December 2001: Tricks of the Trade

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

NSAIDS FOR RENAL COLIC

To control the pain of renal colic, Mark Silverberg, MD, of Brooklyn, New York, opts for giving nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, rather than narcotics. In addition to nauseating patients, narcotics may aggravate ureteral spasm and suppress both mentation and respiration. Dr. Silverberg also claims that NSAIDs reduce ureteral spasm through inhibition of prostaglandin synthesis. If necessary, narcotics can always be given later.

LIGHT BREATHING

This column has received many suggestions for ways to encourage young children to breathe deeply for lung auscultation-including the use of a pinwheel. Certified physician assistant Christopher J. Carlisle of Vero Beach, Florida, relies on the old standby of asking a small child to "blow out" his otoscope. Controlling the light with his thumb, he gets the child to take deeper and deeper breaths until he finally succeeds in blowing out the light. A little cheering on always helps achieve a better assessment of lung sounds in a child.

A CLEAR VIEW

To fashion a cheap splash shield, Dr. Gregory T. Guldner of Loma Linda, California, tears off the transparent plastic eye shield from a trauma face mask and then pokes an 18-gauge intravenous Angiocath through its center. Discarding the needle portion of the Angiocath, he connects the plastic catheter to a syringe with or without a three-way stopcock. The plastic shield provides great protection from splashing while allowing a clear field of vision.

RAISED EYEBROW

To close a laceration of the lower forehead near or involving the eyebrow, use stitches rather than adhesive glue, suggests Dr. Tamela Zimmerman of Cincinnati. The reason? Glue can bond to the eyebrows, so that any effort to remove it will pull the hairs from their follicles, creating a permanent and conspicuous patch of missing hair.

A MESSAGE WITH VISION

From the Lahey Clinic in Burlington, Massachusetts, comes this practical tip via Dr. Tristram C. Dammin. He reminds us that the slit lamp is a handy magnifier that is available in most emergency departments and in some offices. In addition to aiding the evaluation of the eye, the slit lamp can assist foreign body removal elsewhere on the face, as well as on the hands, ears, and even the feet once the patient has been comfortably positioned.

THE IV SOLUTION

How do you prepare a vein for intravenous insertion when there does not seem to be any peripheral access whatsoever? Dr. M. Albert Malvehy of Philadelphia has an old standby method that works even in the most difficult of patients, he says. He inflates a blood pressure cuff, placed just above the proposed intravenous site, to a pressure between systole and diastole. For example, to locate a vein on the hand, Dr. Malvehy leaves a cuff inflated on the forearm. After about five minutes, he reexamines the hand. Most of the time, the vein along the lateral side of the index finger's metacarpophalangeal joint or sometimes another digit will be visibly engorged and ready for an intravenous insertion.

THE NOSE KNOWS NAC

N-acetylcysteine (NAC) works very well to reduce toxic reactions patients may have to radiocontrast materials and, of course, is the agent of choice for treating acetaminophen poisoning. However, its sulfur smell can induce vomiting. To reduce that emetic effect, Andrew McVie of Nashville, Tennessee, dilutes the drug in grape juice outside the patient's room and then covers the cup with an airtight lid or a nonlatex glove in which he has made a small hole in a finger, through which he inserts a straw. He then wraps tape around the straw, preventing odor from escaping and creating a tight seal between the noxious NAC and the patient's nose.

FOREIGN BODY EXTRACTION

To remove small objects from the nose or external ear canal, Dr. Ramsey Hasan of Waipahu, Hawaii, cuts a small feeding tube and attaches it to a suction catheter. Most small objects can then be removed quickly and easily. The larger diameter of the feeding tube provides a better suction device than the typical plastic or metal suction tip. Another advantage is that it is not as traumatic to tender surfaces.