March 2005

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

IRRIGATION TECH

Methods for wound irrigation undergo continual refinement. From Loma Linda, California, Drs. Jennifer Cohen and Gregory Guldner submit a well-planned-out irrigation system that requires a bag of saline, high-flow IV tubing, a clear plastic face shield removed from a standard face mask, a three-way stopcock, a 20-gauge angiocath, and a 30-ml syringe. The saline is attached with the IV tubing to the side in-port of the stopcock, the syringe to the end in-port. The angiocath is poked through the center of the plastic face mask and the needle withdrawn, leaving the plastic sheath in place. The out-port of the stopcock is attached to the angiocath sheath. The angiocath tip is placed in the wound, from the saline bag, and the wound is irrigated at approximately the correct pressure of 7 psi, while the plastic face shield acts as a splash guard. All in all, an excellent setup.
 

POSITIONAL PAIN CLUES

Pain in some illnesses changes with position, Dr. Brady Pregerson of Los Angeles reminds us with some examples. Worse lying down: pericarditis, epiglottitis, Ludwig's angina, asthma, congestive heart failure, gastroesophageal reflux disease. Better lying down: post-spinal tap headache, retropharyngeal abscess. Better lying on the left side: pancreatitis, pregnancy, pyelonephritis on the right, a kidney stone on the left. Better lying on the right side: pyelonephritis on the left, a kidney stone on the right.
 

CHAIR-ISH THE FAMILY

Before performing any procedure on a patient with family or loved ones in the room, Dr. Gus Garmel in Los Altos, California, has the visitors sit in chairs without wheels to reduce the risk of vasomotor syncope and new lacerations to repair.
 

VACCINATION VARIANTS

Certain vaccines make sense for certain patients even though not recommended by the Advisory Council on Immunization Practices of the Centers for Disease Control and Prevention. Dr. Basil Rodansky of Lincoln Park, Michigan, suggests that individuals who have a history of pneumothorax should receive the annual influenza vaccine, a clearly supportable position. Intense coughing from the flu might result in a repeat of the pneumothorax. He also advocates a pneumococcal vaccine, a less well supported idea that may need further study to confirm.
 

NOTHING TO SNEEZE AT

To prevent reflex sneezing during a cauterization and packing for epistaxis, Dr. Brian Collins of York, Maine, has his patient rub the nasal bones between a thumb and a forefinger. This technique prevents inadvertent expulsion of the nasal packing and further trauma to the bleeding site. The rubbing may work via the gate theory, by interfering with sensory input from the irritated nasal mucosa. Dr. Collins uses it on himself to stifle his own sneezes whenever the situation dictates.
 

DR. DON HO

Distraction helps small children undergoing minor procedures. In Hartford, Connecticut, Dr. Scott McIntosh keeps a supply of bubble solution handy. He asks a parent to entertain the supine patient by blowing bubbles, and next thing the child knows, the procedure is done.
 

ANGLE ON THE ANKLE

To apply an ankle splint, Dr. Ramona Potter in Dell, Montana, has the patient lie in a prone position with the knee bent 908 so the ankle is up in the air. In that position, gravity holds the splint in place, and the ankle stays flexed at 90° while the splint dries, making application simple and easy.
 

STETHOSCOPE SHINE

Rather than worry about replacing stethoscope tubing, Dr. Fiona Gallahue in Brooklyn, New York, protects her tubing by coating it once or twice a week with a car vinyl protectant like Armor All. Preventive equipment maintenance has arrived in medicine.