October 2005

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

Going for a Spin

To treat vertigo in an otherwise healthy elderly patient who hasn’t responded to Epley maneuvers, Dr. Jimmie McCready in Panama City Beach, Florida, recommends droperidol, 0.5 to 1 ml intravenously (IV); diazepam, 5 mg IV; meclizine, 25 to 50 mg orally; and pseudoephedrine, 60 to 90 mg orally. The patient must have an ECG prior to droperidol to eliminate the possibility of a prolonged QT interval. The drug doses are subject to adjustment based on the patient’s general health and the response as each dose is given.

Ever-Ready Tool

From Kapolei, Hawaii, Dr. Jamie Juntunen resurrects two uses for that readily available medical instrument—the paper clip. Unbent, the two tips can be used to test two-point discrimination. Properly bent with the long arm uncoiled into an L shape and the remaining rounded end bent backward 180 degrees, the paper clip makes a great retractor for a swollen eyelid or a nonsterile laceration.

Wound Filler

To pack a wound that is too shallow for gauze packing but too deep for a simple bandaid, Dr. Anne Kronish from Closter, New Jersey, fills a 3- or 5-ml syringe with antibiotic ointment and squirts it into the wound, filling it before covering it with a small dressing. The syringe and ointment treatment can be repeated by the patient at home as needed until the wound is healed. Avoid doing this technique with ointments containing neomycin, though, because it often sensitizes the skin.

Baby Sampler

Although a catheter urine sample is the preferred, more reliable urine, when a bag specimen is obtained from an infant or toddler in diapers, Dr. T. R. Jones from Temple, Texas, splits the front of the diaper (if paper) so the urine bag hangs out the front and can be easily seen when filled. The back of the diaper remains intact to catch any stool. Bag urines, when normal, are reliable but should be confirmed if abnormal.

Seal Those Cracks

Now that our ability to wash our hands to avoid being vectors of disease has become a direct reflection on our skills as physicians, we are all going to get more dry skin cracks on our hands, especially on the tips of the thumbs. Moisturizers help prevent the problem, but when it does occur, Dr. Daniel Kohn of Baltimore, Maryland, suggests a solution well known to mountain climbers: cyanoacrylate glue. The glue may initially sting, but when it dries in three minutes, the finger cracks no longer hurt. The glue doesn’t wash off, so fingers stay protected and clean without slippery moisturizers or unwieldy bandages. In support of this advice, I just put some glue on my own cracked thumb tip, which already feels fine!

Pregnancy Tracker

To keep track of significant events during pregnancy, Dr. Arnold Moss of Pinellas Park, Florida, photocopies a birth date or pregnancy calculator wheel and marks these happenings on the wheel. Then he can see the overall course of the pregnancy at a glance. Events such as OB visits, accidents, bleeding episodes, or illnesses can all be noted. Dr. Moss also keys these events to chart notes and has patients sign and date advice written in the notes to show that they understand how to handle specific problems.

Hooked on Fishing

From Pawley’s Island, South Carolina, which has its share of fishermen, Dr. Bradley Peckler sends in a line of treatment for the patient who gets a trident hook caught in the skin. One cannot simply push and pull the hook out through a second puncture wound, so Dr. Peckler pushes the barb out through the skin and flattens it against the shaft of the hook with a hemostat or a pair of pliers. The hook can then be pulled back out of the wound. Others have suggested cutting off the tip with wire cutters or the old standby of encircling the barb with sterile suture material before pulling it back through the puncture site.