February 2006

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

Crutch for Back Pain

In Los Angeles, California, Dr. Brady Pregerson offers crutches to patients with difficulty ambulating due to back pain. Theoretically, the crutches take the weight off the back enough to give additional pain relief. For the less severely affected person, a cane may do.

Weighty Matter

Many physicians use two scales to weigh patients who weigh more than 350 pounds, but Dr. Jerome Lebovitz in Pittsburgh, Pennsylvania, prefers a technique that employs a reflex hammer. He dangles the hammer from a rubber band and hangs it from the “tongue” end of the scale. He weighs the patient, then weighs himself with the hammer on, then with it removed. The difference between his two weights added to the patient’s measured weight is the patient’s true weight. Of course, any additional item, not just a reflex hammer, used as a counterweight will provide the same information.

Heard About Lidocaine?

Prior to extracting a foreign body from the ear canal, Dr. Jimmie McCready in Panama City Beach, Florida, instills 2% lidocaine into the ear canal to reduce pain. The lidocaine must be allowed to stay in the canal for 20 minutes to achieve any significant anesthesia.

Things That Go Bump...

After years of watching students struggle to get the otoscope speculum into the ear canal without causing pain, I can appreciate the trick sent in by Dr. Brian Rudick in Philadelphia. He advises gently sliding the side of the speculum along the posterior wall of the external auditory canal to steady the instrument. This technique limits the potential for bumping the canal area during the exam and thus reduces pain.

Tooth Tech

To seal a dental fracture, Dr. Tammy Foster in Burlingame, California, recommends cyanoacrylate, the same glue we use for lacerations. She pulls away the lip and dries the tooth with some gauze, then dabs a bit of the glue onto the fracture. Seconds later the fracture is sealed, safe and sound.

Out of the Fog

To prevent fogging of an ear-nose-throat mirror, Dr. Chris Dutra from Berkeley, California, recommends a surfactant coating (he uses Shurclens, but I wonder if any lecithin spray would work as well) on the glass. The anti-fogging agent for scuba masks works as well. The advantage of fog prevention is that the mirror does not have to be repetitively heated against a light bulb or other source, so the risk of an inadvertent burn is eliminated.

Wristy Business

Taken alone, the Tinel test to detect carpal tunnel syndrome is neither sensitive nor specific. To improve its usefulness, Dr. Adam Nortick in Vestavia Hills, Alabama, follows up a positive Tinel test with the radial tap test. With the patient’s wrist in pronated position, he gently taps over the distal radius seven times. Resultant complaints of numbness, tingling, or “electrical shocks” and the like in the palm mean the Tinel test result is not reliable and that nerve conduction tests very probably will not prove useful.

Take Stock-In-Ette

In West Hartford, Connecticut, Dr. Ted Sherry finds that slipping dry plaster casting into stockinette makes splint application easier. For example, to make a thumb spica splint, he cuts six-inch plaster casting to length, folds it longitudinally, slides it into three-inch stockinette, then moistens it to mold to fit. Many others support this neat and easy technique to avoid sharp edges on the finished splint.

Casing the Joint

From Roseburg, Oregon, Dr. Marc Smith reminds us of an effective pillowcase and sheet technique to restrain a toddler. Slip the open end of the pillowcase over the child’s arms held behind the back, pulling the opening up to the axillae. Lie the child down on his or her back with an arm at each side in the pillowcase. Wrap the sheet snugly around the legs and trunk and the restraint is complete. Dr. Smith claims that parents tolerate it well, and a further advantage is the near-zero risk of methicillin-resistant Staphylococcus aureus contamination on those clean pillowcases and sheets.