April 2007

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

GLUE STICK

Most practitioners close a wound with acrylic glue by pushing the edges together perpendicular to the laceration. From San Jose, California, Dr. Joseph Toscano submits an idea he learned from Carole McCain, RN: Apply traction along the axis of the laceration before applying the glue. The entire length of the wound is thus approximated more accurately, allowing easy application of the adhesive.

SHIELD THE EYES

To remove a foreign body from the cornea when an eye spud is not available, Dr. Robert Breckenfeld from Farmington Hills, Michigan, eschews a needle in favor of the plastic needle shield from an 18-gauge angiocatheter. The shield is universally available, safe, and easy to use. Dr. Breckenfeld nudges the foreign body off the cornea and then removes it with a moistened cotton swab. This man has vision.

ARM YOURSELF

Applying a long arm splint can be a job for two, requiring extra time for molding the splint while it dries. To bypass this problem, Dr. Barry Hahn in Staten Island, New York, places the splinted arm in a sling, which is then tightened around the patient’s neck to hold the elbow at the desired angle—usually 90°—until the splint hardens. He tells the patient not to move while the splint dries and that he will loosen the sling in a few minutes. In the interim, he writes any necessary prescriptions and discharge instructions. Although this trick has been around for awhile, Dr. Hahn’s experience reminds us all to keep it in our “armamentarium.”

USEFUL DISTRACTION

Do you want to discuss an issue with a parent but not with the child when both are in the room? In Los Angeles, Dr. Leslie Klein gives a stethoscope to the child so he can listen to his heart. The ear piece in the ear canal and distraction from the heart sounds keep the child out of the conversation, thus allowing sensitive issues to be discussed more freely.

THE SPREAD

To ensure complete antibiotic ointment coverage of a sutured wound, Dr. Thomas Crawford in Santa Clara, California, uses the handle of the suture-set forceps like a butter knife to spread the ointment over the entire wound. Smooth idea.

NEED A LIFT?

Dr. Basil Rodansky from Lincoln Park, Michigan, points out that bright sunlight can impair a patient’s ability to drive if she has had her pupils dilated with eye drops. So he advises the patient to use a “designated driver” when she leaves the emergency department. Certainly, a reversing miotic agent could be a useful alternative. This trick is also a reminder that when faced with a patient with dilated pupils, we should get a careful history that elicits mention of any recent trips to the optometrist or ophthalmologist.

MIX IT UP

From Lincoln Park, Michigan, Dr. Rodansky provides another trick. To reduce the likelihood of diarrhea and other gastrointestinal upsets associated with colchicines prescribed for gout, he advises patients to crush their colchicine tablets and mix them with at least one tablespoon of applesauce or mashed potatoes to hide the taste. Not being a pharmacologist, I trust this is a plausible strategy to reduce side effects, but I worry about the speed of relief for gout symptoms. Anyone care to comment?

BENT OUT OF SHAPE

When injecting a digital block, Dr. Gus Garmel of Los Altos, California, uses a bent 27-gauge needle. This allows his hand and arm angle to be upright rather than parallel to the skin. He feels that the bent needle achieves more control and comfort and stays more superficial in the skin.