# There's a what in your what?



## Tincanfireman (Nov 8, 2008)

Got dispatched from my nice warm rack at 0340 the other morning for a "patient in pain". Trying to come up with a good reason short of amputation to get me up at that hour, we went to the truck and got moving (I know, it's my job, it is what I get paid to do, etc. Fine; I'm a grouch at that hour...lol) We arrive to the patient walking out of the house to meet us at the curb, so my BS flag is already way high. "Guys, I'm so sorry to call you, but I have a ...OW OW OWWWWWW... bug in my ear!" Since it was my ride (sigh), I got the guy in the back and sat him down to have a look. "Oh, you can't OW OWWWW see it" sez he. Figuring he was either a psych case or was really hurting, there was little I could do in the back of the rig, so we get enroute. In between apologies and his Tourettes-like outbursts, I learned they had sprayed for bugs that afternoon and he had been awakened by the alleged bug scurrying off the pillow and into his ear canal. Still, I was beginning to believe the guy, to the point that I successfully convinced the ER staff to put him in a room (instead of triage) when we arrived at the hospital. I stayed with him until the nurse arrived with a cheery "so what's going on tonight?" When I told her his C/C, she paused only ever so briefly, then grabbed the otoscope and said "well, only one way to find out." I knew my reputation was gonna take a serious hit if he had been bluffing, but then I heard the nurse say "I'll be darned, look at him!" She told me my guy had a 3/4" roach right up against his eardrum, and every time he moved Mr. Critter was banging away at the tympanic membrane. Very quickly the doc arrived, assassinated the critter with H2O2 and pulled him out of the guy's head. I found out later that I was the newest member of a fairly exclusive club, in that everyone had heard of these cases, but few had actually seen one. In the end, my gut instinct had been proven correct, and he was actually a very decent fellow, and very grateful for the care and transportation we had provided him along with my successful advocacy. He ended up being discharged before I was able to complete all the paperwork!


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## reaper (Nov 9, 2008)

Had a girl with a 1/2 roach in her ear. I could see it move around , but couldn't get it out. Doc hit it with lido and pulled it out.

Makes me want to wear earmuffs when I sleep!!


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## Airwaygoddess (Nov 9, 2008)

*Bugs! Bugs! Bugs!!!*

YUCKY!!!!!!!  I would think it's even worse to find half of a cockroach!!!  Airwaygoddess is creeped out!


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## flhtci01 (Nov 9, 2008)

Recently watched a Tales of the ER where they pulled a 1" beetle out of a guys ear. The video of the bug in the ear canal was neat.B)


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## jochi1543 (Nov 9, 2008)

EWWWWWW!:wacko:


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## fortsmithman (Nov 9, 2008)

Wear hearing protectors.


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## marineman (Nov 9, 2008)

Thank god all those nasty critters don't like the cold up here.


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## JPINFV (Nov 9, 2008)

I WAS a patient in one of these cases. Was playing catch in my front yard earlier in the day about 10 years ago and had the ball go over the fence. Hoped the fence through a few trees and got the ball. Fast forward 3-4 hours when the damn bug started banging away in my ear causing my parents to think I was becoming possesed since I was going absolutely nuts one second, and was perfectly fine the next. Since this was before the time when every minor issue was a 911 call, my dad tried to flush out my ear with a bulb syringe, which brought peace for a few minutes, but failed to exocise the bug. We ended up going down to the local urgent care "doc in a box" office a few blocks away where he was able to power wash my ear with a syringe after taking the time to show my dad (who was -ever so impressed-) the bug with the ottoscope.


As an aside, cases like this (is this person REALLY crazy?) is why I recommend the book The Man Who Mistook His Wife For A Hat: And Other Clinical Tales  by Olive Sacks as a must read. There are plenty of neuological conditions that makes a person seem crazy (like essentially losing vision on one side of their field of view, but the patient thinking they have a normal field of vision) when there's a perfectly reasonable non-psychiatric explanation of their symptoms.


As an additional question, would it be unreasonable as a prehospital provider (because parents and patients self treating is completely different than a medical professional providing treatment) to flush a patient's ear ourself?


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## traumateam1 (Nov 10, 2008)

JPINFV said:


> I WAS a patient in one of these cases. Was playing catch in my front yard earlier in the day about 10 years ago and had the ball go over the fence. Hoped the fence through a few trees and got the ball. Fast forward 3-4 hours when the damn bug started banging away in my ear causing my parents to think I was becoming possesed since I was going absolutely nuts one second, and was perfectly fine the next. Since this was before the time when every minor issue was a 911 call, my dad tried to flush out my ear with a bulb syringe, which brought peace for a few minutes, but failed to exocise the bug. We ended up going down to the local urgent care "doc in a box" office a few blocks away where he was able to power wash my ear with a syringe after taking the time to show my dad (who was -ever so impressed-) the bug with the ottoscope.
> 
> 
> As an aside, cases like this (is this person REALLY crazy?) is why I recommend the book The Man Who Mistook His Wife For A Hat: And Other Clinical Tales  by Olive Sacks as a must read. There are plenty of neuological conditions that makes a person seem crazy (like essentially losing vision on one side of their field of view, but the patient thinking they have a normal field of vision) when there's a perfectly reasonable non-psychiatric explanation of their symptoms.
> ...



I don't think it is. Shoot some NS into the p/t's ear if they have a C/C of a bug being in there. If you don't get it out, well than fine, ERs problem.. However if you do get it out, sweet.


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## Buzz (Nov 10, 2008)

flhtci01 said:


> Recently watched a Tales of the ER where they pulled a 1" beetle out of a guys ear. The video of the bug in the ear canal was neat.B)



Saw that one too... A june bug is a seriously large bug to get inside your ear though...


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## medicdan (Nov 10, 2008)

JPINFV said:


> As an aside, cases like this (is this person REALLY crazy?) is why I recommend the book The Man Who Mistook His Wife For A Hat: And Other Clinical Tales  by Oliver Sacks as a must read. There are plenty of neuological conditions that makes a person seem crazy (like essentially losing vision on one side of their field of view, but the patient thinking they have a normal field of vision) when there's a perfectly reasonable non-psychiatric explanation of their symptoms.



Quick side note:
The book you cite is EXCELLENT-- some fascinating stories written by an excellent doctor. 
If you like Dr. Sacks, consider reading  _ Phantoms in the Brain: Probing the Mysteries of the Human Mind _ by Dr. V. S. Ramachandran (no, I could not spell that without help). Dr. Atul Gawande (and his several books) are also highly recommended.

[/rant]


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## Sasha (Nov 10, 2008)

I was told by my instructor that if you have a bug in the ear, turn off all the lights and draw it out with a pen light, according to him when theyre trapped and have no where to go, theyll scurry too the light instead of away.

If the guy had been MY patient, he woulda gotten a 4x4 over said ear and a speedy trip to the hospital. Im terrified of roaches, spiders, and other creeper crawlies.


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## EMTinNEPA (Nov 10, 2008)

Sasha said:


> Im terrified of roaches, spiders, and other creeper crawlies.



So bugs are horrifying but doing battle with the angel of death every day is no biggie? ^_^


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## Sasha (Nov 10, 2008)

EMTinNEPA said:


> So bugs are horrifying but doing battle with the angel of death every day is no biggie? ^_^



The Angel of Death doesnt have feelers and six legs! That just aint natural!


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## sixmaybemore (Nov 10, 2008)

flhtci01 said:


> Recently watched a Tales of the ER where they pulled a 1" beetle out of a guys ear. The video of the bug in the ear canal was neat.B)



Was that the one where it was a waitress, and she was going ballistic with the junebug in her ear? 

(hey, what can I say, I couldn't sleep and that was all that was on!)


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## flhtci01 (Nov 10, 2008)

sixmaybemore said:


> Was that the one where it was a waitress, and she was going ballistic with the junebug in her ear?
> 
> (hey, what can I say, I couldn't sleep and that was all that was on!)




That was the one.  It was either that or infomercials at that time of the night.


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## sixmaybemore (Nov 10, 2008)

That was a sincerely big bug. Made me want to sleep with earmuffs on lol.


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## MJordan2121 (Nov 11, 2008)

When I was a child, I ended up having a tick in my ear. Now I am totally freaked out and will be sleeping with ear muffs on for the rest of my life.


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## apagea99 (Nov 11, 2008)

There's a statistic somewhere that tells how many spiders the average person ingests in their sleep per year.....I think I read it in one of those bathroom readers. True or not, it's creepy......and a little crunchy I'd say :unsure:


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## MRE (Nov 11, 2008)

Sasha said:


> If the guy had been MY patient, he woulda gotten a 4x4 over said ear and a speedy trip to the hospital. Im terrified of roaches, spiders, and other creeper crawlies.



I wouldn't do anything to keep the bug in the ear.  Last thing you want is for it to decide it can't go back out and start trying to dig through the ear drum.  

I figure if its not causing a problem, just transport.  If it is causing a problem, have the patient lay on their side with the ear that has the bug facing the ceiling, then slowly drip NS into the ear, hopefully when the ear canal floods the bug will make its way to the outside to be collected and taken to the hospital.


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## reaper (Nov 11, 2008)

Just smack them really hard on the opposite side! The bug will fly right out!!!!!!!!


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## MRE (Nov 11, 2008)

reaper said:


> Just smack them really hard on the opposite side! The bug will fly right out!!!!!!!!



If that doesn't work, how about applying a FROPVT to the opposite ear.  40lpm should blast that bugger out, and maybe some other stuff they don't need too.:wacko:


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## sixmaybemore (Nov 11, 2008)

MJordan2121 said:


> When I was a child, I ended up having a tick in my ear. Now I am totally freaked out and will be sleeping with ear muffs on for the rest of my life.



Speak not of the horrid little beastie called the tick. 

And great, now I have all sorts of things to be paranoid about next time we go camping! Between my spider bite, our tick experience this year, and now your tick story, I think I'll just swath us all in netting and call it good.


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## MRE (Nov 12, 2008)

KB1OEV said:


> If that doesn't work, how about applying a FROPVT to the opposite ear.  40lpm should blast that bugger out, and maybe some other stuff they don't need too.:wacko:



Oops, that should be FROPVD.  Not to hyjack the thread, but does anyone use these on their ambulance anymore?


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## daedalus (Nov 12, 2008)

Remember cold fluids introduced into the ear can cause dizziness and vertigo, n&v


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## m_b_williamson (Nov 27, 2008)

thats creepy, really wierds me out


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## Aileana (Dec 24, 2008)

Wow, that is really weird. Goes to show that the 'gut feeling' we get is really accurate, and should be followed. 

As to the using NSS to get the bug out, would that be considered a controlled medical act? In our Regulated Health Professions Act, one of the listed controlled medical acts is "putting an instrument, hand, or finger beyond the external ear canal". If the saline is being dripped in, it's technically not an instrument... 
I'm curious now about pre-hospital treatment, there's definately nothing in protocol for this sort of call


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## aussieemt1980 (Dec 26, 2008)

My ex girl friend sat up one evening in bed at the wrong time and had a small bee (native stingless - thank god) fly straight on in. Panic ensues, she grabs a cotton bud to kill it, and manages to jam it right in against the ear drum. Off to the local ED, where Doc, Nurse and I tried to:

1. Wash it clear with saline (drowned it);
2. Float it out with baby oil (softened it);
3. Using a scope and forceps, remove it (in parts!)

Took about 20 minutes to get everything out and flush the ear clean, but we got there in the end.

Interesting evening though, we shared the waiting room with a psych pt, domr lady with private health insurance and a head ache (we have both private and government funded health care in aussie land), and a bikie gang member dragged in with 'unexplained abdo pain' following an 'abdominal interaction with a sharp metallic thing'.

This topic actually reminded me of a phrase I used to tell new recruits in the army on their first night out in field training - "in your sleep in your life you will eat xx amount of spiders, xx amount of cockroaches and at least one mouse. enjoy your sleep!"


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