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Trauma Awareness Month Is Almost Here – Test Your Knowledge with Genitourinary Trauma Question April 18, 2019

Posted by Andy Jagoda, MD in : Brain Tease , add a comment

A patient suffering blunt abdominal trauma complains of suprapubic pain and has gross hematuria. Initial CT of the abdomen and pelvis with IV contrast is normal. Do yo know the answer?

For trauma patients in the ED, life- and limb-threatening injuries take priority, but renal and genitourinary injury can have long-term consequences for patients, including chronic kidney disease, erectile dysfunction, incontinence, and other serious problems.


Did you get it right? Click here to find out!

The correct answer: A.

Check out the issue on Emergency Management of Renal and Genitourinary Trauma: Best Practices Update to brush up on the subject.Plus earn CME for this topic by purchasing this issue. 

Clinical Pathway for Management of Sexually Transmitted Diseases in the Emergency Department April 15, 2019

Posted by Andy Jagoda, MD in : Feature Update , add a comment

Sexually transmitted disease can cause severe outcomes for patients, their partners, and their unborn babies, and swift and accurate diagnosis and treatment is essential to reduce morbidity and minimize the potential public health risks.

Sexually transmitted diseases are a growing threat to public health, but are often underrecognized, due to the often nonspecific (or absent) signs and symptoms, the myriad diseases, and the possibility of co-infection. Emergency clinicians play a critical role in improving healthcare outcomes for both patients and their partners. Optimizing the history and physical examination, ordering appropriate testing, and prescribing antimicrobial therapies, when required, will improve outcomes for men, women, and pregnant women and their babies.

This clinical pathway will help you improve care in the management of patients with sexually transmitted diseases. Download now.

Clinical Pathway for Management of Sexually Transmitted Diseases in the Emergency Department

Straddle Injuries with a laceration — Brain Teaser. Do you know the answer? October 26, 2018

Posted by Andy Jagoda, MD in : Brain Tease , add a comment

Did you get it right? Click here to find out!

The correct answer: D.

Earn CME for this topic by purchasing this issue or logging in to your subscription.

 

Treatment Pathway for the Management of a Genitourinary Laceration in a Pediatric Girl October 19, 2018

Posted by Andy Jagoda, MD in : Feature Update , add a comment
The presentation of genital injuries and emergencies in pediatric girls can sometimes be misleading. A traumatic injury with excessive bleeding may be a straddle injury that requires only conservative management, while a penetrating injury may have no recognizable signs or symptoms but require extensive surgery.
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This clinical pathway will help you improve care in the management of a genitourinary laceration in a pediatric girl. Download now.
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Severe Pelvic Pain with Dysuria — Managing Genital Emergencies in Pediatric Girls Conclusion October 14, 2018

Posted by Andy Jagoda, MD in : What's Your Diagnosis , 1 comment so far
Case Recap:
A 15-year-old adolescent girl is brought into the ED by her mother for severe abdominal and pelvic pain with dysuria. The patient is otherwise healthy, with no significant past medical history. She is not sexually active and denies any trauma. Upon questioning, the patient states that she has had cyclical abdominal pain over the past year and a half, which typically lasts 2 to 3 days, and then self resolves. She has not yet started her menses. This is the first time that the pain has been 10/10 in severity, and she has new urinary urgency, with inability to fully empty her bladder. On physical examination, she is Tanner stage V for breast and pubic hair development, her abdomen is soft with no palpable mass, and she has no costovertebral angle tenderness. On visual inspection of her perineum, she is noted to have a large, bulging purplish mass in her vaginal area with a small leak of blood. 
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Are there any laboratory tests that you should order? What imaging—if any—would be the best choice for confirming the diagnosis? Should you try to release the pressure and evacuate the blood?
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Case Conclusion:
You obtained a urine sample from the 15-year-old girl to evaluate for pregnancy and a urinary tract infection simultaneously; the results of both were negative. You also ordered an abdominal ultrasound to assess the mass. The ultrasound showed a semisolid pelvic mass measuring about 15 x 10 x 10 cm, suggestive of hematocolpos, with a normal uterus and ovaries. Gynecology was consulted, and the patient was admitted for a hymenotomy.
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Congratulations to Kimia Kashkooli, Eva Soos-Kapusy, Kenneth Dowler, Dane O’Donnell, and Christopher Cruz — this month’s winners of the Pediatric Emergency Medicine Practice Audio Series Vol IV
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Severe Pelvic Pain with Dysuria — Managing Genital Emergencies in Pediatric Girls October 7, 2018

Posted by Andy Jagoda, MD in : What's Your Diagnosis , 24comments
A 15-year-old adolescent girl is brought into the ED by her mother for severe abdominal and pelvic pain with dysuria. The patient is otherwise healthy, with no significant past medical history. She is not sexually active and denies any trauma. Upon questioning, the patient states that she has had cyclical abdominal pain over the past year and a half, which typically lasts 2 to 3 days, and then self resolves. She has not yet started her menses. This is the first time that the pain has been 10/10 in severity, and she has new urinary urgency, with inability to fully empty her bladder. On physical examination, she is Tanner stage V for breast and pubic hair development, her abdomen is soft with no palpable mass, and she has no costovertebral angle tenderness. On visual inspection of her perineum, she is noted to have a large, bulging purplish mass in her vaginal area with a small leak of blood. 
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Are there any laboratory tests that you should order? What imaging—if any—would be the best choice for confirming the diagnosis? Should you try to release the pressure and evacuate the blood?
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Enter to win a free copy of Pediatric Emergency Medicine Practice Audio Vol IV, the latest in our audio series collection, by submitting your answer to the question above. To do so, simply enter your response in the comments box. A valid email address is required to enter. The deadline to enter is October 11, 2018.
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Last Modified: 10-23-2019
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