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Doc:

In Baltimore, Maryland this chief complaint and ultimate diagnosis would probably only allow the hospital to get compensated for the initial screening exam by the triage nurse. I think that's like 80 bucks. It depends on the patients insurance but ?most? insurances won't pay more than that. This is different from the past, I believe, so now hospitals are incentivized to keep non-ED complaints from coming. But we see all patients and all complaints so hospitals eat a lot of costs. 
My understanding of these types of things is evolving so I welcome more insight.

Also, I think most folks use colace to remove wax, not because of a complaint, but so they can see the TM. But for me, it's so goopy after its hard to see no matter what. I basically do what you describe John. I am on the end of the spectrum that does not treat OM unless it's clearly causing moderate to severe symptoms (and looks bad). And I use the watch and wait method often. 

Eric Balighian
St. Agnes Hospital
Baltimore, MD 

Sent from my iPhone

> On Mar 23, 2017, at 7:45 AM, Doc Holiday <[log in to unmask]> wrote:
> 
> By the mere writing of this contribution to the thread, I will be doing more about the condition of cerumen impaction than I have done in the past three or so years... That was when I last contributed to a thread about this substance on this List or another one (can't recall which).
> 
> 
> Working in UK EM, although I recall we used to have patients arrive with such complaints (always adult, though), this was in the remote past and I don't think I have seen this for quite a few years now. I suspect that the rare case is re-directed away from reception without even getting to register as a patient. It forms one of the conditions for which patients are expected to attend their local pharmacy and deal with over-the-counter. Their GP would be the choice for when medical care is required.
> 
> 
> Hence, I write in the complete ignorance of Colace and/or whatever are the other substances people are advised to use. The reason I write is that I am preparing for the visit of a resident from the left side of the Atlantic and the project we aim for her to do while in our ED relates to comparing EM there and here. I would like to know whether a visit for such a complaint generates income for the ED and, if so, how much. Also, does anyone ever see complications from such treatment (regardless of who did the treatment - I have never seen any). Also, are there any treatments for impaction which are prescription-only (or otherwise require a physician and cannot be managed OTC at a pharmacy)? I think we will use this condition in the project. It would help me to have an estimate as to how common such presentations are. Now that you know how little I know of this condition and why, you are probably aware of other questions I should be asking - feel free to answer.
> 
> 
> Thanks, all.
> 
> 
> ________________________________
> From: Pediatric Emergency Medicine Discussion List <[log in to unmask]> on behalf of Howard, John <[log in to unmask]>
> Sent: 23 March 2017 03:28
> To: [log in to unmask]
> Subject: Cerumen impaction
> 
> Hello group:
> 
> 
> I was curious who uses colace in the PED to assist with cerumen impaction?  The guidelines I've read say 1 ml on affected side, leave cotton in ear, reassess in 20-30 min.
> 
> -Do any of you use this?
> 
> -If so, do you keep it stocked inside your ED?  (I think waiting for our pharmacy to deliver it to us in the ED would add too much time to an otherwise straight-forward visit.)
> 
> 
> Thanks for your feedback,
> 
> 
> John Howard, DO
> 
> Advocate Children's Hospital
> 
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