December 2007

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

Before the Fall
In cases of benign positional vertigo or even more general episodes of nausea or vomiting, Dr. Gus Garmel from San Francisco, California, espouses administering 1- to 2-mg doses of IV dexamethasone as a preliminary drug treatment before giving antiemetics to patients. Since glucocorticoids are a recognized therapy for acute vertigo, this advice sounds like a good way to provide a little additional relief from the misery.

Light Touch
When a patient requires aspiration of a peritonsillar abscess, Dr. David Ronan in Spartanburg, South Carolina, advises using the bottom half of a disposable, clear plastic, gynecologic speculum with an attached light source to depress the tongue and illuminate the pharynx. He finds this technique is easier than using the traditional headlamp and metal tongue depressor found in most ENT cabinets. It certainly seems like a patient-friendly alternative for a painful situation.

Bloodless Removal
Dr. Garmel also brings us a helpful tip for removing an intravenous or peripherally inserted central catheter with minimal bleeding. After turning off the infusion, elevate the extremity and remove the catheter or needle along the same axis as the vein. Applying firm pressure to the elevated extremity for at least two to three minutes and applying a bandage results in no bleeding and no bruising.

Untangling the Web
Dr. Chris Galloway in Colorado Springs, Colorado, always asks his patients if they use the Internet. If so, he writes down their diagnosis and asks them to “Google” it for more information. I would only add that it’s important to suggest specific sites that have both good lay information and an easy-to-use search engine. Two of my favorites are the Web pages of the American Academy of Family Physicians at (www.aafp.org) and the American Academy of Pediatrics (www.aap.org). All of us should surf the Web routinely for medical information sites that our patients may find helpful.