March 2002: Tricks of the Trade

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

TEMPORARY RELIEF FOR DENTAL DISTRESS

To dull the pain of tooth decay and abscess until proper dental treatment can be obtained, Dr. Jeff Rosenberg of West Carrollton, Ohio, offers this two-step approach. First, he performs an initial alveolar block. Then he mixes lidocaine jelly with a topical anesthetic spray containing benzocaine, butyl aminobenzoate, tetracaine, and benzalkonium chloride. He uses this mixture to soak some small cotton balls that he stores in a sterile urine sample cup for the patient to take home. The patient can then place the cotton balls next to the diseased tooth as needed to provide pain relief without the adverse effects or risks of narcotics. Another advantage to this approach is that it foils the strategy of patients who are seeking drugs. A concurrent course of antibiotics is also recommended.

PUT THAT BUG IN REVERSE GEAR

To remove an insect from the external auditory canal, Dr. C. Philip Carter of Powell, Tennessee, relies on viscous lidocaine to push the critter out. He draws up 2 to 3 cc of 4% viscous lidocaine in a 3-cc syringe and then attaches it to a flexible 1.5-in., 20-gauge intravenous catheter. With the aid of a head lamp and a metal ear speculum, Dr. Carter can visually insert the tip of the catheter in the external auditory canal past the insect. A quick injection of the thick viscous lidocaine usually expels the insect and at the same time anesthetizes the canal and the bug, so that in the event that the bug is not expelled, it can be easily extracted with alligator forceps.

RECIPE FOR CHILDREN'S PREDNISONE

As Dr. Matthew Ho of Loma Linda, California, reminds us, liquid steroid preparations have quite an unpleasant taste, a reason many children reject these syrups. As a substitute, Dr. Ho crushes regular prednisone tablets and stirs the pieces into some ice cream or yogurt--a concoction that goes over well with finicky young patients. Sounds like a tasteful suggestion.

A PHOTOCOPY IS WORTH A THOUSAND WORDS

Easy access to pertinent information greatly enhances the delivery of medical care, so this suggestion by Dr. Ho is certainly a worthy one. For his patients with a history of old infarctions, atrial fibrillation, or left bundle-branch block, Dr. Ho provides a photocopy of their ECG, telling them to keep it in their wallet or purse. In an acute situation, this practice will definitely pay off, streamlining patient care. Some day, we'll probably all carry computer cards containing every detail of our medical histories.

LP MEANS LESS PAIN

For a less painful lumbar puncture (LP), Dr. Daniel E. Kates of Scottsdale, Arizona, adds a sterile 30-gauge syringe needle to the opened LP tray to use to inject the initial lidocaine skin wheal--the part of the procedure that patients tend to complain about most. As Dr. Kates observes, most LP trays contain only a 25-gauge needle for anesthetizing the skin--too large and too painful. Remember that some studies have suggested that a slow injection of lidocaine markedly reduces discomfort.

KEEPING TRACK OF KETOROLAC

With medication errors frequently in the forefront of the news, Dr. Mark Silverberg of Brooklyn, New York, advises particular caution when administering ketorolac (Toradol). The pain medication can be given either intramuscularly or intravenously, but, as Dr. Silverberg observes, the physician must keep in mind that the route will be determined by the specific type of ketorolac he or she uses. The 30-mg/ ml vials that contain 1 ml, for example, may be given either intramuscularly or intravenously. However, the 30-mg/ml vials that contain 2 ml (60 mg) must be given intramuscularly only, because unlike the smaller vials, they are not filtered to remove pyrogens.

THE GARGLING SOLUTION

According to Dr. Basil Rodansky of Lincoln Park, Michigan, chamomile, menthol, green, and even regular black teabags make excellent gargling solutions. The tannic acid in these teas is astringent enough to be effective yet mild enough on the throat. This "tea break" also avoids the salty taste and occasional salt ingestion that accompany the usual saline gargling solutions.