An always popular topic is the drainage of peritonsillar abscesses. Sometimes it can be difficult to aspirate from a syringe using only one hand, especially with the awkward angle that you might encounter. I can never find syringes with the side rings to allow you to grasp the syringe more securely with one hand (see photo above).
This is a guest post by Dr. Ian Brown (Stanford):
The Roberts textbook describes the procedure of corneal fluorescein staining as touching a moistened fluorescein strip to the cornea. Maybe it is an irrational fear of a paper cut to the sclera, or a fear of touching an already abraded cornea with the paper, but I try to find an alternative. I have seen physicians hold the eye open with one hand, hold the fluorescein with a second hand and then drip tetracaine on the paper and let it drip into the eye with a third hand. I, unfortunately, only have two hands.
Peritonsillar abscess drainage in the ED continues to be one of my favorite procedures to perform. There are several tricks to increase your chances for a successful aspiration. One trick involves using a curved laryngoscope to help depress the tongue AND provide a bright light source.
What if you don’t have a laryngoscope readily available?
High pressure irrigation of wounds is critical in reducing the rate of wound infection. There are a variety of commercial irrigation kits which include splash guards. If you are irrigating correctly and generating at least 8 PSI of pressure, some irrigation fluid should splash up and out of the wound. Be careful not to splash irrigation fluid in your eyes.
What if you don’t have a commercial irrigation setup?
Last week, I talked about the use of Rare Earth Magnets for removing metallic foreign bodies. Sometimes a straight magnet though isn’t quite strong enough to grab a metallic foreign body. If only you had a small magnetic hemostat.
This week Dr. Catherine Perry (Culpepper Memorial Hospital) and Dr. Kolapo DaSilva (PGY-2 at UVA) emailed me with a creative solution. They encountered a patient with a BB pellet lodged deeply in the soft tissue. Small mosquito clamps couldn’t get around the BB. A cardiac magnet alone caused the BB to tent the skin up.
A child presents to your Emergency Department with a small button battery up her nose. Your usual tricks fail:
- Occluding the other nostril and having the mother blow in the patient’s mouth forcefully.
- Using a small curette or forceps to scoop or pull it out.