May 2003

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

THE TRUSTY WAX FLUSH

Techniques to remove ear wax abound, but the one sent in by Dr. Lawrence LaFond in Brighton, Michigan, should be in everyone's armamentarium. A basin is filled with warm water, tested against the practitioner's wrist to avoid excess heat. (Some clinicians advise adding hydrogen peroxide to the water.) An 18-gauge intracath plastic tip on a 10-ml syringe serves to flush out the ear wax. The tip is inserted superiorly and posteriorly in the external ear canal while the pinna is retracted in the same direction. A second basin held below the pinna catches the water exiting the canal. After the wax is out, a soft cotton pledgette is used to dry the canal. This technique and its many variations often work well.
 

PUT A CAP ON IT

To ensure safe and successful drainage of a peritonsillar abscess, Dr. Matt Blue of Kiawah Island, South Carolina, uses a time-honored needle cap adaptation. About one third of the closed end of the needle cap is cut off and the cap is replaced over the needle before insertion, preventing the needle from going too deep.
 

CLUES TO CORONARY CLOGGING

Any hint to help detect underlying cardiovascular disease might prove to be clinically useful, although the evidence is not totally in for this one yet. From Lincoln Park, Michigan, Dr. Basil Rodansky recalls that some data links periodontal infection to coronary atherosclerosis, and he recommends a quick gingival examination be part of routine primary care. Using two fingers to simultaneously lift the upper lip and press down on the lower lip, one can detect such abnormalities as pus along the gingival border and a friable condition in which the gums bleed easily when touched with a tongue blade. I remember that a vertical crease on the earlobe is also purportedly linked to coronary disease. This sign is, of course, a genetic marker while periodontal disease is a sign of infection that may affect the coronaries, predisposing them to lipid deposition.
 

SUTURE YOURSELF

II From Longview, Texas, Dr. Robert Kotch adds some further information to the "Suture Yourself" trick (EMERGENCY MEDICINE, September 2002, p. 8). He reminds us that the combination needle driver-scissors instrument known as the Olsen-Hegar needle holder does very nicely for the situation in which you must both sew and cut on your own.
 

TRICKS OF THEIR OWN

Many drug addicts know that renal colic prompts doctors to give narcotics. From Grand Rapids, Michigan, Dr. Richard Crissman reports a case of a patient who complained of kidney stone pain, claimed to be under the care of a urologist who was conveniently out of town, and after a prolonged bathroom visit produced a urine sample filled with suspicious, noncrenated red blood cells. Dr. Crissman suggested catheter placement to get a "good specimen." The patient's response was to bolt from the ED. We have seen all manner of tricks from addicts, from the fingerprick blood in the urine to the actual passage of a small stone that turned out to be granite from the parking lot.
 

SHEDDING LIGHT ON A LUMP

Using a trick he learned from his physician father, Dr. John Kuhn in Weston, Wisconsin, employs transillumination to dispel a patient's fear that a subcutaneous lump is cancer. He turns off the room lights, leaving a gooseneck lamp switched on, and aims an otoscope light at the lump. He then turns off the lamp so he can see whether the otoscope light shines through the lump. If it does, the lesion is not cancerous but rather a cyst or a lipoma. Of course, a major change in any subcutaneous lump may need further evaluation or excisional biopsy.