Dispatched, 17 yo female, severe head/earache

[eveningsky339]

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?

 

[HotelCo]

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.

 

[exodus]

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...

 

[steele4347]

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.

 

[Lifeguards For Life]

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

 

[Meursault]

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.

 

[HotelCo]

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.

 

[arsenicbassist]

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.

 

[Mountain Res-Q]

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:

 

[Lifeguards For Life]

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?

 

[rescue99]

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!

 

[rescue99]

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

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

 

[ResTech]

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.

 

[Dominion]

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.

 

[Lifeguards For Life]

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.

 

[arsenicbassist]

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.

 

[arsenicbassist]

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.

 

[usalsfyre]

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.

 

[eveningsky339]

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.

 

[rhan101277]

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.