tips and tricks

Discover Shortcuts Devised by Colleagues (January 2011)

Nathan Hitzeman, MD, D. Brady Pregerson, MD, Madhvi Patel, MD, and Scott Graham, MD

Make Your Point With a Safety Pin
Those of us who have responded to overhead announcements for a doctor on the plane or tended to an ailing friend on the hiking trail know that medical care is rarely limited to the 4 walls of the office. A safety pin is recommended by wilderness medicine texts as one of the most useful tools for your first aid kit.1 Its many uses include removal of foreign bodies from the skin or cornea; drainage of abscesses, blisters, subungual hematomas, and thrombosed hemorrhoids; skin testing; holding gaping wounds together; splinting a mallet finger; fashioning a sling for shoulder and arm injuries; removal of ticks; puncture of plastic bags for irrigation of wounds; and pinning the tongue to the lower lip of an unconscious victim to establish a patent airway.

What’s Your Position on Wound Closure?

To make wound closure easier, position the patient so that the wound “points” to your solar plexus or xyphoid process. This will ensure it is at an ergonomic height and that it is perpendicular to the plane of your body.

Bent on Easier Abdominal Exams

Sometimes patients, particularly children and adolescents, are very anxious during the abdominal examination. I ask them to bend or flex both knees, which helps relax abdominal muscles, prevents guarding, and facilitates palpation.

How to “Sell” the Flu Shot to Healthy Adults

When counseling patients about why they should receive the influenza vaccine, I remind them that each year the disease kills 250,000 to 500,000 persons worldwide and more than 37,000 persons in the United States. This means that influenza kills more people per year than auto accidents. I tell healthy, younger adults that even though influenza tends to be more lethal in young children and in persons who are elderly or immunocompromised, getting the flu can put them out of commission for 1 to 2 weeks. I also note that the vaccine can never cause influenza, since it contains only small pieces of the virus. After going over these quick facts, my success rate in convincing patients to receive the vaccine (as my nurse can attest!) is higher than 90%.


1. Auerbach P. Wilderness Medicine. 5th ed. Philadelphia: Mosby; 2007.