There are many exciting places we can turn to when we need to help a patient. The resuscitation room, gyn room, and decontamination shower may come to mind immediately. But another chamber of healing is your local “Break Room.” This bleak refuge often contains a wonderland of overlooked medical remedies hidden amongst the soy sauce packets, roaches, lonely plastic forks, and perpetually defiled refrigerator (Fig. 1).
Explore This IssueACEP News: Vol 32 – No 05 – May 2013
Bite that bag
Even minor oral mishaps can be messy, especially for patients on systemic anticoagulation. Small tongue lacerations, bleeding tooth sockets, and buccal or labial injuries don’t always need suturing, but they still can ooze blood for days.
One of the recommended treatments in many textbooks is to have the patient “bite on a teabag,” because the tannic acids from black tea have a pro-thrombotic effect. You can find plenty of tea bags in most break rooms, overlooked and lonely beneath the shadow of the more popular coffee machine.
Most teabags are not particularly virile. They are flimsy, wispy, flaccid things that just drift around in your mouth. They aren’t large enough to put a significant amount of pressure on the oral mucosa even if the patient is biting down as hard as he can. To allow physical pressure to work in concert with the coagulant effect of the tea leaves, take a roll of gauze and suture the teabag to it (Fig. 2).
Next, saturate the teabag in lidocaine with epinephrine (sometimes I even add a single spray of neosynephrine nasal spray to the mix). Remember, these are going to be topically applied vasoconstrictors, so the concern over injected epinephrine into an end capillary field really doesn’t apply here. Place the whole contraption into your patient’s mouth with the teabag in contact with the bleeding surface, and tell the patient to bite down. Keep it in place for at least 30 minutes.
Once you remove the teabag-gauze combo, you should see resolution of the bleeding. The area will also be anesthetized, allowing you to do a little touch-up cautery with a silver nitrate stick (highly recommended in certain cases).
As with any item you put in the mouth of a patient, make sure he can protect the airway, is not dangerously intoxicated, and can breathe through the noses before you place a wad of gauze, tea, and vasoconstrictors into the oropharynx. Black tea works best.
Save the hippy-dippy chamomile-mint-saffron teabags for your favorite ortho consult.
Paraphimosis involves venous congestion and edema of a retracted foreskin, making it impossible for the patient to reduce it to the normal anatomic position. Immediate action is required if there are signs of acute ischemia to the glans.
Manual reduction or slitting of the foreskin are two common techniques of emergency reduction, both of which are painful and traumatic to the patient. If there are no signs of active ischemia, a slower but more humane technique involves using granulated sugar to draw out edema from the foreskin through osmotic action.1
Your local break room probably contains many packets of granulated sugar from prior coffee runs. Empty a few packets onto the patient’s foreskin (introduce yourself first) and pour some into the finger of a rubber glove, ultrasound probe cover, or even a regular condom.
Place this embarrassing contraption over the penis so the entire glans and foreskin is in direct contact with sugar, and then wait (Fig. 3).
Osmosis is slow, and the “no-peeking rule” applies here. Leave everything in place for 2 hours. Once you remove the penile cover, you should see a significant improvement in the edema, and the patient may even be able to reduce the foreskin himself.
If the foreskin can’t be reduced at this point, allow the osmosis process to continue a little longer before trying again.
It may keep him in the department longer, but most men will happily spend the extra time to avoid afflicting their tormented members with needles, scalpels, or huge amounts of brute force.
I do not know if Splenda, Equal, or Sweet’N Low is effective or safe, although it stands to reason that any dry powder might work as a desiccant. Somehow salt sounds like a bad idea.
Cup ‘n cap
It might be impossible for hospital management to stock your department with exotic items like tape and lidocaine, but everyone has one of those fancy Keurig automatic coffee machines!
When you aren’t having a sincere esteem-building chat with a co-worker over a misty mug of Mocha Mirage, you can actually use Keurig automatic coffee cartridges (K-Cups) for patient care.
Scalp veins are excellent candidates for intravenous catheter placement in chubby infants. Some references suggest taping a paper cup over scalp IV sites to prevent displacement, but these are too flimsy and can easily be crumpled. K-Cups are the perfect size and strength to create a protective “Fez” to keep that IV you fought so hard for safe and sound.
Peel the foil off the top of the cup, dump out the coffee grounds, remove the filter paper, and rinse out the cup. Cut a small notch in the lip of the cup for the IV tubing to exit, then tape the cup to the child’s scalp over the IV site.
Lastly, secure the IV tubing on the outer curvature of the K-Cup for greater stability (Fig. 4).
For patients with visual complaints, viewing an eye chart through a pinhole removes errors of refraction, allowing you to determine if the retina is functioning normally.
Patients with globe trauma or acute glaucoma may need a firm, protective eye cover to prevent any accidental external pressure from exacerbating their condition. K-Cups make great substrates for both these improvised devices (Fig. 5).
- Kerwat, Shandall and Stephenson. Reduction of paraphimosis with granulated sugar. Brit J Urol, 1998; 82:755
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Dr. Fisher practices Emergency Medicine in New England and New York.