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Cat365 Cat365 (Member)

Ears

Emergency   (391 Views 15 Comments)
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How do you handle ears that are so infected/dirty that the tympanic membrane can’t be seen? Do most ERs irrigate? If so, is it something a Dr does or do you do it in your workplace? What do you use?

Edited by Cat365

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We do irrigate at the Urgent Care I work at. The Water Pik has been and out of fashion over the years but I usually attach about 1" of an IV hub/tubing to a 60 cc syringe and use luke warm water. If the'ye old enough I get them to hold an emesis basin under their ear. For the younger ones I usually just remove their shirt and have someone hold them down on a pile of towels to catch the water. We'll irrigate until the TM is visible and go get the MD to come back and look.

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18 minutes ago, OldDude said:

We do irrigate at the Urgent Care I work at. The Water Pik has been and out of fashion over the years but I usually attach about 1" of an IV hub/tubing to a 60 cc syringe and use luke warm water. If the'ye old enough I get them to hold an emesis basin under their ear. For the younger ones I usually just remove their shirt and have someone hold them down on a pile of towels to catch the water. We'll irrigate until the TM is visible and go get the MD to come back and look.

Do you worry about bursting the tympanic membrane? I witnessed an incident recently where the ear started to bleed and even though the dr said that nothing was done incorrectly I’m wondering if that’s what happened. The tympanic membrane couldn’t be visualized after this happened,but since the ear was so blocked up beforehand it might not have been there prior.

 

Edited by Cat365

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When I worked ED I did it all the time. Firstly put a few drops of Debrox in the affected ear(s). Then take a butterfly needle and cut the needle off leaving about an inch of tubing at the hub. We were supposed to use a 10ml syringe but I went rogue and used a 30. Apparently I’m not as bad-ass as Old Dude. If it was really plugged I’d shorten a 14 gauge Angio and use that (without the stylet) but had to be extremely careful. I used 1/2 lukewarm tap water and 1/2 H2O2. DO NOT USE COLD OR VERY WARM WATER!!! I cannot emphasize that enough. If you do it stimulates the vestibulo-ocular nerve reflex (also known as a caloric test) which normally just induces a brief nystagmus but on some patients makes them dizzy and vomit. One of my peers learned this the hard way. 

You would not believe the crap I’ve gotten out of ears. Almost as satisfying as Dr. Pimple Popper! 🤣

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1 hour ago, Cat365 said:

 

I used to worry about that when I first started doing it but since I haven't ever seen or heard of it happening I don't worry about it anymore. 

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34 minutes ago, Wuzzie said:

... We were supposed to use a 10ml syringe but I went rogue and used a 30. Apparently I’m not as bad-ass as Old Dude...

I wear XL gloves and they are snug so the 60 fits my grip better and I can take advantage of the extra volume 😀

 

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I have extra small hands but they called me The Blaster...among other things  

 

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Ok apparently I’m over cautious. The whole red stuff out of the ear thing worried me. I’d never had that happen previously.

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Just now, Cat365 said:

Ok apparently I’m over cautious. The whole red stuff out of the ear thing worried me. I’d never had that happen previously.

I’ve never had it happen...ever. 

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I am not a big fan of ears, and really never look in them.

The best tool for flushing is617ze3PBwfL._SX522_.jpg

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I haven't had bleeding. Was it bright red or more purulent/blood-tinged junk? I guess it wouldn't alarm me really, given that otitis, if it exists under all the gunk, can involve discharge to begin with.

Stinks that auralgan is gone...

 

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We irrigate, it is typically performed by nursing staff. We sometime will use liquid colace to help soften the wax before irrigation. As others have suggested we typically just cut off an inch or so from an extension set, and then I prefer a 60 mL syringe (larger syringes actually produce less pressure as the surface area of the plunger is greater and distributing the same amount of force your hand can apply to it).

Some people will use angiocaths, I don't love this as I feel like they are more rigid and are more likely to scratch the ear canal. I don't love elephant ears, I've never found the to be very effective and the tips are surprisingly expensive. You also have to be pretty diligent in cleaning the setup afterwards as only the tips are disposable, and they become a bit of an infection control nightmare.

It is not uncommon to scratch the auditory canal with irrigation, I've seen it a handful of times of the years. The ear canal is sensitive anyway, and if the patient has been impacted or had URI the tissues is that much more irritable.

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