Testicular Torsion – A Convoluted Case

What do Chubby Checker and testicular torsion have in common? (Wikimedia photo)

The 14-year-old male patient complained of right lower quadrant pain which varied in intensity for 1 day. He denied nausea, vomiting or fever. The abdominal exam revealed bowel sounds and mild tenderness to palpation in the right lower quadrant without rebound. His abdominal ultrasound was inconclusive; the white blood cell count mildly elevated, and the urine microscopy normal. He was admitted for observation. Twelve hours later the patient developed a fever and severe groin pain. A genital exam revealed classic findings for testicular torsion. The testicle was not salvageable. Unfortunately, the patient was born monorchism and rendered sterile by the orchidectomy. The lesson from this case: always include a genital exam in patients with lower abdominal pain.

Can you rely on the history and physical exam to rule out testicular torsion? Is the testicle salvageable after 6 hours? Wrench yourself away from your music downloads and listen to the EM:RAP August podcast called Testicular Torsion by Rob Orman MD and Larry Mellick MD. Get an update and review on this twisted entity and you won’t spiral out of control when faced with the possibility.

Who Knew? “The Twist” is an American pop song written and originally released in 1959 by Hank Ballard and the Midnighters. It was made popular by Chubby Checker, an American rock n’ roll icon, who put his stamp on the song with the twist dance style.

So what do Chubby Checker and testicular torsion have in common? As Mr. Checker said, “Come on let’s twist again…”. Testicular torsion pain can come and go.

 

Potassium: An Element to Love

Photo courtesy of Wikimedia Commons.

Ever chase a patients potassium? Of course, you have…we all have nibbled our fingernails over the ever-changing potassium. So when do you worry? Here are a few questions to contemplate: true or false?

Hypokalemia is associated with hypomagnesemia.

Encourage repletion with potassium-rich foods rather than pills.

The total body deficit is always more than you think.

If the potassium is less than 3.0 meq/L and the QTc is approaching 500 msec, the patient should be admitted for repletion.

Tune into the August EMRAP podcast called: Electrolyte Emergencies – Part 1: All Things Potassium by Rob Orman MD and Corey Slovis MD for the answers.

Who Knew? Potassium was the first metal that was isolated by electrolysis by Sir Humphry Davy in 1807.

EMS in Nepal – Meet Dr. Sanjaya Karki

Dr. Sanjaya greets an opiod overdose patient transferred from a remote district in Nepal to Medicate Hospital, Kathmandu.

Dr. Sanjaya Karki at Mediciti Hospital, Kathmandu Nepal, has been using the CMES thumb drive since 2016. He is a regular reader of this blog and uses the EMRAP cme to prepare lectures along with keeping his knowledge up-to-date. Dr. Karki is the Medical Director for the Department of Emergency Services at Mediciti. He did his MBBS and European official double masters in health and welfare and has done his MD in Emergency Medicine. Well known in Nepal and internationally for his innovation in EMS, he was honored and awarded the David Well Extreme Medicine Award, UK in 2014 and the EMS10 Innovators of The Year 2016 Award, USA.
Dr. Karki shares his insights about the fledgling EMS program in Nepal. “The EMS Helicopter emergency medical service is becoming more and more popular and productive in Nepal. Nowadays many voices are raised in order to streamline this service. The major topic at the government level should be to make a strategy and policies governing this important service.
Due to unavailability of road access in many places of Nepal, as well as no proper ground EMS service available across the nation, Helicoptor EMS will surely play a pivotal role in preventable deaths.”
Who Knew? Opioid Misuse Disorder is new to Nepal following on the heels of Cannabis and alcohol addiction. Read this article to find out more.