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December 2002: Tricks of the Trade
Contributed by readers. Edited by Donald B. Middleton, MD
SPOTTING FACIAL FRACTURE
From Woodhaven, Michigan, Dr. Basil Rodansky cautions everyone
to look for periorbital petechiae as a sign of facial bone fracture,
especially in patients at high risk for trauma, like car crash victims
or teenage boys who have been drinking too much. Of course, other
mechanisms like a sudden increase in thoracic pressure from a cough
can also lead to periorbital petechiae, so a detailed history of
recent events may be necessary to suggest the likely diagnosis.
THE UNIVERSAL SOLDIER
You never know when trouble may strike, so Dr. Jeff Kuch in Largo,
Florida, always arms himself with his "universal procedure needle,"
a 16-gauge, 2-inch purple intracath. Not only can it be used in
an emergency to cannulate a peripheral vein or the subclavian, internal
jugular, or femoral vein, but it can be used as an introducer, for
paracentesis or vein thoracentesis, to irrigate the external ear
canal, or for cricothyroid membrane puncture to give oxygen. I have
also found it to be a great needle to drain pus.
EYE WASH. DO YOU?
When he irrigates an eye exposed to a toxic chemical using the
Morgan lenses, Dr. Matthew Ho from Baldwin Park, California, adds
10 ml of 1% lidocaine to the bag of irrigant solution. The patient
stays comfortable despite the washout of the topical anesthetic
initially used to permit insertion of the Morgan lens.
STRATEGIC NAPPING
Recent studies have suggested that brief cat naps can refresh.
To reduce the fatigue of night shifts, Dr. Stephen Acosta in Portland,
Oregon, advises keeping track of the hours at which you become most
fatigued and taking 15- to 20-minute power naps in a dark, quiet
location at those times if circumstances permit. This works wonders,
he says—as long as you do not go over 20 minutes, which will
only leave you feeling worse than before.
DE-FEETING DRYNESS
From Austin, Texas, Dr. Margie Viscardi finds that patients' dry
winter feet respond very nicely to plain old petroleum jelly, applied
once or twice a day and covered with cotton socks. No muss, no fuss,
and no fancy creams or lotions needed. She adds that a little petroleum
jelly applied each night to the nasal septum with a cotton-tip applicator
helps to prevent nosebleeds in the dry winter air.
EMERGENCY NAIL
To replace a badly damaged fingernail, to protect the nailbed,
and to keep the eponychium separated from the nailbed, Ms. Claudia
Radist, RPA-C, from New York City places a piece of either suture
packaging foil or plastic over the nailbed and beneath the eponychium.
These stiff materials remain in place long enough for the nail plate
to start regrowing and re-covering the nailbed.
DON'T LEAVE THEM BREATHLESS
As a variation on a spacer for self-administration of asthma medications,
the mouthpiece and flexible tubing from the respiratory treatment
apparatus in an emergency department make a superbly suitable substitute,
according to Dr. Kent Carey in Tucson, Arizona. After delivering
a treatment, he gives the patient, usually a child, these parts
of the treatment canister. At home the mouthpiece is inserted into
the flexible tubing with the metered dose inhaler (MDI) in the opposite
end. After a few squirts into the tubing, the MDI is removed, and
the patient inhales through the mouthpiece. The spacer thus devised
is smaller than those available commercially but works better than
the empty toilet paper roll or rolled-up sheet of paper that is
often used in a pinch.
TICK TRICK
To test a patient's hearing, Dr. Mark Silverberg from Brooklyn,
New York, puts his watch up to the patient's ear to find out if
the tick, which is usually in the mid-range of human hearing, can
be detected. Of course, this tip involves a watch that ticks. Or
does it? When I hold my silent digital watch up to the ears of some
older patients, they often tell me they hear the "tick"—which,
of course, strongly suggests the need to test their hearing.
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