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Current Issues

Emergency Medicine Practice

Emergency Department Management Of Priapism

Abstract:
Emergency Medicine PracticePriapism is a genitourinary emergency that demands a thorough, time-sensitive evaluation. There are 3 types of priapism: ischemic, nonischemic, and recurrent ischemic priapism; ischemic priapism accounts for 95% of cases. Ischemic priapism must be treated within 4 to 6 hours to minimize morbidity, including impotence. The diagnosis of ischemic priapism relies heavily on the history and physical examination and may be facilitated by penile blood gas analysis and penile ultrasound. This issue reviews current evidence regarding emergency department treatment of ischemic priapism using a stepwise approach that begins with aspiration of cavernosal blood, cold saline irrigation, and penile injection with sympathomimetic agents. Evidence-based management and appropriate urologic follow-up of nonischemic and recurrent ischemic priapism maximizes patient outcomes and resource utilization.

Points:

  • There are 3 main types of priapism: ischemic (“low-flow”), nonischemic (“high-flow”) and recurrent ischemic (“intermittent” or “stuttering”).
  • Ischemic priapism accounts for 95% of all cases. It is primarily caused by sickle cell disease, but is also caused by other blood dyscrasias, penile intracorporeal injections, and medications (eg, antihypertensives, antipsychotics, antidepressants, oral phosphodiesterase type 5 [PDE-5] inhibitors).

Pediatric Emergency Medicine Practice

Altered Level Of Consciousness: Evidence-Based Management In The Emergency Department

Abstract:
Pediatric Emergency Medicine PracticeA child who presents to the emergency department with an altered level of consciousness can be clinically unstable and can pose a great diagnostic challenge. The emergency clinician must quickly develop a wide differential of possible etiologies in order to administer potentially life-saving medications or interventions. The history, physical examination, and appropriate diagnostic tests can aid greatly in rapidly narrowing the differential diagnosis. Once initial stabilization, workup, and first-line interventions are completed, most patients who present with unresolved or unidentified altered level of consciousness should be admitted for further evaluation and close monitoring. This issue provides a review of the etiologies of altered level of consciousness as well as guidance for the management and disposition of patients with this condition.

Points:

  • Altered level of consciousness (ALOC) has an extensive differential diagnosis, and mnemonics such as “AEIOUTIPS” and “MOVESTUPID” can assist providers in recalling potential etiologies.
  • Hyponatremia usually presents with seizures and should be corrected slowly, with a goal of correction of 12 to 15 mEq/L (12-15 mmol/L) over a 24-hour period.

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Last Modified: 01/24/2017
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