Trick of the Trade: Ear foreign body removal with modified suction setup
A 5 year old boy comes in who has stuck a small unpopped popcorn kernel into each ear. My resident and I discuss different methods to try to get it out including an ear curette, tissue glue, suction, and calling the ear-nose-throat (ENT) specialist. The ear curette won’t work to get around and the kernels are smooth and hard to grasp and might cause trauma with swelling or bleeding. We quickly excluded irrigation because the kernel might swell more. Another method considered was a drop of tissue adhesive onto a q-tip stick to adhere onto the foreign body (FB) for extraction. We were a little leary of this however for fear of gluing the FB to the ear canal and suffering the wrath of ENT.

We are excited to announce our new podcast series, 60-Second Soapbox! Each episode, one lucky individual gets exactly 1 whole minute to present their rant-of-choice to the world. Any topic is on the table – clinical, academic, economic, or whatever else may interest an EM-centric audience. Don’t worry if your are microphone-shy. We will carefully remix your audio to add an extra splash of drama and excitement. Even more exciting, participants get to challenge 3 of their peers to stand on a soapbox of their own!
Every day in the Emergency Department we see older adults with dementia who have developed delirium and are brought in because of worsening agitation, combativeness, or confusion. In order to care for them, we have to consider what the underlying cause of their agitation may be, but we also have to protect the patient and staff in case of violent outbursts. Older adults experience a phenomenon termed ‘homeostenosis’ in which their physiologic reserve and the degree to which they can compensate for stressors is narrowed, putting them at risk for delirium. This post will outline ways to prevent and de-escalate agitation in a patient with delirium, and how to treat it pharmacologically in a cautious manner to minimize side effects.