Discover Shortcuts Devised by Colleagues (July 2009)

Short Cut to Preventing Spread of MRSA

I advise my patients who are carriers of methicillin-resistant Staphylococcus aureus (MRSA) to keep their fingernails trimmed. Long nails make the subungual spaces good havens for bacteria. S aureus, including MRSA, has been isolated from the subungual spaces of the hands of many at-risk patients who are MRSA carriers.1 In addition, long nails can break both the skin and the nasal mucosa, facilitating the transmission of MRSA between the nares and the skin; this can result in prolongation of the nasal carrier state and possibly in skin infections.

— Fadi Jabr, MD Dickson, Tenn

REFERENCE:
1. Rupp ME, Fitzgerald T, Puumala S, et al. Prospective, controlled cross-over
trial of alcohol-based hand gel in critical care units. Infect Control Hosp Epidemiol.
2008;29:8-15.

Get a Jump on Diagnosis of Acute Abdomen in Children A quick way to determine rebound tenderness and differentiate between an acute and a nonacute abdomen in a child is to ask the patient to jump up and down. Patients with nonacute abdominal pain will do this willingly. However, those with an acute abdomen will typically decline because of pain.

— Lance Holtry, DO El Dorado Hills, Calif

No Tongue Blade— No Gag Reflex!

If patients cannot overcome the gag reflex when I try to depress their tongue with a tongue blade, I simply have them stand in front of a mirror and ask them to show me the back of their throat while I hold the light. I have found that most patients are able to do what it takes to see their own throat. This strategy is especially useful with children.

— Brett S. Bilbrey, MD Knoxville, Tenn

Dangers of Dehydration

A Primer for Patients With Heart Failure Patients with heart failure are often hospitalized for dehydration and acute renal failure. Thus, they need to be educated about dehydration as well as about the signs of fluid retention. Make it a habit to tell patients with heart failure the following:

• If you have diarrhea, vomiting, poor fluid intake because of illness, fever, or excessive sweating (such as from working outside on a hot day), consider holding some or all of your diuretics for a day—or for the duration of the illness—and monitoring your weight.
• Signs of dehydration include dizziness, dry mouth, weight below your normal range, fatigue or general malaise in the absence of obvious illness, reduced urine output, low blood pressure, and fast heart rate.
• Drinking extra fluid will not compensate for a dehydrated state.
• If you believe you are dehydrated and are unsure what to do, contact your primary care provider within 48 hours of the onset of the condition—or earlier if you notice the symptoms mentioned above.

— Connie Jaenicke, NP Minneapolis