KW-PEM1CSV Flashcards
When can you close a dog bite? (What does the wound look like, and what level of risk is it)
If the wound is superficial without presence of significant crush injury or tissue loss, primary closure is the best approach for cosmetic outcomes. (=low risk)
Which is most common and also THE WORST: ischemic vs non ischemic priaprism?
Ischemic
Whats the prob with ischemic (low flow priaprism)?
impaired relaxation
and
paralysis of smooth muscle
What’s the time cutoff to define PRIAPRISM?
> 4 hrs
What 2 tests can help determine priaprism type?
penile blood gas (acidotic = ischemic)
Doppler
pH = 7.25, PCO2 >/=60 what kind of priaprism is this?
Ischemic
When does penile damage occur?
@ 6 hrs
What rx for priaprism can you offer while u wait for Urology?
Physical activity
urination
Fluid
Ejaculation
ICE (except if SCD)
Pain management
What is Urology’s procedure?
Aspiration and Irrigation
In Priaprism, whats engorged and whats flaccid?
Cavernosum = ENGORGED
Glans and Spongiosum = Flaccid
What medication reccs are there for priaprism treatment?
1) AUA reccs phenylephrine
2) if < 10 yo, then epi in dilute soln
3) If these dont work, then surgical shunt
Whats the procedure
Injection at 2-3 o’clock midshaft of corpus callosum
Removal of 3-5 ml aliquots of blood until detumescence / red blood
Irrigation with normal saline
What are the consult indications for PARAphimosis
Answ
- Penile necrosis –dark color, firmness, elasticity
- Evidence of blood flow compromise
- Complete urinary obstruction
- Unsuccessful manual reduction
otherwise attempt MANUAL REDUX
What happens in penile fx?
Rupture of tunica albuginea (the layer surrounding cavernosum)
AKA “eggplant deformity”
What must you eval for in penile fx?
Urethral rupture
What is the treatment for penile fx?
URGENT/EMERGENT repair
-surgical
What is the treatment for zipper entrapment?
1) Mineral Oil extraction
2) Cut zipper cloth
3) Cut the median bar of the fastner
For girls with STRADDLE injuries—what is the common injury location? Why is this important?
Anterior/lateral to hymen
if hymen or posterior fourchette involved—>think of abuse
When should you consult for straddle injuries?
-Vaginal bleeding, large vaginal / vulvar lacerations
•Large testicular / scrotal hematoma; testicular rupture, torsion, dislocation, avulsion
•Scrotal laceration through the Dartos layer
•Concern for urethral disruption
Most torsion is due to ____ rotation
Medial
De-torse by lateral rotation (360-270 deg) “open the book”
What are the time delay cutoffs for testicle loss at 90%, 50% and 10%?
<6 hrs: 90% survival of teste
12 hrs: 50%
>24 hrs: < 10%
Tenderness of testicle that is POSTERIOR and SUPERIOR =
Epidymitis
spermatic cord twisting, altered testicular blood flow, increased size, altered echotexture
Torsion
swelling & structural heterogenicit
Epididymitis & TAT