August 2003

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

AH, ATROPINE

When gastroenteritis is refractory in adults who cannot tolerate oral rehydration, Dr. Michael Solis of Visalia, California, recommends intravenous fluids laced with atropine. Using a solution of 0.4 mg/L, he infuses 1 liter of fluid at 250 ml/h. The atropine reduces peristalsis and thus diarrhea, and patients appreciate the relief. According to Dr. Solis, atropine-induced side effects like blurred vision, tachycardia, or delirium are rarely, if ever, seen. For smaller individuals, I wonder if a lower dose might suffice.
 

ANTITERRORIST SAFEGUARD

Some physicians, among them Dr. John Wipfler of Peoria, Illinois, advise that each worker in a medical facility should have access to an N-95 or N-100 HEPA filter mask to defend against bioterrorist weapons. At a cost of $1 to $10 each, these masks filter out viral, bacterial, and radioactive particles. They cannot block chemical agents like nerve gas, which require military-style masks that cover the eyes and are themselves dangerous to the untrained. Most hospitals are equipped with HEPA filter masks, which should be worn by patients, staff, and physicians in any suspicious situation.
 

JOINT EFFORT

Although we do not usually print personal testimonials, S. S. Jaswal, PhD, in Saginaw, Michigan, submitted one that struck a familiar note. Afflicted with arthritis of the knees, he tried numerous cures. What worked, in the end, was improved physical fitness. Dr. Jaswal reduced his weight from 192 pounds to 180 pounds through dieting and took up cycling to exercise his knees. After getting in shape, he even started jogging a mile or two each day. For patients who listen to our advice about weight management and regular exercise, the reward of reduced pain may be forthcoming.
 

BUDDY UPDATE

Instead of the traditional "buddy" taping for an injured digit, Dr. Daniel Determan of Omaha, Nebraska, recommends elastic adhesive bandage for the task. Before binding the two fingers together, he completely wraps the injured digit to provide interdigital padding, extra reduction of movement, and protection against further trauma.
 

A REAL PEARL

For the pain of aphthous ulcers or cold sores, Dr. Lawrence Adler in Beverly Hills, California, reports that benzonatate, available as antitussive pearls, makes a good home remedy. Patients puncture or cut open the pearls and apply the benzonatate to the ulcers with a cotton swab. This local anesthetic is safe and has no side effects.
 

RECYCLE THAT NEBULIZER

From Glenview, Illinois, Dr. Romulo Hernandez reminds us that the mouthpiece and reservoir sections of a respiratory medication nebulizer can be saved for use as an ersatz spacer. The soft plastic reservoir fits snugly over a metered dose inhaler and the mouthpiece fits nicely into the other end of the reservoir. When the patient pumps the aerosol into the reservoir, he or she should cover the open mouthpiece with one hand, or have it already positioned inside the mouth, and inhale immediately after the aerosol enters the tube.
 

VISCERAL SOLUTIONS

To detect peritonitis in a patient who is guarding or splinting the abdomen, Dr. Martin Hecht of Brooklyn, New York, finds two techniques helpful. He asks the patient to cough forcefully or to jump up and down, either of which causes the visceral peritoneum to rub against the parietal peritoneum and thereby produces pain in anyone with peritonitis. I find these ideas most useful in patients who are so ticklish that they won't let me palpate the abdomen.
 

FOLLOW THE LESION

To keep track of irregular nevi or other small skin lesions, some clinicians trace the lesion on a piece of clear tape that has been applied over it, which is then placed in the permanent record and covered with a second piece of tape to avoid loss of the ink outline. Dr. Robert Molino of Mill Valley, California, prefers an alternate version of this method: He traces the lesion directly on the skin, using a ballpoint pen, and then presses the clear tape over it. The tape picks up the outline, he explains, which is smearproof when transferred to the progress note since it is face down. On a return visit the process can be repeated, with the new tape being laid over the old one to reveal any subtle growth.