelles in the freezer. With a tenaculum on the anterior rim of the cervix, the frozen pipelle is just rigid enough to pass through a slightly stenotic os.

 

DOWN THE TUBE

From Columbus, Georgia, Dr. Michael D. Hagues submits a tip on replacing a percutaneous endoscopic gastrostomy (PEG) tube. If the stoma opening is too small to allow easy reinsertion of the tube, try dilating the stoma with urethral sounds from the urethral stricture tray. Dr. Hagues cautions that if the PEG site is newly created (less than two weeks old), verification of tube placement is important because a fistula tract is not yet well established.

 

WOOD'S WONDERS

The standard black light, or Wood's lamp, is an office tool with many uses. It detects the papules of scabies, corneal stains for the diagnosis of abrasions or herpes, fungal infection (yellow-green color), tinea versicolor (yellow), erythrasma (coral red), and Pseudomonas (aqua green to whitish green). In Bloomsburg, Pennsylvania, Dr. Bruce Becker finds this versatile lamp a must for primary care. I hope we will all see the light.

 

THE DIGITAL CLINICIAN

Dr. Scott McIntosh of Hartford, Connecticut, likes to use a digital camera to take pictures of interesting findings. He has a camera memory card reader at one of the computers in his emergency department, where he downloads the picture of interest and emails it to the appropriate consultant to get help. A picture is indeed worth a thousand words.

 

CLOSE CONSULTANTS

Also exploiting his digital resources is Dr. Brady Pregerson in Los Angeles, California, who keeps an email contact list of physicians he trusts, one or more from each relevant specialty, whom he can ask questions from time to time. Using email, he can rapidly reach the most knowledgeable doctor for each situation. He stores the information he receives in a master document that he can review for help with future cases. He finds it an effective way to keep in touch with contacts from medical school and residency days, as well as staff at his own hospital and experts from various medical schools, without having to trouble them over and over.