The patient’s first symptoms were pain in his right hand and knee plus chills the evening before. Late one afternoon, Mr. M, 51 years old, came to the emergency department after suffering a near-syncopal episode. His wife and daughter reported that he turned pale and almost passed out after becoming dizzy and weak. There was…
Patients with conjunctivitis or eye allergies should wash their eyes with a small amount of tearless shampoo and rinse well with water before applying any prescribed ointment or eye-drops. Follow the same procedure each time the medication is applied. I also advise these patients to wash their eyes once pr twice a month during the…
When suturing a fresh open wound, a few drops of lidocaine (Bupivacaine) administered directly into the wound helps with the pain. This is also useful before needle sticks.—Sheryl Lavender, DO, Delray Beach, Fla. (104-19)
To remove impacted cerumen, instill liquid docusate (Colace) for five minutes, then wash out.—Smitha Manoj, MD, Metuchen, N.J. Colace is frequently used in pediatric ERs to remove earwax. This agent has the added advantage of being readily available. Other OTC solutions are basically water, peroxide, or oil-based solutions (some use olive oil or baby oil).…
For migraine relief, administer diphenhydramine (Benadryl) 25 mg IV followed by prochlorperazine (Compazine) 10 mg IV. If the headache does not resolve in 15-30 minutes, giveketorolac (Toradol) 30 mg IV or 60 mg IM. Resolution usually occurs within 60 minutes (IM medications may take longer). This cocktail is effective after triptans fail.—Linda M. Watkins, MSN,…
Rather than bandaging painful cuts at the ends of the fingers near the fingernail with cloth tape (Item 100-28), use an OTC liquid bandage (I find Band-Aid Brand works best). It seals the wound and stops the pain almost instantly. Tape gets wet, acts as a reservoir for bacteria, and looks pretty bad by the…
The Mirena intrauterine contraceptive may be helpful in treating perimenopausal women who smoke.
While the U.S. Preventive Services Task Force, among others, deems it reasonable to use only a Pap smear to screen women older than 65 for cervical cancer because of their low risk (Item 103-18), it seems a bit premature to assume that HPV transmission won’t follow a pattern similar to HIV infection, which has seen…
For what degree of glaucoma is medication considered first-line therapy? Are oral beta blockers as effective as local ones?—Mario E. Palacios, MD, Egg Harbor Twp., N.J. Clearly, if there is evidence of glaucomatous damage to the optic nerve or the visual field, the pressure must be lowered to retard progression. Many clinicians will also treat…
I have two patients with new-onset type 2 diabetes. One, in his early 20s, takes risperidone 2 mg b.i.d., mirtazapine 45 mg at bedtime, and citalopram 40 mg a day, and the other, in his early 30s, takes risperidone 6 mg at bedtime and venlafaxine 225 mg daily. All these medications were prescribed by my…
