Printer Friendly

CLINICAL PEARLS.

I'd like to thank all the wonderful doctors who took the time to share their pearls of wisdom in our recent Clinical Pearls contest. We received more than 200 entries. Even if you didn't win a prize, your pearl may be published in 'an upcoming issue. In fact,: if your idea is both novel and useful, you may actually change the way obstetrics and gynecology is practiced nationwide.

Choosing three winners was extremely difficult, so I turned to several colleagues for advice and opinions. With apologies to the approximately 2 dozen doctors who prefaced their submission with the hopeful phrase "Please send the color Palm Pilot to the following address," here are this year's contest winners.

* First Place

The Palm IIIc personal digital assistant with color display goes to Dr. Cecille A. Tapia Santiago of Ormond Beach, Fla., for her pearl on checking for residual volume after incontinence repairs.

Many of us no longer insert suprapubic catheters at the time of the repair. Instead, we remove the Foley catheter a day or two postoperatively and then wait many anxious hours to see if the patient can void. After she voids, we have the nurse catheterize the patient again to check for residual volume.

Dr. Tapia-Santiago has a better idea that gives instant results and requires no repeat catheterization. First, disconnect the urine bag from the. Foley tube and discard. it. Then use a catheter-tipped syringe, to inject 200 mL of sterile saline or water via the Foley into the bladder and immediately deflate the balloon and remove the catheter. Now have the patient void into a urine "hat" to obtain an immediate void volume.

Simply subtract this number from 200 mL, and you'll know the residual volume. The patient will love the fast results and appreciate avoiding the unpleasant repeat catheterization.

* Second Place

Dr. Richard Grossman of Durango, Colo., is the winner of the, Sony portable CD player for his.spoon trick.

Have you ever pricked'you finger while injecting local, anesthesia into the perineum before a vaginal birth? Have you ever worried about nicking the baby's head with the needle if the patient moves or pushes?

Here's a simple trick that solves, both problems. Just use an ordinary serving spoon as a shield. The edges of the spoon must be filed so they are smooth. Use a little lubricating jelly and slide the spoon between the baby's head and the perineum with the concave side of the spoon curving over the head. There's no need for fancy silverware since common tableware is stainless steel, which won't rust and is easy to sterilize. Hospital cafeterias, beware!

* Third Place

Dr. Rink Murray, a resident at the University of North Carolina Hospitals, Chapel Hill, wins a. Sony portable sports digital Walkman radio and cassette player for his pearl on the tenaculum test.

Patients with pelvic pain after cesarean section sometimes have scar tissue between the abdominal wall and the uterus. The scar tissue can obviously cause problems at the time of diagnostic laparoscopy. A simple diagnostic measure is to grasp the cervix with a tenaculum and gently tug. If the abdominal wall moves with' the uterus, there are adhesions between the. two structures.

DR. BRUCE L. FLAMM is area research chairman and an ob.gyn. at the Kaiser Permanente Medical center in Riverside, Calif.
COPYRIGHT 2001 International Medical News Group
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2001 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:FLAMM, BRUCE L.
Publication:OB GYN News
Date:Jul 15, 2001
Words:551
Previous Article:Behavioral Programs Not Yet Fully Integrated.
Next Article:HHS Chief Pledges Regulatory Relief.

Terms of use | Copyright © 2017 Farlex, Inc. | Feedback | For webmasters