Dispatched, 17 yo female, severe head/earache

[Akulahawk]

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...

 

[eveningsky339]

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

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

 

[mycrofft]

With my typinng skils, whu am i to Kritizces?


Yer aces by me! Keep posting!

 

[Barney_Fife]

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

 

[Sasha]

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

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

 

[HotelCo]

, 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.

 

[mycrofft]

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

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

 

[cm4short]

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.

 

[mycrofft]

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:

 

[Sasha]

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.

 

[ResTech]

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

 

[BruceD]

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.

 

[Bosco578]

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.

 

[mycrofft]

And remember..

The roach is not your patient.

 

[daedalus]

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.

 

[mycrofft]

And no cell phone camera.

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

 

[mycrofft]

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.

 

[mycrofft]

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).

 

[BruceD]

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

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

 

[eveningsky339]

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.