[NP-Clinical] cerumen removal

Sat Jan 6 17:58:09 PST 2007

I think it just comes in one strength (its been a while, sorry).  Kay

pattinp at verizon.net wrote:  Hi Kay,

Did  you just call the Pharmacy and ask for liquid colace or a specific  concentration? I don't want to look like an idiot when I call. LOL.

Patti NP

>From: Kay Schoeller 
>Date: 2007/01/05 Fri AM 11:33:29 CST
>To: NP Clinical 
>Subject: Re: Re: [NP-Clinical] cerumen removal

>Hi  Patti, I used to use liquid colase bacause it was cheaper the debrox  and less irritating.  Out local pharmacy ordered it for me.   Water pics work well, but if you perforate the ear drum you are on your  own legally because of the pressure the water pic uses.  Kay  Schoeller
>
>pattinp at verizon.net wrote:  Ed and Christine,
>
>I  am currently working in an Occ Health Clinic where I am actually doing  more "quasi" primary care. I see a fair amount of patients with HEENT  complaints. Half the time I can't see the TM because of the cerumen. I  have heard that colace works well. Where can I get some liquid colace?  If a Rx is needed how do I order it? When you do the irrigation  afterwards do you use a syringe, Water-Pik? The nurses here don't want  to be bothered with doing irrigations and I am working on "attitude  adjustments". I am expected to treat these employees so they don't take  off work to go to their PCPs for "simple" problems.
>
>Thanks in advance for your help.
>
>Patti Robertson NP of VA
>
>
>>From: Christine Smith 
>>Date: 2007/01/02 Tue AM 05:26:29 CST
>>To: NP Clinical 
>>Subject: Re: [NP-Clinical] cerumen removal
>
>>Ed  -Ah... ER hell... so fresh in my mind after just leaving one. If the  canal looks real traumatized after irrigation I do rx otic suspension  drops such as cortisporin. Only because I get concerned about them  developing an Otitis Externa. If just a bit of blood I don't worry  much. But lots of times they were already digging on their ear before  they see you so it is traumatized. For sure I would give the  cardiologist the drops just because he could make my life miserable if  an infection developed.  Now why are you doing irrigations????  Nursing can do that or ER techs. I won't let my techs use a curette but  they sure as hell can flush ears. Christine Smith, NPAntioch, CA  ----- Original Message ----- From: ed piasecki To:  np-clinical at nurse.net Sent: Monday, January 01, 2007 9:35 PM Subject:  RE: [NP-Clinical] cerumen removal 
>> 
>>I had a new years from hell in the ER here in blessed Iowa. 
>>One  of the cardiologist pops in needing his cerumen impaction resolved  stat. Of course because I am the "mid-level" on duty I get the privlege  to remove his wax. 
>>The part that urked me was he was upset  when it bleed after colace and irrigation only. This guy had some real  potatoes growing up there. 
>>My question is does the group  prophylax with otic antibiotics after they get bleeding? How far do you  go to remove the impaction? 
>>Thanks for your input in advance,
>>
>>
>>
>>
>> Ed Piasecki From: "Christine Smith" 
>>Reply-To: NP Clinical 
>>To: "NP Clinical" 
>>Subject: [NP-Clinical] INGROWN NAILS
>>Date: Sun, 31 Dec 2006 19:01:45 -0800
>>
>>  I do about 5 ingrown toe nails a week. If they are really against a  wedge resection then I will have them try the soapy soaks and wedge a  piece of cotton under the nail like Andy does. This seldom works  in  my opinion, but I suspect it is because it is painful and hard  to get the cotton under. If you are going to recommend that the best  way to get the cotton under the toe nail is give the patient  an cuticle  stick (those wooden sticks that have a beveled  edge for pushing cuticles down sold in cosmetic section). I bought a  bunch and just stock them so I can show them how. Take a regular cotton  ball and wrap a dab of cotton around the beveled portion of the   stick like wrapping cotton candy. Then wedge it under the nail.    However, for the most part I do a resection, wrap with a  pressure dressing, have them remove it in 24 hours and start warm soaks  TID before our recheck. . I see them 48 hours afterwards. The!
>y  are doing well by then. I rarely ever give antibiotics unless  the erythema has spread up into the toe - which is seldom. Most  times, once the offending section of nail is removed, it clears up.    I also do the digital block with Bupivicaine and I give them  Motrin 800 in the office with a Vicodin rx #12. I tell them  to pop two Vicodin right after they fill it, go home, elevate foot  and sleep. By morning, almost all of mine return to work on Motrin all  day with a Vicodin back up. Suckers hurt - I know from  experience. Especially since most my patients are male laborers  and need to get right back to work the next day. I try to get them  to let me do it the night before their day off so they can limit  walking but not always feasible.   I once "operated" on my  daughters boyfriends toe on my bed. I put him on Motrin and sent him  home. That night he called me at 2am in tears due to the intense pain.  I was sure I did !
>something wrong, sure I was going to lose my license, sure the kid
>was  going to lose his toe. I was panicked! I drove one hour to his house,  assessed a normal looking toe and a crying 22 yo 220lb kid. I repeated  the digital block with marcaine (even though the toenail was now  resected) and gave him two old Percocet I had. He ended up fine. I  thought he was a wimp, until I had my own toe done. I am telling you,  these puppies  hurt!   I talked to my own podiatrist  about this (Lorraine Loretz's old professor). He told me that he always  give Motrin 800 to women and Vicodin to most men. He said men are  either wimpier or just need it more - he is not sure why, but that  Motrin seems to be enough for females. He also told me antibiotics are  rarely needed but if there is very much infection it can be more  difficult to get a good digital block.   I am sure Lorraine has  her own thought on this.   Christine Smith, NP Antioch, CA      ----- Original Message ----- F!
>rom: Andy Craig To: 'NP  Clinical' Sent: Sunday, December 31, 2006 12:09 PM Subject: RE:  [NP-Clinical] Foot/nail care by NP's 
> If I see someone with an  ingrown nail that is real early and mild severity, I offer conservative  treatment as an option: warm soapy soaks TID and a small piece of  cotton tucked under the end of the nail to lift it up a bit off the  nail fold and relieve some of the pressure.  But 9 times out of  10, my tx of choice is cold, hard steel ;)  (wedge  resection.)  Especially if it's infected.  And if it is I  typically rx Keflex for 7 days while they heal.  I leave them in a  bulky dressing with a small piece of vaseline gauze tucked into  the proximal nail fold for the first 2 days; After 2 days I see them  back, remove the gauze, apply a band aid and have them do warm soapy  soaks TID for a week   
>>Andy Craig, NP
>>Charlotte, NC -----Original Message-----
>>From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net] On Behalf Of ed piasecki
>>Sent: Sunday, December 31, 2006 2:27 AM
>>To: np-clinical at nurse.net
>>Subject: RE: [NP-Clinical] Foot/nail care by NP's
>>
>> 
>>To the Group: 
>>Same topic, different piece: 
>>Infected ingrown toe nails. Do most treat with antibiotics and then remove nail or do both together?
>>
>>
>>
>>
>> Ed Piasecki 
>> 
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>>>_______________________________________________
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>> 
>> 
>> 
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>>NPCENTRAL.NET/CE/PAIN
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>>FnP Associates offers a complimentary continuing education program.
>>Pain: Current Understanding of Assessment, Management, and Treatments
>>Receive 6.0 Contact Hours of Pharmacology
>>NPCENTRAL.NET/CE/PAIN
>
>
>_______________________________________________
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>NPCENTRAL.NET/CE/PAIN
>
>
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