July 2003

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

SPARE THE SUTURES

Closure of a deep wound in an elderly patient with friable skin is not an easy task. Simple suturing often tears the skin. From Denmark, Maine, Dr. Joseph Shubert reports what he calls his "Steri-Bond technique," a closure method using sterile adhesive strips and acrylic glue. After copious irrigation and debridement, he paints one wound margin with acrylic glue and places sterile adhesive strips along that margin, waiting several minutes for the glue to dry. He then applies a second coat of glue over the strips to secure them, and places a small Penrose drain in the wound. While applying gentle pressure from the side of his left hand to the stripped edge of the wound to push the edges together, he coats the opposite wound margin with acrylic, and with smooth forceps pulls the adhesive strips one at a time across the wound to close it. After several minutes of drying time and before releasing pressure, he applies a final layer of glue over the strips on the other side. The Penrose is removed in 48 hours. This method may be time-consuming, but certainly should allow excellent wound closure.
 

LOOK AGAIN

To counter the natural tendency to focus on the cardiac silhouette and lung fields in diagnostic images of the chest, Dr. Richard Giovannini from Harrison Township, Michigan turns the radiograph or digital screen image upside down. The changed orientation forces the viewer to examine the whole film anew, facilitating detection of rib fractures or other bone pathology. To reduce radiograph-reading errors, others have advised looking at an area of interest through a rolled-up piece of paper used like a telescope.
 

DOCUSATE DOUBLE DUTY

Impacted cerumen seems to have reached epidemic prevalence. In Port Orange, Florida, Tim Foley, PA-C, recommends three drops of docusate liquid in the affected ear held in place by a cotton ball for 10 minutes, followed by plain warm water irrigation. He claims it works like magic. I like to mechanically remove impacted ear wax, so I generally avoid wax softeners because they loosen the solid plug too much. However, if this product works at home, it seems worth a try.
 

LET A GUIDE BE YOUR GUIDE

To successfully catheterize an uncircumcised man with severe penile and scrotal edema, Dr. Patrick Martin of Hamlin, New York, recommends that the standard external pressure to reduce edema be abandoned in favor of a urethral guide inserted into the Foley catheter to stiffen it and to enhance the tactile sensation of the catheter tip finally entering the urethral meatus. As soon as it does, Dr. Martin removes the guide to avoid excess trauma and slips the catheter into the bladder.
 

HANDY SOLUTION

From Pittsburgh, Pennsylvania, Judy Johnson, RN, provides a practical solution to the problem of keeping the bandage on a hand wound while still doing one's work, especially in a setting that requires clean hands or is particularly dirty. Following an accidental burn to her hand, Ms. Johnson applied a dressing, taped it in place, and covered it with a latex glove that had the fingers cut off to allow her to continue her work and wash her fingers. The glove could be changed as necessary. Add that to a long list of good uses for latex gloves—which, incidentally, provide great protection while gardening.
 

PLAYFUL PERSUASION

To gain cooperation in pediatric throat examinations, Dr. Eric Legg from Canal Winchester, Ohio, asks the child how many teeth he or she has. He then asks if he can see all the beautiful teeth and count them. Gently tapping each tooth with a tongue blade and counting out loud, he tells the child he is having difficulty seeing the back teeth (molars) to count. The child will usually open wide to expose the posterior pharynx and tonsils. Dr. Legg writes that after counting teeth, most children will even submit to a gentle throat swabbing without a fuss.
 

CHARCOAL SUNDAE

Another suggestion for overcoming youthful resistance comes from Dr. Michael Solis in Visalia, California. When a child needs to be treated with activated charcoal, Dr. Solis sprinkles it on ice cream, using a cherry-flavored charcoal formulation when available. The high palatability of ice cream apparently compensates for the gustatory deficiencies of charcoal.