June 2007

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

Splendid Splitters

At Brooke Army Medical Center in San Antonio, Texas, Dr. Guyon Hill recommends installing flow splitters on all oxygen outlets, assuming this hasn’t already been done in your emergency department and you don’t have multiple oxygen outlets. The splitters allow him to hook up two systems, like a bag/valve mask and nonrebreathing mask, at the same time. The advantage of this method is that during resuscitation or treatment of respiratory failure, the proper equipment is available without disconnecting the oxygen flow.

Painless Stitch Removal

To elevate sutures off a laceration, Dr. Basil Rodansky from Lincoln Park, Michigan, sprays a bit of topical anesthetic over the wound. He then eases the pointed end of a cotton-tipped applicator under each stitch, one by one, cutting them as he goes. This technique reduces the risk of cutting the patient whether one uses scissors or a #11 blade to snip the sutures.

Fogarty for a FOREIGN Body

To remove a foreign body from a child’s nose, Dr. Mitchel Schwindt of Bemidji, Minnesota, eases a lubricated Fogarty catheter past the object, inflates the balloon, and pulls out the object. This technique is extremely useful when a curette won’t do the trick, and its effectiveness is well documented.

Take Note

When treating a patient involved in a motor vehicle accident, Dr. Gus Garmel in Santa Clara, California, gives the patient a note stating that she was seen in the emergency department. The note serves the patient well for work- or insurance-related purposes. Patients are invariably thankful.

Scratch THE SURFACE

From St. Louis, Missouri, Dr. David Davis reminds us that dermatographism may serve as a marker for urticaria. When a patient presents with a history of an itchy rash but his skin appears normal, scratch a line or circle on the skin to see if it induces a wheal. Although dermatographism is not pathognomonic of urticaria, it may suggest a need for skin moisturizers, antihistamines, or H₂ blockers to stabilize skin reactivity.

NO SUBSTITUTE FOR SOAP

From Dr. Brady Pregerson in Los Angeles, California, comes the tip to remember that alcohol-based hand cleaners do not kill Clostridium difficile spores. These spores must be mechanically removed with soap-and-water washes of at least 15 seconds. New strains of C. difficile are highly toxic and show resistance to multiple antibiotics. The solution is for you, the patient, the patient’s family, and everyone else to wash thoroughly.

Draining Experience

In Colton, California, at the Arrowhead Regional Medical Center, Drs. Thomas Minahan and Joel Stillings drain a subcutaneous abscess using a Yankauer suction catheter connected to a suction canister to reduce the smell and mess from pus and blood. The rigid catheter tip also helps break up loculations.

Getting the Green Light

To examine the eye grounds of a patient with a photophobic headache, Dr. John Gill in Rancho Santa Fe, California, switches his ophthalmoscope to the green light setting. The lower- intensity light provides enough illumination to detect or exclude papilledema or retinal hemorrhage but is less painful for the patient. Alternatively, use the blue light setting or decrease the light intensity with the ophthalmoscope rheostat.