June 2001: Tricks of the Trade

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

TINY TOURNIQUET?

Most often when a new mother seeks help for a baby who cries excessively, the problem is her inexperience and overanxiousness, which usually go hand-in-hand. However, sometimes a real medical malady does exist, as Dr. Mark Silverberg of Brooklyn, New York, points out. He advises examining the infant closely for a previously undiagnosed congenital inguinal hernia or for a hair that has become tightly wrapped around a digit, especially a toe. Either of these problems can cause significant illness if not addressed in a timely fashion. I have even found a hair wrapped around the penis.

LET'S HEAR IT FOR THE EARS

Everyone knows that vinegar contains acetic acid and that acetic acid kills Pseudomonas organisms, the water-borne bacteria responsible for otitis externa, or swimmer's ear. Medical student D. Scott Moore of Woodridge, Illinois, suggests treating this problem according to a procedure outlined by the Chicago Otology Group Physicians.

In a one-to-one proportion, mix ordinary white vinegar with warm water. Fill either an eye or medicine dropper--which works best--or a 2-oz rubber ear syringe and its bulb with the half-strength vinegar. Tip the patient's head to the side, with the infected ear facing upward, and fill the ear canal with the solution. Place the tip of the dropper into the ear canal, but try not to obstruct the opening. Compress the bulb firmly, release, and then repeat. Swishing the solution back and forth repeatedly loosens the debris in the canal. Discard the solution. Repeat the process until the returning fluid is clear. To avoid causing dizziness, make sure that the half-strength vinegar is at room temperature. Repeat this treatment two to three times a day for 7 to 10 days.

The 2-oz suction bulb contains more fluid, but it is a bit messier to use and more difficult to see when the fluid is clear. Rarely, the appearance of itching, burning, or increased ear discharge will necessitate the discontinuation of these ear washes. In addition, patients who have otitis externa should be advised to avoid letting water enter the ear canal during their baths or showers. A cotton ball covered with petroleum jelly and placed in the canal serves as an excellent barrier and is particularly useful during the treatment period.

MELLOW YELLOW

Can't remember the desired color for end tidal CO₂ indicators? Here is a handy mnemonic provided by Dr. Steve Jarrard of Lander, Wyoming. He says the phrase "yellow is mellow" helps him keep the patient the right color and maintain a proper pH.

FANTASTIC PLASTIC

Dr. Khin Maung Aye of Yangon, Myanmar, offers some practical advice to help preserve radiographs, ECGs, and other potentially perishable items: laminate them. The cost is only a few pennies per item, and commonly available lamination machines are big enough to cover even large radiographs. The process is especially useful for chronically ill patients, whose old films, echocardiogram results, sonograms, and other studies might be required for comparison with later results. To keep permanent images, I also like scanning items directly into a computer.

PENETRATION PUZZLE

A useful warning about removing embedded foreign bodies comes from Dr. Mansoor Mosley of Santa Ana, California. Before beginning such a procedure, always consider what an object might have punctured. If a significant risk of penetration exists, such as in the arteries, intestines, or nervous system, the foreign object might be effecting tamponade in a blood vessel, stemming a leak, or masking the site of organ penetration. Even an object as seemingly minor as a toothpick protruding from the abdominal wall or a pencil stuck in the nose may portend underlying serious injury. In the long run, x-ray films and consultation may prove to be the better alternative to immediate removal of the object.

TAKING A SHOT AT BUSINESS

Does anyone recall the date of his or her last tetanus booster? To help her patients remember when they received their last shots, Dr. Martha J. Shadel of Harrison Township, Michigan, has a handy trick that she and her colleagues use. They write the date on the back of their emergency department business cards and give them to their patients to keep in their wallets. Not only do the cards serve as a reminder, they are also a good publicity booster for the hospital.