FOAMed

EM@3AM: Bleeding Disorders

A 23-year-old female with no past history presents with prolonged bleeding from her tooth extraction earlier the same day. Her dentist was planning on removing all her wisdom teeth but stopped after the first extraction due to inability to achieve hemostasis. She has never experienced this kind of bleeding before but notes that recently her gums often bleed when brushing her teeth and describes her last few menstrual cycles as “heavier” than usual. She is not on any blood thinners and was adopted at birth without record of family medical history. She is stable. Tooth number 17 appears to have been extracted, and there is blood-soaked cotton balls and gauze between the buccal mucosa and the cavity where tooth 17 used to be. Upon removal of the gauze, you notice a slow oozing of blood from the extraction site. What are some of the bleeding disorders on your differential given this clinical presentation?

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EM@3AM: Cerumen Impaction

A 17-year-old male with no past medical history presents to the ED with a complaint of right ear fullness and hearing loss which has been present for the last month. He reports that he tried to clean out his ear 3 days ago with a cotton-tipped swab but has had worsening of the pain and hearing loss after attempting this. HEENT exam reveals normal external auditory canal and tympanic membrane on the left, but you are unable to visualize the right tympanic membrane due to cerumen impaction. What is the next step in management of this patient?

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