September 2006

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

HOT IDEA

Most sources recommend ice application for a bee or other insect sting, at least initially, to reduce swelling. From Westfield, Massachusetts, Dr. Stuart Rose takes the opposite tack: he applies heat, following the lead of the many sources that espouse heat to denature the thermolabile proteins (mainly enzymes) in marine envenomations. Dr. Rose finds that stinging insect venom also packs less of a wallop when the stung area is immersed in hot water for 15 to 20 minutes immediately after the event. Stings on the trunk or face can be treated with hot packs. The heat is reapplied as needed. Any heated responses?

JOLLY GREEN DOCTOR

This month we have a couple of recommendations for the behavioral management of young patients. Dr. Basil Rodansky in Lincoln Park, Michigan, reminds us that a child who is taken to an emergency department is probably frightened enough about the situation that he does not need any more excitement. One calming effect that the physician may try is to get at the child’s eye level so that the patient does not feel as if a giant is standing over him. I actually like to get down on the floor when necessary or at least put my head at the same level as the examination table, but try not to get too close until it comes time for the examination.

EASY OPEN

To get a child to open her mouth, Dr. Brian Collins in York, Maine, has her sit on the parent’s lap with her face toward him. He then asks the parent to take each of the child’s hands in theirs and place the hands next to the child’s ear to hold the head still. The child who feels secure in the parent’s lap will then usually allow Dr. Collins to open her mouth with a tongue blade and get a quick look at the oral cavity and pharynx.

VOICE LESSON

Whether the patient who complains of hearing loss is really having difficulty or not is sometimes tough to tell. From Pittsburgh, Pennsylvania, Dr. Jerome Lebovitz sends in a hint about how to determine who truly has significant hearing loss. He asks the patient to read from a book or magazine, then stands behind the patient’s head crinkling a piece of paper beside the patient’s ear. If the patient raises the volume of his voice, then he probably does not have a significant hearing loss. If there is no change in volume, the patient may have a significant deficit that needs to be evaluated more fully.

THE STERILE DON

From Santa Clara, California, Dr. Thomas Crawford sends in his method of donning a pair of powder-free, non-latex, sterile surgical gloves. These gloves can be a challenge to get on because they are folded on themselves in the package, much like a case of intussusception. The first glove usually donned is the left, which is easy to get on because you have the free right hand to hold the cuff. Putting on the right glove, however, can be troublesome. Dr. Crawford uses his right hand to grasp the fingers of the glove from the bottom of the paper wrapper, keeping the surface sterile. He then uses his gloved left hand to grab the cuff of the glove and fully extend it, so that it is easier to slip in his now free right hand. Thanks to Dr. Crawford for providing us with an easy-on solution.

LOCATION, LOCATION

To relocate a dislocated hip often requires some athleticism. From Los Angeles, California, Dr. Brady Pregerson notes that leverage can be obtained by placing the patient on a surface other than the gurney or by taking a special approach to the patient’s problem. If necessary, he will sometimes put the gurney mattress on the floor with the patient on top of it to get better leverage. However, his favorite technique is to put the gurney at its maximum height and slide the patient down until the buttocks are at the foot of the gurney. He then positions himself under the patient’s dislocated leg at the foot of the gurney with the patient’s popliteal fossa resting on his shoulder. With one or two assistants pressing down on the patient’s pelvis while he pushes up on the leg, he can often get the hip to relocate without major difficulty.