Round 4 (Flank Pain)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!



Case Introduction



The nurse tells you that you have a new patient and is requesting a verbal order for nausea medicine. She advises you that the patient is the CEO of your hospital…



Initial Vitals



* Temp 98.9* HR 99* RR 18* BP 120/80* O2 98%



Critical Actions



* Perform Genitourinary Exam* Rule Out Abdominal Aortic Aneurysm* Consult Urology* Treat the Patient’s Pain* Resist Delays on Consultant Pushback



Dangerous Actions



* Delaying Urology Consultation to Obtain an Ultrasound



Final Diagnosis



Testicular Torsion with Referred Pain



Tips and Tricks



Don’t forget to verbalize genitourinary exam when appropriate



Additional Reading



* Testicular torsion overview (EM Clerkship)



Corrections



It is rare for testicular torsion to occur at this age