SAEM Clinical Image Series: An Incidental Finding

nail gun

A middle-aged man presented after a motor vehicle collision with a logging truck at 55 miles per hour with low back pain. A computed tomography scan (CT) of the abdomen and pelvis at an outside facility showed a burst fracture of the third lumbar vertebra (L3). The patient had no other complaints. Given the fracture, additional CT imaging was done and the above finding was discovered.

After the incidental finding was found, the patient reported a nail gun accident three years prior where he thought it had just recoiled and struck him in the lip and nose, causing a lip laceration and a minor bloody nose. The patient was seen in the emergency department. The laceration was repaired, and he was discharged without imaging. The patient denied any significant residual symptoms or personality changes. The patient had no idea that a nail had discharged from the gun and lodged in his face and brain.

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SAEM Clinical Image Series: Atraumatic Proptosis

An 85-year-old female with a past history of hypertension presents with acute right-eye pain, redness, and proptosis/bulging for the past two months that has been worsening over the past two days. She endorses blurry vision that began two days prior. She does not use contacts or glasses. No trauma, headache, or loss of consciousness are reported. She reports a “whooshing” sound in her right ear for two to three months.

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Trick of the Trade: An Improvised Foreign Body Removal Device

Foreign bodies in the ear or the nose can be extremely challenging to remove, especially considering that a majority of them occur in children less than 7 years old who are likely to be uncooperative with exam [1]. In a previous post, we emphasized the need to pick the best tool for the job in order to minimize complications. What happens when you find yourself in an austere environment and the usual tools are not available?

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By |2020-04-14T12:40:35-07:00Apr 29, 2020|HEENT, Tricks of the Trade|

SAEM Clinical Image Series: Facial Swelling in a 2 Year Old

Facial swelling


[Click for larger view]

Chief complaint: Left-sided facial swelling

History of Present Illness: A 2-year-old male presents to the emergency department in January after waking up with left-sided facial swelling. Mother states her son has had cough and congestion for the past 4 days for which she has been giving Tylenol and a children’s cough medication. The patient went to bed, awoke the following morning with facial swelling, and was brought to the emergency department.

He has no allergies, history of trauma to the area, or bug bites. The patient is fully vaccinated including the influenza vaccine.

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