June 2005

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

DETECTING A DRINKER

To uncover a severe alcohol dependency, Dr. Basil Rodansky in Lincoln Park, Michigan, asks the patient if he or she has ever spent his or her last penny on one last martini and had an empty gas tank to go with the empty pockets. I suppose each physician finds his or her own best questions to ask to detect alcoholism (I like "How many beers do you have for breakfast?") The CAGE questions are a tried-and-true method to reveal a problem drinker: (C) Have you ever tried to cut down on your use of alcohol?; (A) Have you ever been annoyed by others criticizing your drinking?; (G) Have you ever felt guilty because of your drinking?; and (E) Have you ever needed an eye opener in the morning to settle your nerves? A "yes" to two or more of these questions should prompt an investigation into overall alcohol consumption.

 

THE VENERABLE BEAD

I wonder who first thought up the idea of giving small children beads to string? A bead seems to be a favorite object to stick in a nose. Dr. Mel Schorin from Cambridge, Massachusetts, has found some handy help for that dilemma. He looks to see if the hole for the bead is visible. If so, a small paper clip bent to a 90º angle at the tip of one end can serve as a hook inserted into the hole and the bead can be extracted. He cautions that a cooperative, still head makes this tool work safely.

 

NUMB NOSE

To insert a nasogastric tube, Dr. Scott McIntosh of Hartford, Connecticut, sprays anesthetic into the throat, then inserts a cotton swab laced with lidocaine into the nostril. After five to 10 minutes, the numb nose allows an easier passage of the tube. Sounds worth the effort.

 

LACERATION LESSON

To create a dry wound and to avoid bleeding during a laceration repair with acrylic glue, Dr. Jorge Botero in Chester, New Hampshire, treats the wound with LET (lidocaine, epinephrine, tetracaine) prior to closure. Having struggled with acrylic glue on occasion, I can attest to the usefulness of Dr. Botero's suggestion.

 

CLOSE SHAVE

Prior to suturing a laceration, Dr. Brady Pregerson of Los Angeles, California, shaves off any visible body hair near the wound. Thus he spares his patients one discomfort associated with adhesive removal when the dressing comes off: hair pulling.

 

FLUIDS MADE SIMPLE

From Farmington Hills, Michigan, Dr. Diane Kaiser sends in a simple formula to determine maintenance fluid intravenous (IV) rate. Everyone knows the time-tested formula of 4 ml/hr for the first 10 kg, 2 ml/hr for the next 10 kg, and 1 ml/kg/hr for the remaining weight. For children over 20 kg in weight, Dr. Kaiser simplifies the math by adding 40 to the patient's weight to get a total IV rate per hour. So if a child weighs 30 kg, the calculation is 30 kg + 40 = 70 ml/hr maintenance rate. Why does this formula work? With X as total weight, the traditional formula would be the first 10 kg x 4 ml/hr = 40 ml/hr plus the second 10 kg x 2 ml/hr = 20 ml/hr plus the remaining (X - 20) kg x 1 ml/hr, or X - 20 ml/hr. Add them together and you get 40 + 20 + (X - 20) = X + 40. If the child weighs 10 kg or less, simply multiply the weight by 4. If he weighs more than 10 kg, up to 20 kg, the equation is 2X + 20, based on 40 (for the first 10 kg) + (X - 10) x 2 (for the remaining weight) = 40 + 2X - 20 = 2X + 20.

 

NO WICK? NO PROBLEM

When Karol Bauman, PA-C, from Waynesville, North Carolina, finds herself short of an ear wick, she cuts a 1-cm piece out of a tampon to use in its stead. Ear wicks are pencil-lead-thick cylinders, so the piece of tampon should be cut to match. It will absorb the topical medicine and expand to stay in place in the canal.

 

ON THE SPOT

When blood, coffee, or povidone spills onto a lab coat or clothes, Dr. Thomas Crawford in Santa Clara, California, quickly dilutes the stain with a little water, then applies a generous amount of hydrogen peroxide. The peroxide works slowly, so he gives it some time. In most cases, the potential stain is gone in an hour or two.

 

ACCURATE ASSESSMENT

In the setting of hand trauma, vascular assessment is paramount. Rather than use an often inaccurate capillary refill assessment, Dr. Patrick Martin of Hamlin, New York, quantifies nail bed perfusion with a fingertip oxygen saturation probe. He states that the local plastic surgeons prefer this measurement over all others.