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Emergency Department Management Of Priapism - $39.00
Publication Date: January 2017 (Volume 19, Number 1)
CME: This issue includes 4 AMA PRA Category 1 Credits™; 4 ACEP Category I credits; 4 AAFP Prescribed credits; and 4 AOA Category 2 A or 2B CME credits.
Gregory S. Podolej, MD
Department of Emergency Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL
Christine Babcock, MD, MSc, FACEP
Assistant Professor, Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, IL
Jeffrey A. Holmes, MD
Assistant Professor, Department of Emergency Medicine, Maine Medical Center, Portland, MD; Tufts University School of Medicine, Boston, MA
Sanjay Shewakramani, MD, FACEP
Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
Priapism 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.
Excerpt From This Issue
A 53-year-old man with a history of hemoglobin SS (HbSS) sickle cell disease presents with 5 hours of a persistent, painful erection. This is the third time this has occurred in the past 2 years. Prior to presentation, he took pseudoephedrine tablets that were prescribed by his urologist, with no improvement. He denies fevers, chills, or trauma. He appears to be in a moderate amount of pain and his physical examination is notable for a fully erect penis that is tender to palpation, without lesions or discharge. You wonder: How long does it take for irreversible tissue damage to occur?