July 2007

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

Lump Sounds

When faced with a complaint of a lump in the groin, Dr. Gus Garmel in Santa Clara, California, asks the patient whether he or she hears or feels bowel sounds or gurgling in the lump. A positive response invariably leads to a diagnosis of an inguinal hernia. Auscultation of the lump may confirm the presence of bowel sounds. One should remember that a hernia may contain only omental fat and that intestines may be strangulated, preventing peristalsis.

AbScess Abolition

To reduce the risk of an explosion of pus—and possible MRSA exposure—while injecting lidocaine into the skin over an abscess prior to definitive drainage, Dr. Jeff Henderson from Austin, Texas, performs a stepwise drainage. He anesthetizes a small area at the point of the abscess, then lances it with an 18-gauge needle. As the pus drains, he continues to inject lidocaine into the planned incision route.

HANDY REMINDERS

From Lincoln Park, Michigan, Dr. Basil Rodansky suggests posting reminders about what to do for digital trauma in work places where workers are exposed to machinery that could injure the hands. Any avulsed or amputated portion of a digit should be wrapped in clean gauze (preferably sterile), placed in cold water in a clean container, and brought to the emergency department with the patient.