September 2004

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

PAINLESS PACKING

Repacking an abscess with gauze can be extremely painful. In Pleasanton, California, Dr. Thomas Crawford makes it easier on the patient by filling the abscess cavity with 0.5% bupivacaine and waiting 10 minutes before he begins.
 

NAIL NUMBNESS

Another pain-saving tip from Dr. Crawford: Prior to draining a subungual hematoma, he soaks the patient's finger in ice water to the point of pain. After a quick dry, cautery drainage is nearly painless.
 

UMBILICAL TOOLS

Seeing the bottom of the umbilicus is tough. In Mill Valley, California, Dr. Robert Molino praises a disposable speculum on an otoscope for illumination of this often elusive sight. An ear speculum helps when examination is complicated by umbilical edema from such conditions as omphalitis, while a larger nasal speculum allows removal of foreign material or cauterization of a granuloma. A plastic ear curette or wax scoop is useful for extracting offending squamous or fibrous debris.
 

LICK THOSE LICE

The drug trimethoprim/sulfamethoxazole (TMP/SMX) can be given to treat resistant head lice. Usually, three days of the single-strength (80 mg TMP/400 mg SMX) dose given twice a day is effective, but since nits are unaffected, retreatment in 10 days is necessary to eradicate offspring. A combination of topical pediculocides with TMP/SMX may work best. In Tivoli, New York, Dr. Michael Jaeger recommends a straight two weeks of treatment. The drugs probably kill lice gut bacteria and thereby prevent metabolism of ingested nutrients. Folic acid metabolism may also be disturbed.
 

LAUNDRY SUPPLEMENT

Next time your lab jacket has an encounter with Betadine or iodine, try this technique from RNs Linda Lane, Roni Taylor, and Sheri Palmatesso from Oswego, New York: Moisten a vitamin C tablet and rub it over the stained areas prior to washing. The result is a stainless reputation, the nurses say.
 

SCRATCH AND LISTEN

The scratch test is a time-honored method to detect an enlarged liver in an obese or muscular individual. With the stethoscope over the xyphoid process, the examiner scratches the abdominal wall with a fingernail or reflex hammer handle tip. A change in note as one ascends from the lower abdomen signifies the liver edge. Thanks to Dr. Jerome Lebovitz from Pittsburgh, Pennsylvania, for the reminder.
 

THE FLIP SIDE

From Bryn Mawr, Pennsylvania, Drs. Chris Daly and Len Checchio report that turning a patient into the prone position facilitates immobilization. The idea, they say, came from observing that turning a trout upside down to remove the fly hook causes the disoriented fish to stay still. The medically stable agitated, psychotic, or combative patient is much calmer or more easily subdued if face down on a stretcher. However, the psychological impact of this position has to be monitored because some individuals may panic when they lose visual clues to the room.
 

REALITY THERAPY

If he encounters a teenage girl who has engaged in unprotected sexual intercourse, Dr. Stephen Acosta from Portland, Oregon, asks her if she has thought of "a name for the baby." Sometimes this blunt question shocks the girl into protective action. A softer approach involves questioning what the girl might do if she became pregnant, serving to remind her of the seriousness of her decision. Always be ready with birth control and sexually transmitted disease advice.