A 32-year-old man presented, complaining of a painful erection for the last 18 hours. His medical history was significant for sickle cell disease,  insomnia and depression, for which he was taking quetiapine, bupropion, and prazosin. Examination revealed a mildly tender, fully erect penis and a soft glans. He was given 0.25 mg of subcutaneous terbutaline, with no improvement of symptoms. A color Doppler ultrasonograph in the transverse plane was taken before definitive treatment.

Which of the following is NOT an possible treatment for priapism?

1.  Perineal massage
2. Sedation with ativan
3. Phenylephrine instillation into the corpora cavernosa.
4. Epinephrine instillation into the corpora cavernosa

This case was taken from Annals, the article discusses the use of ultrasound for determination of high flow vs low flow priapism, well described in urology literature, it is a non invasive and effective way to look for arterial pulsations vs low flow states.

Eric B. Tomich, Robert Blankenship. Painful Erection. Annals of emergency medicine 1 September 2008 (volume 52 issue 3 Page 202 DOI: 10.1016/j.annemergmed.2007.11.029) (more…)

Filed under: GU, Pearls by natasha
Comments Off

A middle aged man presents to the ED after almost 2days of penile pain and swelling. The sx started suddenly, during intercourse and he didn’t present until now 2/2 embarrassment.  But now the pain has not abated, the condition has not improved and he hasn’t been able to urinate. He recalls missing the introitus and the hitting the perineum; he heard a snap and had sudden loss of erection. Diagnosis? Management?

(more…)

Filed under: GU, Pearls, Trauma by makini
Comments Off

An elderly man presents with new bloody urine x2days and abdominal distention/fullness. He noticed some clots prior to presentation and now hasn’t urinated x5hours despite a real urge to micturate. He has a h/o BPH and is on coumadin for afib. At clinic yesterday his INR was 2. On sono you appreciate a full bladder with 800cc of fluid. You d/w urology and plan for bladder irrigation. You are being shadowed by an eager med student. Talk her through the procedure.

(more…)

Filed under: geri, GU, Pearls, Ultrasound by makini
Comments Off

How does kayexalate work? Is it useful in the ED?

(more…)

Filed under: critical care, GU, Pearls by makini
Comments Off

How do you evaluate for an ectopic pregnancy (versus an intrauterine pregnancy)?

(more…)

Filed under: GU, OB/GYN, Pearls, Ultrasound by makini
Comments Off