In a presentation from Lauren Westafer, DO, MPH, MS, advised emergency physicians to not treat genitourinary trauma as a joking matter and instead to treat such injuries as true emergencies. She suggests considering penile fracture in men with a bloated and purple penis, as well as though who report hearing a snap during intercourse. Inflammation in such cases can impinge on the urethra, causing urethral injury, scare, and erectile dysfunction. Dr. Westafer suggests calling urology in such cases, but after gathering such information as whether the patient can urinate and whether blood is at the meatus. While surgery is the ultimate treatment, emergency providers can offer supportive care until surgery is available. In cases of ischemic priapism, Dr. Westafer notes that irreversible damage occurs in 24 hours, adding that the first step in treatment should be a dorsal nerve block and aspiration of the blood, followed by phenylephrine and immediate urology consult in patients who remain erect. For women with vaginal tears, Dr. Westafer advises considering non-consensual behavior if there are red flags of sex trafficking, sexual assault, or intimate partner violence. Because such patients can hemorrhage substantially or have a rare intraperitoneal perforation, she recommends treating the bleeding and considering an ob/gyn consult. With cases of foreign bodies in the rectum, she suggests avoiding judgement in taking history followed by an exam and x-ray and calling surgery when objects are sharp or considering removal of blunt objects.
July 10, 2019
October 14, 2020
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