Clinical Pearls, November 2005

Give an Arm Hug
Take , blood, and pressure are all words that evoke fear in young children. To promote cooperation, tell pediatric patients that you are going to give them an "arm hug." Following the procedure, verbally introduce the phrase blood pressure; this will familiarize children with the correct term (and hopefully spare any new provider who does not know the magic of an arm hug!).
Donna Garrett, NP, Pickens, SC

True or False: Back Pain
When examining a patient whose complaint is lower back pain, conduct the straight leg-raising while the patient is seated. Converse with him or appear to be examining the knee in order to differentiate a true positive from a false-positive.
Kristopher Stillwell, PA, Deer Park, NY

A Better Choice for Mono Patients
Treat uncomplicated infectious mononucleosis symptomatically. If the patient has an associated strep infection, prescribe erythromycin or penicillin instead of ampicillin. About 80% to 90% of mononucleosis patients develop a maculopapular rash within five to eight days of starting ampicillin, due to the altered immunologic state caused by the disease. (As a side note, the reaction will subside eventually, with only 5% of patients continuing to show sensitivity to ampicillin after one to 17 months.)
Tom Johnstone, PA, Reidsville, NC

Turn Here for Bundle Branch Block
Here's a way to interpret a bundle branch block on an ECG: Think of the turn signal of a car. To turn right, the turn signal handle moves to the up position. To turn left, the signal handle goes down. Similarly, once the presence of a bundle branch block has been established, look at lead V₁. If the QRS complex is primarily up, it is a right bundle; if the complex is down, it is a left bundle.
Linda Tavares, MS, RN , ACNP, Richmond, Va

CLASSIC PEARL: Time for Mental Status Evaluation
Too busy to perform a formal mental status evaluation? Give the patient a sheet of paper with a large circle drawn on it and ask him or her to draw a clock. Once the patient has drawn the numbers, ask him or her to put the hands in to read 2:30. Errors in number and hand placement may indicate comprehension problems, visual-spatial difficulties, a visual field deficit, or memory deficits. This test is not culturally or educationally biased and can be used with patients who are non-English speaking (a mental status evaluation through an interpreter is of questionable validity).
Freddi Segal-Gidan, PA-C, Downey, Calif