Download e-book for iPad: A Gun for Dinosaur by L. Sprague De Camp

By L. Sprague De Camp

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What not to do: Do not waste time trying to locate a bleeding site while brisk bleeding obscures your vision in spite of vigorous suctioning. Have the patient blow out any clots and insert the medicated cotton pledgets. Do not get routine clotting studies unless there is other evidence of an underlying bleeding disorder. Do not cauterize or use instruments within the nose before providing adequate topical anesthesia (some initial blind suctioning may, however, be required to clear the nose of clots before instilling anesthetics).

After initial inspection using a nasal speculum and bright light, suction out any purulent discharge and insert a cotton pledget soaked in 4% cocaine or a solution of one part phenylephrine (Neo-Synephrine) and one part tetracaine (Pontocaine) to shrink the nasal mucosa and provide local anesthesia. Be careful to avoid pushing the foreign body posteriorly. Remove the pledget after approximately 5-10 minutes. If the patient is able to cooperate, have him try to blow his nose to remove the foreign body.

In a patient with mononucleosis, ampicillin can produce an uncomfortable rash, which, incidentally, does not imply allergy to ampicillin. Do not unnecessarily frighten the patient about splenic rupture. If the spleen is clinically enlarged, he should avoid contact sports, but spontaneous ruptures are rare. Discussion All of the above probably apply to cytomegalovirus as well, although the severe tonsillitis and positive heterophil test are both less likely. Some who report having mono twice probably actually had CMV once and mono once.

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A Gun for Dinosaur by L. Sprague De Camp


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