Emergencies Flashcards
What is Priapism
Prolonged pathologic penile or clitoral erection
+
Absence of ongoing sexual stimulation
+
Unrelieved by ejaculation
Differentiate the types of Priapism
Low flow: Decreased venous outflowflow > increased cavernosal pressure > exceeds arterial pressure > blood stagnation and ischaemia > compartment syndrome
High flow: Excess arterial inflow leading to prolonged cavernosal engorgement
Often not painful, usually caused by arterial injury, fitula or spinal cord damage
Neurogenic: A form of high flow
What are the causes of low flow (aka ischaemic, veno-occlusive or anoxic) priapism?
Drugs (Cocaine, Antipsychotics, PDE5 inhibitors)
Malignancy (leukaemia)
Sickle cell disease
Malaria
Metabolic (gout, amyloidosis)
What are the causes of high flow priapism?
Trauma to penis
AVM
Congenital disease
Neurological injury (ie spinal cord)
Neurological disease (ie MS)
Lactrodectism (red back)
What is Paraphimosis and what are the causes?
Restriction of blood flow to the glans of the penis, usually by the foreskin
Hair tourniquet (babies), infection, trauma, masturbation, clothing or other tourniquet
Also if foreskin pulled back but then not returned post IDC insertion
What medications are associated with Priapism?
PDE5 inhibitors
Vasoactive erectile agents (ie alprostadil, papaverine)
Stimulants (Methylphenidate, cocaine, dexamphetamine etc)
Tamsulosin/Prazosin
Hormones (Testosterone)
Antipsychotics
Antidepressants
Lithium
Anticoagulants
What is the management of low flow priapism?
Analgesia +/- sedation
Warm compresses causing vasodilation or cold compress
IV fluids can reduce sludging
Exercise can help produce endogenous catecholamines and bring it down
Local anaesthetic (dorsal block or penile block)
Large bore cannula then aspirate +/- flush saline (May need to do this many times)
Inject phenylephrine 100-200mcg
Inject Adrenaline 100mcg
Salbutamol IV controversial
Treat reversible causes (ie chemotherapy for leukaemia)
Refer to Urology
