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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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My Heart is Racing! Select Cardiac Arrhythmias and Practice Updates

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viernes, 26 de agosto de 2016

Priapism

emDocs - August 25, 2016 - Authors: End B and Conroy M
Edited by: Koyfman A and Alerhand S
"Background
While an uncommon presenting complaint, priapism is a urologic emergency requiring fast and effective management by emergency physicians to prevent significant morbidity. Defined as a persistent, painful erection lasting greater than four hours beyond, or in the absence of, sexual stimulation, priapism was first documented as a case by Tripe in 1845 [1]. In the following write-up, we will examine the initial evaluation and management of patients presenting to the emergency department...
Pearls
  • Ischemic priapism is a time-sensitive diagnosis and urologic emergency, time is tissue and erectile function!
  • History and physical exam may help delineate ischemic vs. non-ischemic, but cavernous blood gas is paramoun
  • Remember to provide adequate analgesia, either with oral medications or through local anesthesia/penile block (https://www.youtube.com/watch?v=3p0qEfISggs)
  • Aspiration should be performed laterally to avoid damage to the dorsal neurovascular bundle (https://www.youtube.com/watch?v=KWf5MAobWoM)
  • A stepwise approach (aspiration, injection of vasoactive agent, emergent urologic consultation for shunt) is the key to success
Pitfalls
  • Not obtaining a cavernous blood gas sample to differentiate between ischemic and non-ischemic priapism
  • Aspiration at the dorsum of the penis (avoid the neurovascular bundle!)
  • Only one attempt at vasoactive injection (may repeat at 5-10 minute intervals until detumescence is achieved)"