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