November 2007

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

Shield Yourself
When draining an abscess, Drs. T.R. Jones and Jody Henson from Temple, Texas, offer the following suggestion. Take two clear face shields, put one on your face, and have an assistant hold the other shield a few inches over the abscess. As you inject or incise the abscess, you not only protect your eyes but also your clothes and the surrounding area from a biohazard splash. The slit in the face shield can also be attached to the hub of the needle for the same effect.

Get the Picture
Dr. Gus Garmel from Santa Clara, California, suggests that if your hospital or office policy allows it, you should e-mail electronically stored radiographs to your patients. He’s found that patients, especially children and those with fractures, love having copies of x-rays in their photo libraries to share with relatives and friends. Patient satisfaction is every bit as important a part of medical care as the return of good health.

Light Show
Before looking in a toddler’s or older infant’s ear canals, Dr. Jennifer Donohue in Lake Oswego, Oregon, points her otoscope up at the ceiling and repeatedly attaches and detaches the speculum, as if playing with a stacking toy. Most children find the light show entertaining and react with less fear when the time comes to look in their ears. I like showing the child that the speculum isn’t painful by putting it in my own ear canal. Sometimes shining the light into a doll’s or stuffed animal’s ear helps. If all these tactics fail, placing the patient supine on the exam table and holding the head to the side while a parent holds the hands is a quick, safe way to view the tympanic membranes.

ECG Evidence
To help detect a faulty lead placement on an ECG strip, Dr. Hein Khin Maung Auy in Yangon, Myanmar, looks for an inverted P wave in lead I and a large positive wave in lead aVR, which should be always be negative. These findings indicate a mix-up of the right and left arm leads. An additional tip is that leads I, aVL, and V6 should look similar because all three detect impulses moving right to left across the chest.

SharpS Safety
In Augusta, Maine, Rob Boudewijn, PA-C, leaves no chance for a needle stick after suturing. He places any used suture or anesthesia needles into the barrel of the irrigation or anesthesia syringe, then puts the plunger back into the barrel, trapping the used needles inside. The whole thing then goes in the sharps container.

Exemplary Eversion
From Kahului, Hawaii, Dr. Michael Klaper gives us a trick to assist with eyelid eversion. When a plain cotton-tipped applicator is used to evert the lid, it can get stuck to the skin. Removing it can hurt the patient or even cause the eyelid to flip back to the normal position. Dr. Klaper’s solution is to apply a thin coat of ophthalmic antibiotic to the cotton tip and proximal inch of the applicator. It’s then an easy, painless task to slip it out and leave a folded eyelid behind.

Speculum Tip
Many doctors use an otoscope with a disposable speculum to assist them in removing a foreign body from the ear or nose. When problems arise fitting an alligator clamp or homemade extractor (like an L-shaped paper clip) through a too-small hole, Dr. Mel Vallero of Sacramento, California, suggests cutting off the tip of the speculum to get the right-sized hole for the tool and for your vision.