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June 2008
Contributed by readers/Edited by Donald B. Middleton, MD
HorsePlay
Properly diagnosing peritonitis in a young child can be difficult. To this end, Dr. Brady Pregerson of Los Angeles, California, finds the “bounce test” helpful. Have the patient’s parent or guardian bounce him on her knee as if they were playing “horsey.” If the child cries, it may be the result of jarring of an inflamed peritoneum, and peritonitis should be considered. If the child smiles, however, a less serious problem is more likely. Along these same lines, an older child can be asked to jump as high as possible. Additionally, the cough test for peritonitis is well described and doing a sit-up can detect some problems. All of these maneuvers irritate the peritoneum without placing direct pressure on the abdomen, which can produce erroneous results due to fear or ticklishness.
Revised Rectal Exam
Everyone knows patients don’t enjoy rectal examinations. So when a rectal mass, enlarged prostate, active rectal bleeding, or hemorrhoids are not a consideration, Dr. Caxton Opere, from Baton Rouge, Louisiana, offers this tip to reduce both the invasiveness and discomfort of the exam. He uses a lubricated cotton-tipped applicator to obtain a stool specimen. It is gentler and less intrusive than the traditional method. He can perform the exam himself or, if they feel up to it, allow his patients to do so. In the latter case, it is important to make sure the patient is gloved and to instruct him to proceed gently and not insert the applicator more than two inches. Dr. Opere claims he hasn’t had to repeat the exam yet.
Picture Perfect
With so many emergency departments turning to digital radiology, showing patients their radiographs is becoming more difficult. Instead of sitting his patients in front of a computer screen, Dr. Chris Galloway in Colorado Springs, Colorado, prints out the radiographs to give to them. The printed copies are clear enough to show fractures, nodules, and other findings, which he can point out with a red pen. Patients, especially children, are often thrilled to have pictures to accompany their stories for friends and relatives.
Take Your Pick
When a patient presents with an early abscess from an infected hair follicle, Dr. James Nelson, of Brawley, California, takes a dental pick and runs it through the follicle at the center of the lesion. By pulling on the pick slightly and squeezing the lesion firmly, he is often able to squeeze out a dab of pus that could not have been reached with an incision or needle aspiration. It is, of course, imperative to anesthetize the area prior to the procedure.
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