[B277]Becoming A Medical Assistant

Stethoscope ring sign:
An early and reversible sign of systemic distress in asthmatics is that the skin changes demonstrated when auscultating the chest wherein as you lift the stethoscope a visible ring or impression is left. This reliable sign corresponds to the degree of circulatory change in the skin. Considered with other findings and observations it gives a real-time indicator of improvement or change.

When a ventilator mask is the wrong size:
If you must mask ventilate an adult or child who is small in stature with a typical adult mask which is larger than can readily seal on the patient's face, try inverting the mask so that the usual chin portion lies across the nose and cheek bones and the narrow nasal portion of the mask is used to fit against or around the chin; this may be sufficient adaptation to control the situation until an appropriately sized mask is available.

Refractory dental bleeding:
Persistent blood oozing from a dental socket that resists swishing with warm saline and damp gauze is often stanched by substituting a damp tea bag for the gauze. The astringent action of the tea helps with hemostasis.

Weighing a too-heavy patient:
Hang a small object on the balance beam and then weigh the patient with it in place. Next, weigh any other person whose weight is within the scale's usual range with the extra weight in place, and then remove the weight and weigh again, calculate the difference and add it to the measured weight of the outsize patient as checked with the weight in place. Just using a little math!

A picture worth a thousand words:
Save yourself the awkward description of a minor injury's location by simply including a picture taken with a digital camera of the injury's location. Or you can go on writing for paragraphs explaining exactly where the splinter was. Up to you!

Minimize vaccination soreness:
Minimize residual soreness from a tetanus shot by giving it in the deltoid muscle of the dominant arm. The additional exercise and circulation of this arm will help it clear the tissue reaction.

For securing the reluctant patient:
A physically combative patient restrained in four points on a gurney may still buck his hips and otherwise move the gurney around. To prevent them tipping it or injuring staff, tie two more gurneys to each side of the patient's gurney. This "outrigger formation" will stabilize the gurney so it can't flip over, the patient can still be accessed from the head or foot end, and with the extra weight and the visible presence of three gurneys the patient will give up and calm down quicker.

Cleaning up broken glass:
Ordinary adhesive tape is good for removing broken glass fragments from a wound. For patients who come into ER with broken glass raining from their clothes, many ERs keep a dustbuster or other hand vacuum.

Your stethoscope is a hearing aid:
In the elderly it is often difficult to communicate because of hearing loss. In a pinch, try putting your stethoscope on the patient (after cleaning their ears). Speak slowly, softly and clearly into the diaphragm and it serves as a microphone. The patient gets the message without a lot of yelling and repeating.

Keep your smelling salts handy:
An ammonia inhalant is the kind of thing you want handy, either to stop a patient before they swoon or for the obnoxious drunk who's pretending to be too asleep to be discharged. But keeping it in your pocket runs the risk of it breaking at inconvenient moments. The solution is called the "CIA method": take an ordinary ball-point pen - the kind that screws together - and remove the insides and keep the inhalant capsules in there. Now you have a handy clip to keep it on a pocket.

Controlling a struggling patient's hands:
Remember that the thumb is always the weakest part of the hand. To control the hand always grab the thumb. As the thumb is directed toward the radius, the arm will follow. This also works if you are encouraging a patient to return to his or her cart. Simple and effective!

Glove trick for an injured finger:
A useful tip for hand injuries is to apply a sterile glove to the hand with the injured finger. Cut the fingertip of the glove corresponding to the injured finger. Roll it back to the knuckle like a condom. You now have a previously dirty hand which does not soil the treatment area, the rolled portion now acts as a tourniquet on the finger for a bloodless field, and care can proceed more neatly.

Removing a ring from a finger without cutting the ring:
Windex sprayed on the finger (if there's no wound) and ring often makes it easier to slip off. The window cleaner has a wetting agent that decreases surface tension. Lacking that, cut one finger from a rubber glove and slide it onto the ringed finger. Cover it with K-Y jelly and slip the ring off over the gloved finger. The glove rubber helps to keep the skin from bunching up.

Avoid greasy lotion hands:
Wash your hands first like normal and partially dry them. Then apply a smaller amount of lotion and rub it in. Then continue to dry your hands. Now you can handle paperwork and it won't spot!

Insects in the ear:
Most live bugs can simply be coaxed out by shining a bright light into the ear canal. Simple and non-invasive. The classic method if this fails is to use warm olive or mineral oil in the ear canal which should simultaneously smother and still the insect so it can be floated out.

Odor control:
A cup or plate filled with powdered coffee absorbs all kinds of ugly odors and leave a pleasant smell. Many ERs also keep a box of baking soda around, which can be sprinkled on smelly shoes and socks, left open to absorb room odors, or sprinkled in the bottom of disposal receptacles to eliminate odor. What works in the home works in the ER!

Get kids to take their medicine:
Virtually any liquid's taste and smell can be covered up with chocolate milk. Kids never turn it down, and it works on grown-ups too!