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Backstabbed by another doctor?

3/2/2021

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There is too much to say, so you just have to listen to the whole video.
What do you think? Comments welcome down below.
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PNA in a soldier after serving in Asia

3/1/2021

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soldier present with typical PNA symptoms after serving in Asia, also had a balck eschar lesion on the abdomen.
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Rash on the chest of this patient

2/28/2021

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patient presents with very itchy rash to the chest 1 day after first exposure to sun in the spring time.
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Urinary Tract Infection and Flank Skin infection in this patient

2/27/2021

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this patient presented to the ER with typical symptoms of a urinary tract infection. But also had a discolored painful area on the same side as the symptoms.
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Penetrating Eye Injury - Metal stabs the EYE

2/26/2021

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Patient presented to the ER with eye pain, decreased vision after cutting a metal wire and felt something hit the eye. In this clinical case presentation we show the eye exam, radiographs including CT scan and discuss initial emergent treatment in the ER.
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Teenager with eye trauma - Teardrop Pupil

2/25/2021

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Patient had trauma to his eye, now has a brown ‘thing’ popping out of his eye.
​Visual acuity is preserved, patient NOT in a lot of pain.
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Patient presents with symptoms of appendicitis, but we find THIS on an ultrasound.

2/25/2021

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This 15 year old presented to the ER with typical presentation consistent with acute appendicitis but on ultrasound was found to have these pearl-like structures.
What are they?
How did the finding change the treatment and diagnosis?
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Is that milkshake in the urine?

2/23/2021

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Picture
This is a foley bag with urine being collected in it.
As you can see, a layer separating a white fluid from a urine fluid is present. This is severe infection present in the urine making a layer of white cells (basically pus) to layer since it is heavier and denser than regular urine. This is also called leukosuria (urinating white cells).
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What is the difference between a Stroke / a mini Stroke / and a TIA ?

2/22/2021

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TIA and mini-Stroke are terms that are used interchangeably, however they are NOT the same thing! In this video we attempt to explain what that difference is, and how using the proper terms conveys the right information to your medical providers.
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How to irrigate wax out of the ear?

2/20/2021

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Ear irrigation is an ear cleansing method that people use to remove a buildup of earwax. Irrigation involves inserting liquid into the ears to flush the earwax out.
The medical term for earwax is cerumen. A buildup of earwax can cause symptoms such as impaired hearing, dizziness, and even ear pain.
Doctors will not recommend ear irrigation for people with certain medical conditions and those who have had eardrum tube surgery. They may also have concerns about a person carrying out ear irrigation at home.
In this article, we discuss the benefits and risks of ear irrigation and explain how most people perform it.

Uses for ear irrigation
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A doctor may recommend ear irrigation to remove an earwax buildup.A doctor performs ear irrigation to remove an earwax buildup, which can cause the following symptoms:
  • hearing loss
  • chronic cough
  • itching
  • pain
Doctors do not usually recommend irrigating the ear unless a person’s symptoms are definitely due to earwax buildup.
Alternative options for removing excess earwax include placing earwax softener drops in the ears or mechanical removal by a doctor.
According to the authors of a 2010 systematic review, it was unclear from the existing research whether ear irrigation or mechanical methods were more beneficial for removing earwax. However, they noted that certain softener drops were effective.
People should not try to remove earwax at home with tools such as cotton swabs or hairpins due to the risk of damaging the eardrum.

Procedure
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A person can perform an ear irrigation at home using a 20- to 30-milliliter syringe.People can follow the steps below to try ear irrigation. They should use a syringe containing clean water at room temperature.
  • Sit upright with a towel on the shoulder to capture water that drains from the ear. Some people may also place a basin underneath the ear to catch the water.
  • Gently pull the ear upward and backward to allow the water to enter the ear more easily.
  • Place the syringe in the ear, inserting it up and toward the back of the ear. This position will help the earwax separate from the ear and drain out of it.
  • Gently press on the syringe to allow water to enter the ear. If a person feels pain or pressure, they should stop irrigating.
  • Dry the ear using a towel or by inserting a few drops of rubbing alcohol into the ear.
Sometimes, a person may have to repeat this procedure up to five times to notice the earwax breaking free. If they attempt the process five times without results, they should stop and talk to their doctor about other options.
People can purchase an ear irrigator or make their own from a 20- to 30-milliliter syringe with a soft, blunt, plastic catheter at the end to minimize the risk of damage to the ear. Some people may use a needleless 16- or 18-gauge intravenous catheter instead.
Ear irrigation kits for use at home are available to purchase online.
It is essential to use caution and avoid inserting the syringe too far into the ear, especially when using a needleless IV catheter on its tip.

Is ear irrigation safe?
There are not many studies looking at ear irrigation to remove earwax.
In a 2001 study, researchers studied 42 people with an earwax buildup that persisted after five attempts at syringing.
Some of the participants received a few drops of water 15 minutes ahead of ear irrigation at the doctor’s office, while others used earwax softening oil at home before going to bed. They did this for 3 days in a row before coming back for irrigation with water.
The researchers found that there was no statistical difference between using drops of water or oil to soften earwax buildups before irrigation with water. Both groups required a similar number of irrigation attempts to remove the earwax afterward. Neither technique caused any severe side effects.
However, there is some concern among doctors that ear irrigation could cause eardrum perforation, and a hole in the eardrum would allow water into the middle portion of the ear. Using an irrigation device that manufacturers have created specifically to irrigate the ear may help minimize this risk.
Another important consideration is to use water at room temperature. Water that is too cold or hot can cause dizziness and lead to the eyes moving in a fast, side-to-side manner due to acoustic nerve stimulation. Hot water can also potentially burn the eardrum.

Side effects and risks
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After an ear irrigation, a person may feel dizzy.Some groups of people should not use ear irrigation because they have a higher risk of eardrum perforation and damage. These people include individuals with severe otitis externa, also known as swimmer’s ear, and those with a history of:
  • ear damage due to sharp metal objects in the ear
  • eardrum surgery
  • middle ear disease
  • radiation therapy to the ear
Some of the potential side effects of ear irrigation include:
  • dizziness
  • middle ear damage
  • otitis externa
  • perforation of the eardrum
If a person experiences symptoms such as sudden pain, nausea, or dizziness after irrigating their ear, they should stop immediately.

Outlook
E​ar irrigation can be an effective earwax removal method for people who have a buildup of earwax in one or both of their ears. Excess earwax can lead to symptoms that include hearing loss.
Although a person can make an ear irrigation kit to use at home, it may be safest to buy and use a kit from a store or online.
If a person has persistent earwax buildup, they should talk to their doctor about using ear irrigation as an earwax removal method. Alternatively, a person can use earwax softening drops or ask their doctor to perform mechanical earwax removal.
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    Author

    Carlo Oller, MD FACEP
    ​Board Certified Emergency Physician (18+ years)

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