July 2001: Tricks of the Trade

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

TACKY APPROACH TO FOREIGN BODIES

A new twist on an old trick to extract a foreign body from a child's ear canal or nose comes from Dr. Marc Deshaies of Chicago. He pulls most of the cotton off the tip of a cotton swab, leaving just enough to absorb some skin closure acrylic glue, which is more plentiful than commercial acrylic glues in most emergency departments. This "tacky" applicator is then pressed against the lodged object. The result? Quick adhesion and easy removal, solving an otherwise sticky dilemma.

PUZZLING AND PERSISTENT SORES

Nonhealing abrasions and wounds, body piercings, and other persistent and treatment-resistant skin lesions may raise concern about a number of diseases and conditions, including diabetes, anemias, blood dyscrasias, steroid overuse, liver disease, AIDS, and other immune-deficiency problems. Before embarking on extensive investigations, however, Dr. Basil Rodansky of Lincoln Park, Michigan, finds it most helpful to inquire about the product that a patient has been using to clean such wounds. Rather than signal a drastic diagnosis, more often than not the nonhealing wound turns out to be a consequence of repetitive application of a toxic substance such as hydrogen peroxide. Discontinuing the practice is almost always curative. Incidentally, Dr. Rodansky informs us that Cornell University researchers have identified hydrogen peroxide as the main ingredient in the stinger stream of the bombardier beetle, which uses the toxin to disable its prey.

ENHANCING THE NGT EXPERIENCE

Nasogastric tubes (NGTs) are never fun or easy to place. However, Dr. Mark Silverberg of Brooklyn, New York, offers some tricks to make them pass smoothly. Place a nasal trumpet in the nostril halfway down, then pass the NGT through the trumpet. This procedure allows the tube to pass by the turbinates easily, causing minimal discomfort. Another tip: The patient may wish to suck on a piece of ice, so that he or she will have something to swallow as you pass the tube.

THE FIFTH VITAL SIGN

Pulse oximetry, also known as the "fifth vital sign," has been used increasingly in the emergency and outpatient departments over the past decade. However, the bright sources of ambient light in these environments can compete with the light-emitting diodes of the pulse oximeter. The photodetector sensor may either give a false oxygen saturation value or, owing to the changes in the signal-to-noise ratio, be unable to calculate the oxygen saturation. To avoid such problems, Dr. Ahmad Hakemi of Mount Pleasant, Michigan, covers the sensors with an opaque material. In the case of a child who has a disposable sensor on his big toe, Dr. Hakemi simply puts the child's sock back on his foot, being careful to recheck the sensor position if the oxygen reading suddenly falls.

REHYDRATING SOLUTION

Dr. Brian P. Hagerty of Tucson, Arizona, sends in this simple formula for administering oral rehydration to a child suffering from dehydration caused by gastroenteritis: 1 ml of rehydration fluid/pound every 15 minutes. If the patient vomits, the amount should be halved for an hour to determine whether the vomiting persists. Over a period of 12 hours, this replacement regimen gives 48 ml/lb, which may be slightly more than most older children with gastroenteritis need, but it does offer a simple way to start rehydration and it is generally well tolerated. And even if vomiting does occur, the stomach is not completely emptied; some fluid is always retained. (The formula is actually appropriate for patients of any age.)

MY KINGDOM FOR A SPACER

To replace a lost metered-dose inhaler (MDI) spacer, Dr. Charles Liang of Bloomington, Illinois, says that a triamcinolone canister, with its built-in MDI, will do just the trick. Simply slip out the steroid canister and replace it with an albuterol canister. This substitution ought to work well, but I would caution your patients to try it out at home before going on the road, where even the best plans--as we all know--often go awry. Other good substitutes are a piece of rolled-up paper or the cardboard core from a roll of toilet paper or paper towels.