By David M. James MD
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Additional info for Field Guide to Urgent and Ambulatory Care Procedures
5. Have patient sit upright; drape towel under ear to be irrigated; have patient hold K basin under ear to catch water. 6. With one hand, pull pinna posteriorly to open and straighten EAC. 7. Insert soft catheter tip 1 cm into EAC; firmly depress syringe plunger to irrigate ear. Direct stream anteriorly and superiorly; do not allow catheter tip to go deeper into EAC (Fig. 2). 8. Repeat irrigation until cerumen bolus or FB appears at exterior meatus of EAC; at this point, you may elect to remove the cerumen or FB with Adson forceps or an ear curette.
Ellis class II fractures are more complex. They not only involve the enamel, but also expose the dentin layer of the tooth. Treatment is based on the patient’s age. As less dentin is present in the teeth of patients younger than 12 years of age, these injuries warrant dressing the exposed dentin with calcium hydroxide paste (or toothpaste), and then with a dry gauze. Referral to a dentist is required within 24 hours. Patients older than 12 years of age will have a relatively greater dentin-topulp ratio.
9. Apply Polysporin or similar antibacterial cream, and apply pressure dressing. PRACTICAL TIPS • Reexamine patient or arrange follow-up within 24 hours. Hematomas may recur. Reapply pressure dressing, and leave in place for TWO WEEKS. • We suggest applying Polysporin or similar antibiotic ointment liberally over the hematoma incision before applying the pressure dressing. The cream not only is antibacterial, but serves as a lubricant between skin and pressure dressing. FIG. 1. Using dental rolls to form a hemostatic buttress.