# Dispatched, 17 yo female, severe head/earache



## eveningsky339 (Sep 18, 2009)

You arrive on the scene to find the patient sitting on her bed and clutching the left side of her head.  AOAx3, pearl, BP and HR somewhat high, but nothing major considering the patient's distress.  

While assessing your patient, your partner takes a look in her ear and-- lo and behold-- a dead cockroach.  The little guy must have crawled in while the patient was asleep.  

  You decide to go ahead and hoof it to the ER, because that little guy could be causing some serious damage.  But, you have some tools in your truck and some tricks up your sleeve, so you decide to radio in for permission to remove the roach yourself en route.  MD gives you the go ahead, but advises you not to force it out.  (I'm uncertain as to whether an MD would give permission for this or not, I suppose a lot of it depends on ETA).  ETA is twelve minutes.

You give the roach a tug.  The patient screams bloody murder and the little guy doesn't budge.  What's your next course of action?


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## HotelCo (Sep 18, 2009)

My next course of action is to provide pain relief as needed, monitor, and continue transport. Let them get it out in a controlled setting.


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## exodus (Sep 18, 2009)

As a basic... Well we can't do crap...

As a medic, get her on a monitor + ECG, establish patent IV, get some pain management on board, and have her mom try to comfort her...


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## steele4347 (Sep 18, 2009)

First I would never ask for permission to to remove it. Suppose that a body part had somehow punctured the ear drum. You pull it out, not knowing the full extent of damage, and she is now deaf forever. Let the doctor figure that out. As long as she is maintaing VS, O2 sat, and ETCo2 approriately a little morphine would be okay.


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## Lifeguards For Life (Sep 18, 2009)

xport in position of comfort, monitor vitals, treatment consists of supportive measures


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## Meursault (Sep 18, 2009)

The only ALS vs. BLS difference I see here is the ability to provide pain relief, and I'm not even sure if that's indicated.

If the bug is actually dead, it's not going to be causing any more damage. There's no need to remove it before you reach the ED, regardless of ETA. And unless you carry viscous lido and whatever else the ED physician is going to be using to remove it, good luck trying to get it out anyway.

BLS: Position of comfort, reassurance, and a nice, gentle non-emergent ride.


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## HotelCo (Sep 18, 2009)

exodus said:


> As a basic... Well we can't do crap...
> 
> As a medic, get her on a monitor + ECG, establish patent IV, get some pain management on board, and have her mom try to comfort her...



As long as there isn't any history of anything cardiac-related, and the other vitals are fine, I wouldn't even bother doing a 3-lead.


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## arsenicbassist (Sep 18, 2009)

exodus said:


> As a basic... Well we can't do crap...
> 
> As a medic, get her on a monitor + ECG, establish patent IV, get some pain management on board, and have her mom try to comfort her...



Having pulled a few out in other parts of the world, I can tell you that they cause extreme pain, but there is no indication whatsoever to use pain management. IV access wouldn't really be a necessity, but can be established (what else are ya gonna do in 12 minutes...since it'll get done at the hospital.) I would say this would be more of a simple VS, PoC, and transport. It's almost rare for a cockroach to break the TM, as they normally come in and feast on cerumen in the EAC.


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## Mountain Res-Q (Sep 18, 2009)

NO NO NO... you have it all wrong...

This scenerio is is the same as a vehicle extrication... you don't remove the patient from the vehicle... you remove the vehicle from around the patient...  That's right folks, I would NOT remove the roach from the the girls head...  I would remove the head from around the roach...  

And they say that basics can't do anything...  :unsure:


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## Lifeguards For Life (Sep 18, 2009)

arsenicbassist said:


> Having pulled a few out in other parts of the world, I can tell you that they cause extreme pain, but there is no indication whatsoever to use pain management. IV access wouldn't really be a necessity, but can be established (what else are ya gonna do in 12 minutes...since it'll get done at the hospital.) I would say this would be more of a simple VS, PoC, and transport. It's almost rare for a cockroach to break the TM, as they normally come in and feast on cerumen in the EAC.



extreme pain is not an indication for pain management?


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## rescue99 (Sep 18, 2009)

exodus said:


> As a basic... Well we can't do crap...
> 
> As a medic, get her on a monitor + ECG, establish patent IV, get some pain management on board, and have her mom try to comfort her...



Say what? What's all that stuff for? And don't you say; because we can!


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## rescue99 (Sep 18, 2009)

Lifeguards For Life said:


> xport in position of comfort, monitor vitals, treatment consists of supportive measures



Yes..this is most appropriate in the given scenario.


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## ResTech (Sep 18, 2009)

If a patient is in pain they are in pain. What does it matter the cause of the pain. Does it really matter if the pain is from a fracture or something whacky like a dead cockroach in the ear? Why are providers so afraid to administer pain meds? I never understood this. It's our job to relieve PAIN AND SUFFERING which is what analgesics do. It's almost like pain relief in the field is taboo. 

Pain meds are more effective when administered early before the pain reaches the excruciating point. If you let the pain level progress, than your faced with having to administer higher doses to control it. Treat it early and you can provide relief with lower doses which is a win-win. Given this scenerio I am pretty certain the patient got something for pain at the hospital so why not get it onboard in the field. 

If a patient is in obvious moderate to severe pain treat it. Just my opinion and what I would want done for me and my family. There are many current journal articles advocating EMS to be more aggressive with pain management in the field.


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## Dominion (Sep 18, 2009)

As a basic: Position of comfort, monitor vitals, transport.  

As a medic: I would consider orders for pain management but in this case, even if I had standing orders I would call it in.  If the girl is not in pain when you aren't trying to yank it out of her ear, I'm giving this run to my basic partner.  Even if she was in a state of pain, I might consider withholding meds due to the short transport time and rather attempt to have the mother calm her down.  She's probably more freaked out than in active pain.  But what do I know, Cockroach in the ear isn't something I've seen nor is have I ever heard it really discussed much.


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## Lifeguards For Life (Sep 18, 2009)

Dominion said:


> As a basic: Position of comfort, monitor vitals, transport.
> 
> As a medic: I would consider orders for pain management but in this case, even if I had standing orders I would call it in.  If the girl is not in pain when you aren't trying to yank it out of her ear, I'm giving this run to my basic partner.  Even if she was in a state of pain, I might consider withholding meds due to the short transport time and rather attempt to have the mother calm her down.  She's probably more freaked out than in active pain.  But what do I know, Cockroach in the ear isn't something I've seen nor is have I ever heard it really discussed much.



my basic instructor had mentioned running a patient with a roach in there ear, but i thought it was some sort of odd joke.


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## arsenicbassist (Sep 18, 2009)

not when you're 12 minutes out and there's no reason to push pain meds on someone in this state of pain. supportive care...unless you wanna explain why a girl requiring a simple removal of the insect in the ED needed Dilaudid or whatever you're planning on giving.


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## arsenicbassist (Sep 18, 2009)

ResTech said:


> If a patient is in pain they are in pain. What does it matter the cause of the pain. Does it really matter if the pain is from a fracture or something whacky like a dead cockroach in the ear? Why are providers so afraid to administer pain meds? I never understood this. It's our job to relieve PAIN AND SUFFERING which is what analgesics do. It's almost like pain relief in the field is taboo.
> 
> Pain meds are more effective when administered early before the pain reaches the excruciating point. If you let the pain level progress, than your faced with having to administer higher doses to control it. Treat it early and you can provide relief with lower doses which is a win-win. Given this scenerio I am pretty certain the patient got something for pain at the hospital so why not get it onboard in the field.
> 
> If a patient is in obvious moderate to severe pain treat it. Just my opinion and what I would want done for me and my family. There are many current journal articles advocating EMS to be more aggressive with pain management in the field.



Do yourself a huge favor here....don't assume anyone is afraid to administer pain meds. I'm sure there are people here who have seen some pretty incredible things. This is more of a "have to see it to believe it" things. Do you have any idea how sensitive the TM and EAC truly are? Might as well get your Narcan ready, cause you're gonna load them up to make much of a difference. You're not sitting on them overnight, you're 12 minutes from the hospital. Make the RIGHT decision for the patient....and if all else fails, medical control.


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## usalsfyre (Sep 18, 2009)

Removing the roach from her ear will most likely make the pain go away. Transport in a position of comfort, let the ED remove the roach. If pain control is needed P.O. hydrocodone w/APAP is probably a lot more approprite in this case than IV pain meds.


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## eveningsky339 (Sep 19, 2009)

steele4347 said:


> First I would never ask for permission to to remove it. Suppose that a body part had somehow punctured the ear drum. You pull it out, not knowing the full extent of damage, and she is now deaf forever. Let the doctor figure that out. As long as she is maintaing VS, O2 sat, and ETCo2 approriately a little morphine would be okay.



I wouldn't ask for permission if I encountered this in the field; I would provide support and comfort on the way to the hospital.  However, I do enjoy confronting circumstances that are above my head as a lowly Basic with a health science certificate.


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## rhan101277 (Sep 19, 2009)

I have been told by other medics that pain won't kill you, while this may be true, I will give an example.

Dislocated knee, teenager moderate pain, medic doesn't give morphine.  Morphine does have side effects to worry about in certain situations but for this I think I would administer it.


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## Barney_Fife (Sep 19, 2009)

Would it be possible to flush the ear with some sort of medication that would paralyze the insect and kill the pain? Like lidocaine? Then, remove it. I certainly wouldn't go tugging on something if it causes the child to scream in pain. Also think of not only the physiological effect, but the psychological effect. Because that's just down right creepy.


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## Lifeguards For Life (Sep 19, 2009)

Barney_Fife said:


> Would it be possible to flush the ear with some sort of medication that would paralyze the insect and kill the pain? Like lidocaine? Then, remove it. I certainly wouldn't go tugging on something if it causes the child to scream in pain. Also think of not only the physiological effect, but the psychological effect. Because that's just down right creepy.



while it is good to think outside the box, you should not put Lidocaine in peoples ears. Lidocaine is an antidysrhythmic, not a analgesic/ Lidocaines is used to convert ventricular dysrhythmias(vfib andvtach) to a sinus rhythm. And flushing peoples ears with IV medications is not a route of administration they teach us


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## Akulahawk (Sep 20, 2009)

Lifeguards For Life said:


> while it is good to think outside the box, you should not put Lidocaine in peoples ears. Lidocaine is an antidysrhythmic, not a analgesic/ Lidocaines is used to convert ventricular dysrhythmias(vfib andvtach) to a sinus rhythm. And flushing peoples ears with IV medications is not a route of administration they teach us


Lido can be used as a topical anesthetic...  and it is injectable however, _those _usages are not normally taught to medics for their use in the field... as we normally use it for it's antiarrythmic properties...


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## Lifeguards For Life (Sep 20, 2009)

Akulahawk said:


> Lido can be used as a topical anesthetic...  and it is injectable however, _those _usages are not normally taught to medics for their use in the field... as we normally use it for it's antiarrythmic properties...



darn. once again not in the drug guide were using for paramedic class. maybe my drug guide is broken


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## Akulahawk (Sep 20, 2009)

Lifeguards For Life said:


> darn. once again not in the drug guide were using for paramedic class. maybe my drug guide is broken


Not broken... just doesn't include uses not normally intended for paramedics..


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## Lifeguards For Life (Sep 20, 2009)

Akulahawk said:


> Not broken... just doesn't include uses not normally intended for paramedics..



yeah. our instructors told us to stay away from guides aimed at nursing as they use some of the same drugs in different context and dosages.


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## Akulahawk (Sep 20, 2009)

Lifeguards For Life said:


> yeah. our instructors told us to stay away from guides aimed at nursing as they use some of the same drugs in different context and dosages.


The nursing guides aren't so bad... you just have to be aware of what is pertinent to your usage. If you know your stuff, you'll be able to figure out what dosages and routes for whichever medication is appropriate for you. Besides, sometimes you'll see a drug that is in the chart and you'll not find that usage in the ALS guide...


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## VentMedic (Sep 20, 2009)

Lifeguards For Life said:


> darn. once again not in the drug guide were using for paramedic class. maybe my drug guide is broken


 
Which is why a college level pharmacology class could have pointed out many different types of medications with many different uses and then when you got into Paramedic you could focus on the 20 - 30 used in the field.   You would then be less likely to have tunnel vision and would be able to carry on intelligent discussions with RNs and MDs during your clinicals.


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## Lifeguards For Life (Sep 20, 2009)

and i intend to take that course...after paramedic. just the way it happened to work out. I took EMT as a dual enrollment course during high school, and was offered guaranteed admission and scholarship to our community college's paramedic program, 4 months out of high school. We had 48 seats in our program this year, nearly 100 applicants. seemed like a good idea at the time...
I fully intent to pursue education is i can carry on an intelectaul conversation.


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## daedalus (Sep 20, 2009)

Funny that this scenario generated so much discussion. There are no tools on a BLS ambulance let alone most ALS ambulances that could assist you in removing a foreign body from the ear canal. You would need an otoscope in case the object was not immediately visible or you pushed it back in an attempt to remove it. You would also need ear curettes and forceps, and enough knowledge on the anatomy of the ear to use these instruments.

Note: Lidocaine is known far better for its anesthetic properties than its antiddsrhythmic properties. Just as it acts as a sodium channel blocker in the heart, so does it in the nerves. I think that most paramedics are taught to use viscous lidocaine as a lubricant. It can also be injected for nerve block with or without epi (to prevent systemic abosorbation.)


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## Lifeguards For Life (Sep 20, 2009)

daedalus said:


> Funny that this scenario generated so much discussion. There are no tools on a BLS ambulance let alone most ALS ambulances that could assist you in removing a foreign body from the ear canal. You would need an otoscope in case the object was not immediately visible or you pushed it back in an attempt to remove it. You would also need ear curettes and forceps, and enough knowledge on the anatomy of the ear to use these instruments.
> 
> Note: Lidocaine is known far better for its anesthetic properties than its antiddsrhythmic properties. Just as it acts as a sodium channel blocker in the heart, so does it in the nerves. I think that most paramedics are taught to use viscous lidocaine as a lubricant. It can also be injected for nerve block with or without epi (to prevent systemic abosorbation.)


yes, we did learn lidocaine as a lube for different airway adjuncts


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## ResTech (Sep 20, 2009)

Lifeguard... how dare your program for not teaching you about the ottoscope and the ear curettes.... such a shame


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## Sasha (Sep 20, 2009)

HotelCo said:


> As long as there isn't any history of anything cardiac-related, and the other vitals are fine, I wouldn't even bother doing a 3-lead.



Me either. A 3-lead is not indicated in this situation, and we shouldn't do things just because we can.

However, I have a problem with this "Our txp time is only 12 minutes..." If the patient is in pain, they are in pain. Be it 12 minutes or 12 hours it still sucks and if we have the ability to mitigate or assuage that pain, we should.


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## DV_EMT (Sep 20, 2009)

you don't need a college level pharmacology class. take a RX tech class... plenty of pharmacology w/o the homework


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## mycrofft (Sep 20, 2009)

*Seal O2 to other ear, bypass pressure reducer....nonono...*

Done lotsa FO's inluding dead and live bugs. Bugs almst NEVER damage a healthy tympanic membrane (TM, Eardrum). Many legends abound, and I would guess many instances of self damage or from a helpful buddy with a pin, hairclip, etc. If an insect can get in, it can usually get out, and they don't curl up in there to die or go to sleep because it's  "warm".

Oh, wait. The roach often found in ears is the _cannabis sativa_ roach!  (Yes, really).

O2: why? EKG: why? MS: why? (Couple Advil maybe PO, not into ear). If you're on the way in, don't mess with it, th ER crew will appreciate not having to chase your "bug bits" around with a scope.

Oh, OP, it's P.E.R.L., not "pearl".


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## maxwell (Sep 20, 2009)

exodus said:


> As a basic... Well we can't do crap...
> 
> As a medic, get her on a monitor + ECG, establish patent IV, get some pain management on board, and have her mom try to comfort her...



...Would we be looking for a roach-induced ST segment elevation MI:wacko:?!  That is overkill.  Just go to the hospital.  She will be in pain.  If you're really pressed to do something, call ALS.  Ask them for an amp of lidocaine.  Put it in her ear.  It will make sure the cockroach is dead (and it will stop moving) whence providing some pain relief.  No medics?  Go to hospital.


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## rescue99 (Sep 20, 2009)

Lifeguards For Life said:


> yes, we did learn lidocaine as a lube for different airway adjuncts



During the ALS assessment section students should be learning how to visualize the ears. It's part of the program. If not, ask!


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## Lifeguards For Life (Sep 20, 2009)

rescue99 said:


> During the ALS assessment section students should be learning how to visualize the ears. It's part of the program. If not, ask!



We're still not very far into the program. I read briefly about it in the overview of a comprehensive examination chapter, but it was not a skill we were given the oppurtunity to practice<_< I guess thats a skill we will work on later in the program


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## FireMedic254 (Sep 20, 2009)

I.V. Normal saline, place the patient sitting up. No pain meds yet. Attach an 18g cath to a 10cc syringe. Draw up hydrogen peroxide and normal saline. Gently push the mix into the patients ear. The bubbling will most likely make the roach pull out. If that doesnt work, request a pain management med with medical control and pull it out. The problem with tugging or pulling on it is that it wants to get away and goes deeper. It can also cause you to break parts of its body off inside the ear. But usually the bubbling sensation of the peroxide makes it want to back out of the ear.


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## mycrofft (Sep 20, 2009)

*Again, why IV?*

1. Do not shoot lido or anything else) into the ear unless it is USP designed for use in the ear and you have an order.
2. My experience is that once you put liquid in the ear the bug drowns and then you have a flaccid bug. 
3. Rule of thumb, if you cannot directly and completely visualize the TM, do not instill anything. Preextant or new trauma, surgical perfs, "tubes", can all admit fluid to the inner ear and you just commited a tort.
4. If you were out in the middle of Bjeezis, Nowwhere County, the standard first aid/household remedy is to instill cooking oil (preferably olive oil, it is also available USP), then gently tease the critter out. An otoscope and bayonette forceps work well most of the time, maybe alligator forceps if you have the money. But if you are a pro, you will need SOP's, orders, etc., and with a 12 min ride, why upset the risk benefit ratio by goofing around?
One of the EMS worker's finest qualities is not buying into the excitement, and knowing when to wait or withold is an aspect of that.


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## Akulahawk (Sep 20, 2009)

*This advice should NOT be followed...*

Yes, indeed...

But why not use the shotgun method of clearing bugs from the external ear canal? Caution: Patient might be a little uneasy about the procedure...

Procedure:


 Apply muzzle of shotgun to opposite side of head, preferably against ear
 Ensure bore of shotgun is directed towards opposite ear, maintain alignment for duration of procedure
 load either of
 1 oz slug
 000 Buckshot
 
 apply steady pressure on trigger until shotgun discharges.
 check for presence of bug.
 repeat if bug is still present...
If that doesn't clean out a bug from the ear canal quickly, I don't know what would...


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## eveningsky339 (Sep 20, 2009)

mycrofft said:


> Oh, OP, it's P.E.R.L., not "pearl".



You shouldn't let my muscle memory when typing ruin a good acronym...


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## mycrofft (Sep 21, 2009)

*With my typinng skils, whu am i to Kritizces?*


Yer aces by me! Keep posting!


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## Barney_Fife (Sep 21, 2009)

You could argue that the "A" in PEARL.. is the AND.


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## Sasha (Sep 21, 2009)

Barney_Fife said:


> You could argue that the "A" in PEARL.. is the AND.



I use PERRLA.. Pupils equal, round, reactive to light and accommodation


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## HotelCo (Sep 22, 2009)

eveningsky339 said:


> , BP and HR somewhat high, but nothing major considering the patient's distress.



That right there seems to  tell me that the patient is in pain, even when the roach isn't being tugged. Pain management should be considered.


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## mycrofft (Sep 23, 2009)

*Let's say they decide an OR visit is needed...*

The anesthetist will appreciate any IV sites used up, and the morphine, too.


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## cm4short (Sep 24, 2009)

FireMedic254 said:


> I.V. Normal saline, place the patient sitting up. No pain meds yet. Attach an 18g cath to a 10cc syringe. Draw up hydrogen peroxide and normal saline. Gently push the mix into the patients ear. The bubbling will most likely make the roach pull out. If that doesnt work, request a pain management med with medical control and pull it out. The problem with tugging or pulling on it is that it wants to get away and goes deeper. It can also cause you to break parts of its body off inside the ear. But usually the bubbling sensation of the peroxide makes it want to back out of the ear.



I've heard this method to work extremely well. The hydrogen peroxide is irritating to them and will cause them to come running out.


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## mycrofft (Sep 24, 2009)

*Horseapples*

Nothing will make the bug "come running out", unless it is "running" as in "liquified". If the TM is perfed and you introduce H2O2 you will wind up in court and have a pt running like Curley Stooge on the floor on one elbow.
 Even for cerumen irrigs we use warm water and H2O2  in a 50/50 solution once we are pretty darn certain the TM is patent, then we use an otoscope after each short irrigation to check. If the pt complains, we stop. In any event, we try to rinse out the remaining H2O2 wi SNS because it alone can cause irritatoin of the ear canal.

Hey, I know. Drip in a little gasoline then defib....:wacko:


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## Sasha (Sep 25, 2009)

cm4short said:


> I've heard this method to work extremely well. The hydrogen peroxide is irritating to them and will cause them to come running out.






> While assessing your patient, your partner takes a look in her ear and-- lo and behold-- a dead cockroach. The little guy must have crawled in while the patient was asleep.



Not when the buggy is dead.


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## ResTech (Sep 25, 2009)

the hydrogen peroxide is like epi to a cockroach... it fires up there little dead hearts


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## BruceD (Sep 25, 2009)

The hydrogen peroxide trick is one I hadn't heard of before.  
I had always heard the lidocaine bit.
I don't believe we carried an otoscope in our truck, if that's how the roach was visualized, kudos to you.

For those who have never worked with the ear, be gentle with the patient as the ear canal can be or become exquisitely tender to manipulation and pressure (such as that applied when using instruments to extract a FB ).

-----

Hmmm, what if the cockroach is still viable?

If you carry tiny ecg leads you could attach and just print a strip.

If you don't carry the proper size leads or if it has a shockable rhythm, maybe you could just drop a bit of epi & put the defib paddles on each side of the patient's head and let loose with a couple hundred joules to see if you can resus.

Once you've revived the roach, the hydrogen peroxide could tease it out?

I think I've worked too many hours...
-B

and oh gosh, because this is a public forum in a litigious society...

PLEASE DO NOT EVER EVER SHOCK ANYONE'S HEAD - you'll kill the person. This was a JOKE.


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## Bosco578 (Sep 25, 2009)

Full C-Spine, 2 large bore (14g at minimum) IV's, 1 NS 1 Ringers, NRB@15-25lpm, Cardiac monitor, 12 and 15 lead ECG......Drive like a raped ape to a level 1 trauma centre.


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## mycrofft (Sep 25, 2009)

*And remember..*

The roach is not your patient.


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## daedalus (Sep 25, 2009)

If you harm the roach during removal, I recommend the following course of action (on the bug): bilateral EJ lines, 15 lead continuos cardiac monitoring, pulse ox, foleys, chest tubes, empiric needle decompression, intubation, and code 3 transport to the ER.


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## mycrofft (Sep 25, 2009)

*And no cell phone camera.*

..................:blush:


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## mycrofft (Sep 26, 2009)

*BruceD, didn't mean to blow on by.*

Yeah, ear pain is nt atypical and can be tough.
Pain suggests middle ear or TM source. TENDERNESS to manipulation of external ear or visualization suggests external canal.


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## mycrofft (Sep 27, 2009)

*Wait. You don't use otoscopes??*

What a simple, relatively inexpensive importasnt tool to assess ears and differentialing between a basal skull fx sign versus a scratched external canal.
Get a little one, some speculae, and look around! (Good for peeping into lockers, gunbores and through keyholes too).


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## BruceD (Sep 29, 2009)

mycrofft said:


> (Good for peeping into lockers, gunbores and through keyholes too).



Holy cow, never thought of that for gun bores!!


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## eveningsky339 (Sep 29, 2009)

daedalus said:


> If you harm the roach during removal, I recommend the following course of action (on the bug): bilateral EJ lines, 15 lead continuos cardiac monitoring, pulse ox, foleys, chest tubes, empiric needle decompression, intubation, and code 3 transport to the ER.



Child's play.  A bug is much too valuable for this BLS nonsense.

Epinephrine 1:1000, Furosemide, Ammonia Capsules, Nitroglycerine sub-lingual, Activated Charcoal and a Lidocaine IV drip should all be done in addition to the BLS procedures you mentioned.


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## mcdonl (Oct 27, 2009)

*Pain and Suffering....*

OK, please remember.... my only experience is having ready the first 10 chapters of the orange book and gone on a few dozen call's as a FF Assist....

I would consider mental anguish a part of the suffering. Given that, if the right call is to leave the bug in her ear would the best thing to do be to get her comfortable, transport and NOT tell the poor kid she has a cockroach in her ear?

I am assuming that no one knew this until the EMT looked in a saw it. Having pain is bad enough, but a 17 year old with a cockroach in her ear is just going to freak her out. I have teenage daughter, that much I DO know!


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## tcemsr3 (Nov 8, 2009)

I would monitor vitals, transport in position of comfort and have mom try to calm her down, nice smooth ride to ed and let the dr do the rest!


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## mcdonl (Nov 9, 2009)

Thats what I figured. I talked to a couple of guys on our department and they said the same. They said they may say something it causing an infection, but not tell them what.


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## WTEngel (Nov 9, 2009)

I have never seen a roach or other insect successfully removed using hemostats or something similar. They always tend to destroy the insect and pull it into pieces. Add in the factor that you are in the back of a moving ambulance, and I don't recommend sticking anything into the patient's ear.

The preferred method for getting an insect out of someone's ear is irrigation. Warm water with castille soap added, along with an 18 or 16 g catheter from an IV attached to a 60 cc syringe is a good set up to irrigate the ear. proceed with irrigation, and watch the insect float out...

The other benefit of irrigation is that you will most likely get the entire bug out, and not have bits and pieces remaining in the ear canal.

This would be done in the hospital, not in the back of an ambulance. There is no reason to take the insect out before it is looked at by a physician, NP or PA.


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