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The last time www.sinaiem.org addressed the topic of cerumen (ear wax) impaction was in 2013. See this post: http://sinaiem.org/50yo-man-with-chest-pain-and-also-with-r-ear-pain/  If you’re like me, you likely believe that the world of cerumen impaction is a rather static one. Given that, another post on cerumen impaction would seem to be duplicative…Well you (and I) are wrong, and here’sRead more

Here is a pearl about nasal foreign bodies:   The nose is the MC site of fb insertion, seen mostly in children <5 years. Most of the time, the risk of aspiration and complications are low. However, if the fb is a button battery or a set of paired disc magnets, the risks can beRead more

So you’re working a Saturday overnight B side shift at Elmhurst. Its 3am and you have a patient in the hallway who looks questionably intoxicated and has been assaulted. Grossly he has no facial or head injuries (no lacs or abrasions) but you walk over to the patient and he is grabbing his jaw. YouRead more

25 y/o F with multiple painful lesions of the right gingiva and low grade fever. The symptoms started off as a stinging sensation with sensitivity to the gums on her right side that she noticed 3 days ago, but now there are lesions that hurt to touch, especially when brushing teeth. She has never had this before.Read more

32 yo overweight female presents with a headache.  This headache is similar to prior headaches, which she gets frequently.  The rest of her story seems consistent with a migraine and her physical exam, including a through neuro exam, is normal.  However, you still feel concerned because she’s in the right demographic for idiopathic intracranial hypertension.Read more

A 50 y/o M with a PMH of hypertension presents to the emergency department with epistaxis. A rhino rocket is placed. You note the patient’s blood pressure to be 196/100. He is A&Ox3 and denies any other symptoms. Should you treat this patient as hypertensive emergency and lower his BP?Read more

A 19-year-old-male with no known past medical history, presents in progressive respiratory distress shortly after undergoing a tooth extraction about 6 hours prior to presentation. Symptoms began initially as “a lump in his throat” and difficulty swallowing, but eventually progressed to mild dyspnea after 1-2 hours. Denies FB or allergies. On arrival he appears anxiousRead more

A 15yo girl comes into your ED complaining of unilateral facial swelling that started this morning as a little bit of swelling under her R ear, and 8 hours later, is now her entire R cheek. No fevers/chills. ROS otherwise negative. VS normal. Exam with induration to the R cheek, non tender, no overlying erythema.Read more

Post by @FTeranmd   Clinical scenario: 72 yo F with history of lung carcinoma with permanent trachestomy placed four  months prior presentation, brought by EMS with profuse, active bleeding from the stoma site. Patient is ventilator dependent and is being assisted with BVM at arrival. Per nursing home staff bleeding was noted an hour prior presentationRead more

A 60 yo F with sudden onset loss of vision in right eye, painless.  Proceeded by a few episodes of amaurosis fugax. Physical exam: pupils appear normal on initial inspection, however afferent pupil defect noted. Fundoscopic exam: cherry red spot, pale retina, +/-boxcar segmentation (not shown in this picture). DDx for loss/reduction of vision: Glaucoma,Read more