Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
A 19-year-old black man with sickle cell anemia comes to the emergency department with a painful, persistent erection for the past 3 hours. He explains that for the last 3 days before presentation he had a œcold and had not been eating or drinking very much. He did vomit a couple times yesterday but began feeling better this morning. After lunch he got an erection and it has not gone away. He denies any bone or joint pain. On examination he is uncomfortable. His temperature is 37.3 C (99.1 F), blood pressure is 146/88 mm Hg, pulse is 108/min, and respirations are 26/min. Heart, lung, and abdominal examinations are noncontributory. Genital examination displays an erect phallus that is diffusely edematous. The penis is tender to palpation along its entire course and although examination is limited because of tenderness there does not seem to be any sign of infection or trauma. There is no urethral discharge. The corporal bodies are aspirated of dark, old blood and then injected with an alpha-adrenergic agent. The priapism responds minimally. Analgesics are administered. Which of the following is the most appropriate next step in management?
A.
Consider emergent arteriography and embolization of the internal pudendal artery
B.
Perform a corporal-glandular shunt
C.
Provide intravenous hydration and oxygenation
D.
Send the corporeal blood for a blood gas
E.
Transfuse packed red blood cells emergently
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
B: Perform a corporal-glandular shunt to restore normal blood circulation
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
the ans given is c.. my doubt is..dont we transfuse prbc in acute vasoocclusive crisis? priapism is an acute vasoocclusive crisis..so,shouldnt e be the ans???
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
the explanation given is as follows
The correct answer is C. This patient with known sickle cell disease is suffering from low-flow priapism. There are two categories of priapism, low-flow and high-flow. In low-flow priapism there is decreased venous outflow that results in increased intracavernosal pressure, resulting in an erection. Increased intracavernosal pressure leads to decreased arterial inflow and stasis of blood, causing local hypoxia and acidosis. On examination the penis is fully erect with a rigid corporal cavernosum but a soft glans and corpus spongiosum. A blood gas of this corporal body will show a pH 10, thereby reducing the percentage of hemoglobin S.
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
The correct answer is C. This patient with known sickle cell disease is suffering from low-flow priapism. There are two categories of priapism, low-flow and high-flow. In low-flow priapism there is decreased venous outflow that results in increased intracavernosal pressure, resulting in an erection. Increased intracavernosal pressure leads to decreased arterial inflow and stasis of blood, causing local hypoxia and acidosis. On examination the penis is fully erect with a rigid corporal cavernosum but a soft glans and corpus spongiosum. A blood gas of this corporal body will show a pH 10, thereby reducing the percentage of hemoglobin S.
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
i am sorry ,,not able to print the whole explanation here
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
no one with the explanation?
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
Acording to kaplan book the asnwer should be blood transfusion, option E
