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April 2008
Contributed by readers/Edited by Donald B. Middleton, MD
STAND-IN FOR SPUDS
Eye spuds can often be difficult to find in the emergency department, but Dr. Christina Shih from San Francisco, California, doesn’t resort to using a needle to remove corneal foreign bodies. Instead she snaps a wooden cotton swab in two, which usually leaves one piece with a point that is sharp enough to extract the foreign body, but not sharp enough to injure the patient’s cornea. Also, if the swab is broken near the end, it is longer than a needle and consequently easier to maneuver when using a slit lamp. After the foreign body is dislodged, the cotton tip can then be used to retrieve it. One caveat: make certain the wood has no splinters. There’s no reason to replace one foreign body with another.
PEG TUBE: FIZZY FLUSH
From Houston, Texas, Dr. Kent Erickson reports his handy solution for opening a clogged percutaneous endoscopic gastrostomy (PEG) tube: a carbonated soft drink. When an ounce or two of soda is poured inside the tube, the release of carbon dioxide unclogs dried feeding tube preparations. While this seems effective, I’m surprised that there is no dedicated PEG tube cleaning solution on the market.
PEG Tube: The Sequel
Once you’re finished cleaning a blocked PEG tube, reinserting it in the proper channel with minimal discomfort to the patient is crucial. In Farmington Hills, Michigan, Dr. Robert Breckenfeld advises using lidocaine gel for the job. This can take some time to fully take effect, so it should be injected into the exit hole well before attempting to probe the site. After anesthesia has been achieved, a Salem sump tube should be used to open up the channel. The tube is both firm and flexible, making it an excellent device to reestablish the channel.
Sound Advice
In a noisy environment, cardiac auscultation can be difficult. To better hear heart sounds, Gregory Wanner, PA-C, of Collingswood, New Jersey, places the stethoscope on the patient’s chest and then takes his hand off it. Perhaps because this reduces stethoscope movement from a natural hand tremor or because the diaphragm or bell pressure is just right, heart sounds become clearer. Our colleagues in obstetrics are well aware of the interference their hand can create when listening for fetal heart sounds. Although counterintuitive, the “hands off” approach may help. If necessary, the stethoscope can be supported by holding onto its rubber tubing.
TOPICAL TRIPLE PLAY
To treat alopecia areata, Dr. Basil Rodansky of Lincoln Park, Michigan, utilizes a course of anthralin cream, minoxidil solution, and cortisone cream. He stresses the importance of waiting roughly two hours after application of one of the three components. When all three are applied daily, Dr. Rodansky has seen speedier resolution. In severe cases, he advises the use of an immunosuppressive drug like cyclosporine.
GO EASY
Before performing a digital block, Mr. Jon Gootnick, PA, in Penfield, New York, sprays a cotton-tipped applicator with ethyl chloride. He then holds it directly against the injection site for three to five seconds, allowing him to insert the needle with little or no discomfort for the patient.
WAR EAR WASH
Many of us have our own unique ear wash mixes. In Alton, Illinois, Dr. E.J. Aragona advises mixing equal parts alcohol and hydrogen peroxide in a small glass and then topping it off with 10 drops of povidone-iodine solution. He warms the mixture before application and uses a 20-gauge catheter attached to a syringe to control the spray.
GOT A STAPLE BUDDY?
To close large, retracted scalp lacerations, Dr. Brady Pregerson from Los Angeles, California, has an assistant apply pressure to the skin several inches away from both sides of the wound. By having the lacerated edges pushed together, he can staple without having to work against retractile tension. An antibiotic ointment can be used to mat down hair near the edges of the wound. Alternatively, an assistant can hold the edges together with forceps while you staple. Either method is sure to improve the outcome.
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