July 2004

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

COPY THAT ECG

When Dr. Brady Pregerson from Los Angeles, California, finds an abnormal ECG on a patient in the emergency department, he gives the patient a photocopy to bring back in the event that a return visit is required. It has often been suggested that we should have electronic cards that could have this kind of information imprinted on them, but in the absence of a rapid retrieval method, Dr. Pregerson's precaution seems a useful idea.
 

TIP ON DIGIT LACERATIONS

In Pittsburgh, Pennsylvania, Dr. David Lemonick repairs a lacerated digit after crafting a digital tourniquet out of a sterile glove. After first anesthetizing the digit with a regional block and irrigating the wound, he slips the finger from a sterile glove over the digit, cuts a slit in the glove's tip, and rolls the glove finger down to the base of the digit to create a firm tourniquet, allowing a sterile, bloodless field for the repair. The entire sterile glove could also be placed on the hand to provide a more extensive sterile work surface.
 

PUTTING ON THE SQUEEZE

Everyone knows the old trick of puncturing the lid of a soft liter bottle of either sterile saline or water to use as an irrigation device to debride wounds. From Lewisburg, West Virginia, Dr. Jane Tallman reminds us to use a small (250 ml) bottle for smaller wounds, an 18-gauge needle to make the hole or holes, and three or four punctures if the wound is big. She adds the twist of putting a blood pressure cuff around the bottle to keep the irrigating stream powerful without tiring the hands, especially for wounds that really need a thorough wash.
 

CHEST SPECULATION

To treat a clinically significant spontaneous pneumothorax, Dr. Robert Halpern of Peachtree City, Georgia, places a small-caliber thoracostomy tube into the pleural space, but he finds these tubes to be flimsy and sometimes difficult to guide through a small incision site. To open the planned placement tract, he puts a large, sterile nasal speculum into the wound to allow the tube to pass easily and to visualize its passage into the pleural space. The speculum can be easily pulled back over the end of the tube after the tube is in place.
 

BATTLING UPPER AIRWAY OOZE

In Wichita, Kansas, Dr. Mark Mosley stops upper airway bleeding with inhalations of nebulized epinephrine (1 cc of 1:1000 solution) to clamp down the blood vessels. This inhalation works best for post-tonsillectomy hemorrhage or oozing and helps to stop epistaxis after suctioning and neosynephrine application. Although I have never been a fan of topical epinephrine, Dr. Mosley's idea seems worth a try to avoid a trip to the operating room. I would hesitate to use it in anyone with known cardiac disease and would watch the vital signs, but young patients tolerate epinephrine well.
 

GLUE BARRIER

Miracle though acrylic glue is, its delivery system leaves something to be desired. When repairing a laceration around the eye, Dr. David Yew in Honolulu, Hawaii, prevents leakage of glue onto the eyelid or into the eye by covering potential problem areas with clear adhesive plastic wrap like that used to cover intravenous needles. Any glue spill leaks onto the wrap, not the skin or eye. He waits a few moments for the glue to dry, then peels the wrap off, leaving the patient safe and sound.
 

PREVENTING TUBE DECAY

From Albany, New York, Dr. Vernon Wheeler, Jr., notes that stethoscope tubing is prone to stiffen and become brittle due to contact with oils from the skin. To avoid this deterioration, he covers his stethoscope with elastic cohesive bandage. It is flexible and adheres to itself, protecting the tubing for a long time. I wonder if it alters the acoustics, but stethoscopes do need something to halt "tube decay." I hope Dr. Wheeler shares the "Trick" stipend with his nurse, who first conjured up the wrap.