Dispatched, 17 yo female, severe head/earache

[Barney_Fife]

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.

 

[Lifeguards For Life]

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

 

[Akulahawk]

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...

 

[Lifeguards For Life]

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

 

[Akulahawk]

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..

 

[Lifeguards For Life]

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.

 

[Akulahawk]

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...

 

[VentMedic]

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.

 

[Lifeguards For Life]

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.

 

[daedalus]

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.)

 

[Lifeguards For Life]

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

 

[ResTech]

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

 

[Sasha]

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.

 

[DV_EMT]

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

 

[mycrofft]

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".

 

[maxwell]

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.

 

[rescue99]

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!

 

[Lifeguards For Life]

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

 

[FireMedic254]

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.

 

[mycrofft]

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.