December 2003

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

AUSCULTATION ALTERNATIVE

To detect an area of chest dullness, Dr. Martin Hecht of Brooklyn, New York, has abandoned the traditional finger-on-finger tap in favor of auscultating the chest while percussing the sternum anteriorly with the tips of one or two fingers. He says the area of dullness is readily appreciated with this technique.
 

NASOGASTRIC TUBE LUBE

To reduce discomfort from nasogastric tube placement, Heather Schalon, PA-C, from Santa Maria, California, sprays a commercial mixture of benzocaine, butyl aminobenzoate, tetracaine, and benzalkonium chloride into the nostril prior to tube insertion. She reports that the resulting anesthesia is superior to that of topical lidocaine gel, and that the spray drips back to the throat to numb it as well.
 

SMOKE OUT LUNG DISEASE

From Espanola, New Mexico, Dr. Miguel Dozier points out that some patients fail to report past episodes of wheezing, denying that they have asthma or COPD. To make sure this important information gets into the history, he asks patients whether they have ever used a metered-dose inhaler (MDI) or "puffer." Patients often omit an MDI from their medication lists, failing to recognize the potency of these useful medications, or forgetting or discounting the MDI because it is not used every day. We all need to remind our patients that medicines can be other than pills.
 

NO SPACER, NO PROBLEM

Speaking of asthma, Dr. Ilene Burns of Pittsburgh offers a tip for patients and especially for parents of asthmatic children: Try a plastic drink bottle as an inexpensive substitute for a lost spacer. Briefly heat a wooden-handled paring knife over a stove burner, then cut an X into the bottom of a clean, empty, single-serving water or soda bottle. This X-shaped opening will hold the mouthpiece of the inhaler. The patient places the lips around the open screw-top of the bottle, pumps two puffs from the inhaler into the bottle, and inhales.
 

SAFETY CUP

From Sugar Hill, Georgia, Dr. Kela Henry reminds everyone to guard against inadvertent splashes when using a syringe to irrigate a wound. Inserting the needle into the bottom of an inverted clear plastic cup or, in a pinch, an ordinary paper cup is an excellent way to do this. The clear plastic is best for visualization, but any guard may reduce the risk of bloodborne organism contamination. Remember your eye protection, too.
 

COMING UNGLUED

In the unlikely event that acrylic glue spills onto a patient's eyelashes or into the eye, Dr. Ariel Marks in San Carlos, California, applies over-the-counter eye makeup remover to the eyelashes or any ophthalmic antibiotic ointment, such as erythromycin 0.5%, to the orbit. These preparations lubricate the cyanoacrylate, allowing it to slough off the surface without causing deep injury. Although we all hope this difficulty will never confront us, Dr. Marks's advice is worth keeping in mind.
 

STRIPPED DOWN

To align wound edges prior to acrylic glue application, Dr. Edward Junn of Portland, Oregon, puts a few sterile strips across the wound to oppose the edges and, after applying the glue with a cotton-tipped applicator, leaves the strips in place to better secure the wound for healing. He finds this trick minimizes scarring as well.
 

IMAGINARY FRIENDS

When a child needs an ear examination, Dr. Netti Riggs from Santa Clara, California, follows the suggestion from Dr. Gus Garmel in the April 2003 issue about asking which ear the child wants her to inspect first. She often goes on to ask what the child thinks will be in there. Then, as she examines the first ear, she whistles and says, "It's a bird!" Moving to the other ear, she meows and exclaims, "There's a kitty-cat!" She says some kids find this playful routine so entertaining that they ask to be re-examined.
 

CARDIAC MEASUREMENTS

Lacking a ruler, Dr. Kevin Meyer from Cincinnati points out, one can always make do with a strip of EKG paper. Each small box is 1 mm and each large one is 0.5 cm. Dr. Meyer finds the EKG paper especially helpful in measuring kidney stones, nevi, or lacerations.