March 2008

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

Big Mac
Many doctors use a tongue blade and a headlamp to allow for adequate visualization of the pharynx before draining a peritonsillar abscess. Dr. Dan Firestone in San Diego, California, however, finds a Macintosh laryngoscope held upside down can both light the pharynx and control the tongue. The blade shouldn’t be inserted too deeply or the patient may gag, and some care is needed to avoid trauma to the teeth. But when the procedure is executed correctly, he is rewarded with an excellent view. With the laryngoscope in one hand, the other is free to perform a needle aspiration of the abscess. Dr. Firestone has the patient hold a suction catheter to clear away saliva and pus, and a glass of water is handy for gargling and rinsing.

PILLOW TALK
Patient comfort is paramount in the emergency department. When additional head support is needed but extra pillows are in short supply, Dr. Thomas Crawford from Santa Clara, California, uses an unopened roll of paper towels as a stand-in. Others have had success using rolled-up sheets or towels bundled together with tape or simply placed inside a stockinette.

On the Edge
Jon Gootnick, PA, in Penfield, New York, reminds us of an old trick to determine whether stitches or staples are ready to come out. In order to check the status of a healing laceration without risking reopening it, he removes every other suture or staple, testing the strength of the wound edge as he does so. If the wound margins begin to separate, the removed suture or staple is replaced with an adhesive strip. The others are then left in place for a few more days, when another attempt can be made.

Intertrigo Intervention
When Dr. Basil Rodansky of Lincoln Park, Michigan, has trouble treating intertrigo, he supplements the patient’s antifungal therapy with multiple applications of antiperspirants, sometimes up to four times a day. Antifungal powders help relieve dryness, and topical steroids can quickly relieve the symptoms of intertrigo while the infection is brought under control. Dr. Rodansky reminds us that if intertrigo persists, we should consider an underlying condition like diabetes mellitus.