May 2008

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

Humerus Hold
To examine the nose or mouth of a particularly fussy infant or young child, Dr. Melodie Isgro in Portland, Oregon, offers this tip. With the child in the supine position, she has the mother or father stand near the head of the bed and grasp the child firmly by the distal humeri. She then asks the parent to raise both of the child’s arms above the head and squeeze them together, forming a secure brace on both sides of the head. With the arms fully extended, the child is unable to squirm out of the hold and the head is perfectly immobilized. This allows for a quick and thorough nasal or oral exam.

Keep the Heat On
In San Diego, California, Dr. James Nelson uses a unique source of topical heat to alleviate the pain from a sty or hordeolum. Instead of using a plain warm compress, he tells the patient to boil an egg and then wrap the compress around it. This method holds the heat much longer than a compress alone, improving drainage from the clogged gland or follicle.

Band-Aid Solution That Works
Identifying the precise location of an injury or source of discomfort in a young pediatric patient with a history of relatively minor trauma can be challenging under the best of circumstances. When the child is timid, uncomfortable, or frightened, the problems only multiply. In Jonesboro, North Carolina, Dr. Michael Tomlinson asks the patient or parent to apply an adhesive bandage to the site of the “boo-boo” before the exam and radiographs are performed. He finds that this step not only makes the patient feel more comfortable with the emergency department experience, but also reduces the number of x-ray studies ordered.

Guidewire Control
Maintaining a sterile environment while placing a central line can be difficult, especially when removing the guidewire. To lessen the threat of infection, Dr. Diann Krywko of Mount Pleasant, South Carolina, suggests placing the guidewire back into its holder as you withdraw it from the vein. This prevents an out-of-control length of guidewire from falling into the nonsterile field. It also makes it easier to dispose of the guidewire into a sharps container.