Monday, January 10, 2005

Shorned scrotum -- a case study

A scrotum can be a delicate thing. While on call, I was paged and upon answering the distress call, I learned that a patient's scrotum was bleeding substantially. I pondered the potential causes of scrotal bleeding in an ICU patient, as the nurse frantically expressed her concerns for the copious bleeding. An ice pack was initially tried without success, she said. The patient could not tolerate such a painful endeavor. I asked her just how could a shorned scrotum could come about in this patient. She expressed to me it must have been a bedpan malfunction. As I pondered the mechanics of such an injury, my champion PGYI colleague arrived on the scene. After carefull examination, he determined that the injury was not going to stop bleeding on pressure alone. At which point, I entertained the notion of scrotal chemical cauterization. Silver nitrate on a scrotum?, he said. Why not?, I said, unless you want to use your hand to manually tamponade his testicles the rest of the evening. He opted for plan A. When the deed was done, my champion PGYI collegue said that the patient tollerated the procedure well, until the silver nitrate hit the "money spot." At which time, he said he ellicited the most beautiful cremasteric reflex you had ever seen. Hemostasis was effectively achieved post procedure.

Conclusion: It was concluded that not only does silver nitrate provide excellent hemostasis for shorned scrotums, but a silver nitrate stick is excellent in elliciting cremasteric reflexes even without stroking the inner thigh.

Disclaimer: This case report may contain some embellishments, as I have not had much sleep over this weekend call.

posted by Flash @ 1/10/2005 02:00:00 PM   4 comments


At 5:36 PM, Blogger Clay said...

Great Work Flash!! You stayed cool under fire and have lived up to your reputation. You now have first-hand experience of a problem that has led to the popular saying-"Hell hath no fury like a scrotum shorned."

At 5:53 PM, Blogger joe said...

Very eloquent for your first entry, as of course I expected!

Vascular ectasis of the scrotum are very common and bleed with profusion if "snagged" as your pgy1 would say.

At 6:59 PM, Blogger joe said...

The AgNO4 didn't hold and so the scrotum is getting a few stiches.

At 9:20 PM, Blogger Flash said...

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