October 2003

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

LIDOCAINE'S STING

Many physicians believe that adding 1 to 2 ml of sodium bicarbonate to 1% lidocaine reduces the sting of an anesthetic injection, a suggestion sent in by Dr. Bruce Becker in Bloomsburg, Pennsylvania. However, a recent double-blinded trial has shown that slow injection with a 30-gauge needle is less irritating than altered-pH lidocaine and that bicarbonate adds no benefit to the slow injection technique. I keep checking with my patients, but most of them say it makes little difference how the injection is done.
 

FEED THE NEED

When you are faced with an impatient, angry, or suicidal patient, a little offering of food may turn the emotional tide in your favor. Dr. D. Brady Pregerson in Beverly Hills, California, writes that he once used food successfully to soothe a woman who was threatening to kill someone. Now I understand why the emergency department staff usually has a few snacks scattered about. Of course, most of us need only recall the pre- and postprandial phases of a family car trip to be convinced that this idea has merit.
 

HIP IDEA

To reduce a nonfractured, dislocated hip, Dr. Paul Gill, Jr., in Plattsburgh, New York, enhances the Allis maneuver with a gravity boost. The patient lies supine on a stretcher with buttocks one foot from the end. Dr. Gill stands on a chair at the foot of the stretcher, which is elevated to its maximum height. Conscious sedation helps. An assistant pulls laterally on the inside of the thigh with one hand and presses down on the pelvis with the other. With the patient's knee flexed, Dr. Gill applies longitudinal traction in line with the femur. Reduction is achieved by gentle flexion, adduction, and internal rotation of the thigh.
 

SPECTACULAR VIEW

When you really have to see into the pharynx, as in draining a peritonsillar abscess, a tongue blade just seems inadequate. Dr. Michael Solis of Visalia, California, reports that the bottom half of a plastic vaginal speculum makes a terrific tongue depressor in this situation. The handle allows an assistant to hold down the tongue without impeding the view, and the wide lip of the speculum compresses more of the tongue for a clearer picture of the throat.
 

HELP FROM A BARBER

Almost every time I irrigate an ear canal, the patient gets a little unintended bath. In Alexandria, Virginia, Dr. A. Aljuburi solved that problem by persuading his barber friend to donate one of the plastic capes used to cover clients during haircuts. Perhaps we ought to get our own.
 

FINISHING TOUCH

From East Canton, Ohio, Dr. Dean Varian resurrects an old trick he published in the 1980s: the gauze pad compression bandage. Sometimes a finger laceration continues to bleed even after it is repaired. In such cases, Dr. Varian unfolds a 4 x 4 gauze pad once, then refolds it a few times along the long axis to create a strip 1/2'' to 3/4'' wide. After wiping the blood off the sutured wound, he quickly wraps the folded gauze around the finger and over the wound, pulling firmly on the free ends to create enough pressure to halt the bleeding. A hemostat clamps the free ends tightly against the digital surface opposite the wound to hold the pressure on the repair. The clamped gauze can be removed in 10 to 15 minutes and a final dressing is then applied. The gauze pad not only stops the bleeding but reduces the incidence of wound hematoma.
 

BLOW THE PAIN AWAY

If a child is suffering with ear pain in the middle of the night, Dr. Michael Jaeger of Tivoli, New York, tells the parent to set a hair dryer on low and blow it directly into the ear canal. This trick almost always relieves the pain, but caution should be observed with young infants and toddlers, for whom it might easily lead to a burn.