Tips for cleaning kid's ears

[HLxDrummer]

The bane of my existence in the kid's ED... fever and/or pulling at the ear but tons of wax. I have the nurse irrigate with peroxide, colace, water, saline, unicorn urine... doesn't help. I try curreting but by the time I get deep enough I feel like I'm about to scoop out brain. I end up spending way too much time on these situations. Any suggestions are appreciated!

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[Daiphon]

Most AOM = viral. So don't need abx emergently, and ear tugging may be due to cerumen impaction.

So, Debrox + motrin/APAP, f/u PMD for reeval.

Stop wasting time.

Semper Brunneis Pallium

 

[RustedFox]

The bane of my existence in the kid's ED... fever and/or pulling at the ear but tons of wax. I have the nurse irrigate with peroxide, colace, water, saline, unicorn urine... doesn't help. I try curreting but by the time I get deep enough I feel like I'm about to scoop out brain. I end up spending way too much time on these situations. Any suggestions are appreciated!

Discharge home.

 

[wysdoc]

The bane of my existence in the kid's ED... fever and/or pulling at the ear but tons of wax. I have the nurse irrigate with peroxide, colace, water, saline, unicorn urine... doesn't help. I try curreting but by the time I get deep enough I feel like I'm about to scoop out brain. I end up spending way too much time on these situations. Any suggestions are appreciated!

These are my favorites - the one 3 from the right, with no loop but a tiny scoop shape. Safe Ear Curettes™ - Bionix Medical Technologies Pull laterally on the pinna (It straightens out the ear canal for you) , gently slide the curette along one wall of the wax blob (the ear canal side away from the face) and then drag the wax out toward you. Don't pack it in further. With soft wax you might be able to plunge this little scoop into the wax and get it out in a couple of scoops.

 

[GeneralVeers]

I don't waste my time. This used to be the bane of my existence on peds rotations. Cleaning out screaming kids earwax to "look" at the TM.

Honestly, otitis media is NOT an emergency. Even with no treatment 90% of these will get better. I just tell parents that I see no sign of infection and discharge. Recommend f/u with pediatrican for BS cerumenectomy.

 

[RustedFox]

I don't waste my time. This used to be the bane of my existence on peds rotations. Cleaning out screaming kids earwax to "look" at the TM.

Honestly, otitis media is NOT an emergency. Even with no treatment 90% of these will get better. I just tell parents that I see no sign of infection and discharge. Recommend f/u with pediatrican for BS cerumenectomy.

This. All day long.

"Go clean out your kids ears."

"But, won't you do it here?"

"No. He will stay much more still for you than he will for me."

"But..."

"**Dr. RustedFox we have a stroke alert coming in. Five minutes.**"

 

[RustedFox]

Elaborating...

It's this kind of nonsense that should never see the ER. For realsies.

I propose using our tax dollars to fund pubic education programs in middle/high school to teach everyone "here's how not to be a completely incompetent zero with common health ailments."

Of course, Godwin's law applies here as well. Someone soon (med student or below) will accuse me of being a Nazi because I proposed a state-sponsored self care initiative designed to ease a national healthcare burden.

 

[wysdoc]

Elaborating...

It's this kind of nonsense that should never see the ER. For realsies.

I propose using our tax dollars to fund pubic education programs in middle/high school to teach everyone "here's how not to be a completely incompetent zero with common health ailments."

Of course, Godwin's law applies here as well. Someone soon (med student or below) will accuse me of being a Nazi because I proposed a state-sponsored self care initiative designed to ease a national healthcare burden.

I'm a ped not an ER doc, I agree it's not an ER worthy visit. Especially since you can find a ped open 7 days a week

 

[HLxDrummer]

Awesome, thanks guys. I thought of sending them all home with debrox and FU but wasn't sure if my attendings would be on board. Sometimes I get these kids with a fever and no clear source and I kind of want to see the TM so I have something to pin (or not pin) it on but I guess if they're older, well appearing, and have close FU it is probably fine.

 

[gman33]

As a resident, this is going to be attending dependent. Some won't care, some will want you to do everything.

As an attending, my thoughts are this is usually a waste of time and otitis doesn't usually matter in the short term.

 

[shoal007]

Awesome, thanks guys. I thought of sending them all home with debrox and FU but wasn't sure if my attendings would be on board. Sometimes I get these kids with a fever and no clear source and I kind of want to see the TM so I have something to pin (or not pin) it on but I guess if they're older, well appearing, and have close FU it is probably fine.

careful with this trap. although aom is a common cause of fever in children... it should not be used as a source in sick kids, young kids, immunocompromised kids, no immunization kids... all in all i prefer not to treat strep or aom as an attending. however its expected in my community.

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[WilcoWorld]

Awesome, thanks guys. I thought of sending them all home with debrox and FU but wasn't sure if my attendings would be on board. Sometimes I get these kids with a fever and no clear source and I kind of want to see the TM so I have something to pin (or not pin) it on but I guess if they're older, well appearing, and have close FU it is probably fine.

careful with this trap. although aom is a common cause of fever in children... it should not be used as a source in sick kids, young kids, immunocompromised kids, no immunization kids... all in all i prefer not to treat strep or aom as an attending. however its expected in my community.

Yep.

I've seen people torture themselves and their patients so that they can avoid a fever workup by finding a red TM.
They're doing it wrong.

Febrile child in the ED: The question you need to answer is whether or not the child is "sick" (in the EM sense). If the kid is "sick" then you need to do a work up. If the kid is not "sick" then you make a reasonable effort to identify a cause, but do not spend more than 2 minutes trying to find a condition that will resolve on its own.

And if the kid is too young to tell you when they're sick (<28 days), then do the work up.

 

[Tenk]

This is only dependent on one factor: how bored I am.

If I am bored I will clean their ears. If I am busy I do not.

If you ever want to not do something that is non emergent just say "we don't do that here" and discharge the patient.

 

[GeneralVeers]

Febrile child in the ED: The question you need to answer is whether or not the child is "sick" (in the EM sense). If the kid is "sick" then you need to do a work up. If the kid is not "sick" then you make a reasonable effort to identify a cause, but do not spend more than 2 minutes trying to find a condition that will resolve on its own.

And if the kid is too young to tell you when they're sick (<28 days), then do the work up.

Exactly right. When I see the kid, I already know in my head what dispo is. If discharge home, then no workup and discharge. If admission, then usually CXR, UA, Flu/RSV to try and identify a source.

I am constantly frustrated by my PAs who tie up fast track for hours getting flu/RSV on every febrile kid. Not sure what the point of this is, as it takes about an hour to collect, send and result each test, and the treatment/dispo is the same regardless of a positive or negative result.

 

[gman33]

Exactly right. When I see the kid, I already know in my head what dispo is. If discharge home, then no workup and discharge. If admission, then usually CXR, UA, Flu/RSV to try and identify a source.

I am constantly frustrated by my PAs who tie up fast track for hours getting flu/RSV on every febrile kid. Not sure what the point of this is, as it takes about an hour to collect, send and result each test, and the treatment/dispo is the same regardless of a positive or negative result.

Those tests rarely have any value.
Same with a strep swab.

You turn a 2 minute stay into 2 hours for the same dispo.