ERDoc Posted April 25, 2007 Posted April 25, 2007 You are called to a farm in a very rural area for a 26y/o hispanic male with b/l testicular pain. It is 2330 and he states the pain started around 1500 and has gotten progressively worse. Let the fun begin.
Timmy Posted April 25, 2007 Posted April 25, 2007 Well you’re the doctor… lol Scene Safety? How did it happen? (Do I want to know)
EMS-Cat Posted April 25, 2007 Posted April 25, 2007 So... just exactly how had he ticked off his wife / sister / significant other / buddies / etc? And has he had any intoxicants today? Sorry if that sounds trite, but it sounds like, based on what little we've heard, that I'd have to wonder if someone let him have it in a bar fight or a DV call or something. At least, that's one of the things that would be running through my head if that's all I got from dispatch. Well, along with things like kicked by a farm anaimal, fell off the top of a fence and straddeled the railing on the way down, bounced off the tractor seat and hit the tow bar. But I won't r/o testicular torsion, testicular rupture, acute epididymitis and things of that nature. Or he could be a *really* late starter and just now caught mumps. There's a lot of things to run through here. More info, please? Also, BTW, etc: If he's been trying to tx this himself, how long has he sitting on the ice pack [i don't know why, but something makes me wonder if he might have sorta froze his 'nads a bit] Just a thought.
ERDoc Posted April 25, 2007 Author Posted April 25, 2007 [i don't know why, but something makes me wonder if he might have sorta froze his 'nads a bit] OK, that's pretty funny. No trauma. He just kinda noticed the pain earlier in the day and it has been getting worse. He has not been drinking or doing drugs. He also has been c/o some chills for the last hour. He's never had anything like it before. What else do you want to know?
Just Plain Ruff Posted April 25, 2007 Posted April 25, 2007 this has the hallmarks of a really funny ending. There is just so much wrong with this one that I'm trying to keep it in check. The requisite questions abc's scene safe environmental hazards such as organophosphates? anyone else there to help explain the pain or history Differentials: trauma - any? Epididimytis- most common cause of testicle pain in men ages 18 and higher Torsion - well this is a bad thing if he's got it as it's been goin on longer than the testicle can survive with torsion. He'll most likely lose his nut but since this has been gradually coming on and getting worse I'll put this down as last on my list. Hernia - when's the last time he's been checked by a doc for a hernia? Low on list of suspicions though. Orchitis - anyhistory of mumps??? Tumor - not probable but could be hematocele/rupture - low on probability though Ruptured Testicle - that just hurts me thinking about it. Are any of these signs or symptoms present???? 1. Swelling: The testicle or the scrotum may become inflamed, red, and swollen. 2. Prior incidents: A history of similar episodes suggests that the pain may be due to torsion. 3. Nausea/vomiting: With severe pain, these symptoms could be torsion. 4. Fever: You may see fever (or chills) with epididymitis but less frequently with torsion. 5. Pain on urination or a penile discharge: These symptoms also are common with epididymitis and less frequent with torsion. 6. Pain with intercourse, pain with ejaculation, blood in the semen Even if any of the above are present - take him to the ER. There is no way we can diagnose this in the field. Just supportive treatment to the ER and go from there.
ERDoc Posted April 25, 2007 Author Posted April 25, 2007 this has the hallmarks of a really funny ending. There is just so much wrong with this one that I'm trying to keep it in check. The requisite questions abc's scene safe environmental hazards such as organophosphates? anyone else there to help explain the pain or history Differentials: trauma - any? Epididimytis- most common cause of testicle pain in men ages 18 and higher Torsion - well this is a bad thing if he's got it as it's been goin on longer than the testicle can survive with torsion. He'll most likely lose his nut but since this has been gradually coming on and getting worse I'll put this down as last on my list. Hernia - when's the last time he's been checked by a doc for a hernia? Low on list of suspicions though. Orchitis - anyhistory of mumps??? Tumor - not probable but could be hematocele/rupture - low on probability though Ruptured Testicle - that just hurts me thinking about it. Are any of these signs or symptoms present???? 1. Swelling: The testicle or the scrotum may become inflamed, red, and swollen. 2. Prior incidents: A history of similar episodes suggests that the pain may be due to torsion. 3. Nausea/vomiting: With severe pain, these symptoms could be torsion. 4. Fever: You may see fever (or chills) with epididymitis but less frequently with torsion. 5. Pain on urination or a penile discharge: These symptoms also are common with epididymitis and less frequent with torsion. 6. Pain with intercourse, pain with ejaculation, blood in the semen Even if any of the above are present - take him to the ER. There is no way we can diagnose this in the field. Just supportive treatment to the ER and go from there. No h/o trauma. Considers a walk in clinic to be his family doctor, hasn't been there in about 1 year. No h/o mumps. 1. None of the above 2. Never had pain like this before. This pain is not excruciating, just more of a dull ache. 3. Feels a little nauseous, but not enough to stop him from eating a bag of chips in the waiting room. 4. Has chills but has not checked his temp. Do you want to check one? 5. No dysuria, hematuria or discharge. 6. Has not had any of these symptoms but has not had sex since the pain started. Do you want to have sex with him to find out? (OK, that may be a little overboard, but I commend your dedication to pt care)
Just Plain Ruff Posted April 25, 2007 Posted April 25, 2007 Doc what happens on scene stays on scene 6. Has not had any of these symptoms but has not had sex since the pain started. Do you want to have sex with him to find out? (OK, that may be a little overboard, but I commend your dedication to pt care) But seriously - I have to go and review what your reply to my reply was and then I'll be back.
Richard B the EMT Posted April 25, 2007 Posted April 25, 2007 And has he had any intoxicants today? . Never discount this question. I once had a patient who was severely intoxicated, with heavy smell of AOB, and verbal statement of the patient confirming large ETOH intake, who had been stabbed in the scrotum. He had lost copious amounts of blood, and the damage was such that he should have been screaming from the pain. Such pain was masked by his ETOH ingestion.
EMS-Cat Posted April 25, 2007 Posted April 25, 2007 A couple of other things now come to mind. 1: Does he have any children or is living in a house with children? 2: If so, have any of them been sick in the last couple of weeks? 3: Does he flunk the 'pickle test'? {Honest, I'm not totally fixated on mumps. Any of the other childhood virals might be involved}. 4: Does he have a hot PPD, chest film or anything that might suggest TB [night sweats, red streaked productive cough, etc]? This comes to mind for me as we have a high PPD positive community where I am and I have friends in Idaho with Public Health who are *really* concerned about the increasing number of hot PPDs. So... any more info? Vitals, please?
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