March 2006

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

Be a Ringmaster

Most physicians know about using a string or thread to remove a ring from a swollen finger. From Jenson Beach, Florida, Dr. Frank Malto adds that practice makes perfect. He advises practicing this method on a normal finger until one gets the hang of it. I think that stronger and smaller thread like dental floss or silk suture material works better than string.

Patch Work

From Ashton, Maryland, Lisa Ashton, PAC, reports that the ubiquitous coated cotton disks sold for cosmetic purposes make excellent home-use eye patches for problems like a corneal abrasion. She has added these pads to her first-aid kit for camping.

Seal That Tap

After tapping ascitic fluid from patients with severe liver disease, Dr. Nicholas Testa in Venice, California, often found he was left with fluid leaks that could not be controlled with pressure dressings, sutures, or blood patches, but he found an excellent solution. He now closes the puncture wound with acrylic glue, just like a laceration.

Think Acetone

Available in small, alcohol-wipe-like packets, acetone is an effective cleanser of surface oils or tenacious tape adhesives from the skin. Dr. Robert Molino of Mill Valley, California, recommends acetone for cleaning the skin in two situations: prior to EMLA cream application (he says this preparatory step speeds the onset of anesthesia) and to improve tape adherence. This trick may be one we all should stick with.

Tar Remover

From Tucson, Arizona, where this is a good thing to know, Dr. Fred Leonard reports that regular vegetable oil beats other agents like neomycin ointment at removing solidified tar from burns. Advantages of vegetable oil are that it can be found at home, so it is readily self-applied in a pinch, and that allergic reactions are unlikely.

Double Flush

From New York City, Dr. John Magnan reminds us that a nasal cannula tubing attached to an IV tubing coming from a normal saline bag can be placed over the bridge of the nose to simultaneously irrigate irritants like pepper spray out of both of a reclining patient’s eyes. Of course, Morgan irrigation lenses are best, but in their absence the nasal cannula can do the job.

Jawboning

The usual method to reduce a dislocated mandible is to first medicate with midazolam 2 mg IV and morphine sulfate 2 to 4 mg IV. Then, standing in front of the patient, put your thumbs into the patient’s mouth over the molars, with your fingers on the dislocated mandible at the angle of the jaw, and pull down and forward. However, Dr. Stuart Rose of Westfield, Massachusetts, stands behind the patient and pushes down on the mandibular heads using the base of his thumbs. Recognition of a spontaneous jaw dislocation is not always easy, let alone getting it back in place, so adding Dr. Rose’s approach to your armamentarium makes great sense.

Aroma Barrier

When confronted with a particularly noxious odor—poor hygiene, vomitus, melena, gangrene, and the like—Dr. David Yew in Honolulu, Hawaii, sprays the inside of a surgical mask with cetacaine and wears it while assessing the situation and cleaning the patient. Others prefer eucalyptus or some sweet-smelling balm on the inside of the mask. I smell success in this idea.

LP: Lidocaine Preferred

To completely anesthetize tissue prior to a lumbar puncture (LP), Dr. Scott Weiner in Boston injects 5 to 10 ml of 2% lidocaine with a 27-gauge needle into the skin and subcutaneous tissue prior to using the LP kit’s 5 ml of 1% lidocaine to numb the deep tissues. He gets painless LPs with this technique, but it might not be advisable in cases where one anticipates a difficult LP and perhaps the need to try a different lumbar space. The amount of injected lidocaine is already at the upper limit using Dr. Weiner’s method—100 to 200 mg from the 2% solution and 50 mg from the LP kit—so it becomes imperative to get it done on the first try.