|
April 2006
Contributed by readers • Edited by Donald B.
Middleton, MD
REPACKING PEARL
When packing or repacking an abscess after incision and drainage, Dr. Anne Kronish in Closter, New Jersey, first irrigates the wound with 1% lidocaine. The irrigation flushes out debris and provides some anesthesia, dulling the pain of repacking the wound.
AND SPEAKING OF LIDOCAINE
Several good studies have proved that slow injection of lidocaine produces less pain. To further reduce anxiety-heightened pain in a pediatric patient, Dr. Lawrence Gill in West Bend, Wisconsin, lets the girl or boy be in charge of the speed of injection. After the first needle insertion with a tad of lidocaine, the patient instructs Dr. Gill how quickly to inject. An anxious child has some measure of control, and the slower injection reduces pain overall.
CANINE TRICK
To get a better look at the oropharynx, Dr. Tom Whelan in Troy, New York, asks his patients to pant like a dog. He even demonstrates for those who have trouble with the panting task. I like to have the patient breathe deeply through a wide-open mouth and usually breathe right along with them to keep the pace smooth. Both techniques do make a look in the oropharynx easier. Deep mouth breathing even suppresses the gag response to a tongue depressor.
PREDNISONE TO THE RESCUE
To relieve the pain from burns, Dr. James Twombley from Dillon, South Carolina, prescribes brief courses of prednisone. For severe sunburn, especially with blisters, he uses 20 mg, three times a day, for three days. For first-degree burns like those from welding, he gives one blast of 60 mg. To learn whether his prescriptions have helped, he gives his patients stamped, self-addressed envelopes with a check-off card inside to send in after a few days. I would enjoy seeing the results published.
ORDER OF BUSINESS In nonemergent situations, Dr. Luis Camarillo
in Temple, Texas, suggests a change to the order of the history and physical.
He first gives the patient and family his business card and some information
on his medical background. Then he confirms the patient’s age and other personal data, elicits important parts of the medical and social history, and makes certain he knows everyone in the room. At that point he asks, “What brought you in today?” I would suggest that an early question ought to be “How are you feeling?” to make certain acute issues are addressed first thing.
ON-THE-SPOT NOSE JOB
Before swelling and clotting peak, nasal bone fractures can be immediately reduced with less pain. At a recent athletic event, Dr. Steve Fahey of College Park, Maryland, reduced a two-sided nasal fracture on the spot. He inserted a nasal tampon into the nostril with a depressed fracture and applied traction to the nose in line with the axis of the nasal spine. Topical lidocaine spray helped lessen discomfort. Pressure on the side with the elevated fracture pushed it back into place and, transmitted through the tampon, pushed the depressed segment out and back into place. He found no evidence of a septal hematoma or other head injury and notes that radiographs generally add little to the evaluation of nasal fractures, so he didn’t do one. Dr. Fahey also advises splinting the nose and an ENT referral for a later check on positioning.< p>
SALICYLIC ACID SOLUTION
Dr. Hong Liu in Alexandria, Louisiana, reminds us that aspirin produces excellent topical relief for sore throats. Two plain aspirin pills held in the mouth to dissolve them and then slowly swallowed to bathe the throat provide highly effective relief. Of course, aspirin should be used only in patients more than 16 years old with no history of peptic ulcer.
COAXING CRITTERS OUT
Insects in the external ear can be difficult to extract. Viscous fluids like mineral oil are helpful both to quickly paralyze and to kill various pests like cockroaches. In Newport, North Carolina, Dr. Nancy Sun prefers viscous lidocaine (2% or 4%) injected through a 20-gauge angiocath inserted underneath the insect to “float” it out. Often manual extraction is required despite the lidocaine, which can cause vertigo in patients with punctured tympanic membranes.
|
