Elderly Patients And Patients With Cardiovascular Disease
Treatment of priapism in elderly patients and patients with cardiovascular disease requires increased vigilance, should these patients require phenylephrine therapy. Because this subset of patients is at high risk for serious complications from systemic phenylephrine toxicity, smaller doses should be used (100 mcg per dose at increased intervals). Injections should never be performed into the dorsal or ventral aspect of the penis or over a visible vein. Furthermore, the corpora are very vascular, and injected drugs have a high potential to enter systemic circulation. These patients should be observed on continuous cardiac monitoring in the ED for systemic side effects for at least 1 hour after injection. Emergency clinicians should be aware of and monitor for possible complications such as hypertension, bradycardia, arrhythmias, stroke, intracranial hemorrhage, and myocardial infarction.63
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