A 19-Year-Old Man Comes to the Emergency Department with Penile

question 181

Multiple Choice

A 19-year-old man comes to the emergency department with penile pain.  He started to get an erection about 2 hours ago, and it has not subsided.  He took pain medications without relief.  The patient has had no manipulation or trauma to his genitourinary tract.  His only medical problem is sickle cell disease (Hb SS) , with his usual vasoocclusive crisis being joint and bone pain.  His last pain crisis was about 4 months ago.  His medications include hydroxyurea, folate, oxycodone, and acetaminophen.
His temperature is 37.8 C (100 F) , blood pressure is 140/90 mm Hg, pulse is 120/min, and respirations are 32/min.  Pulse oximetry is 95% on room air.  Examination shows a very uncomfortable man with an erect penis.
Laboratory results are as follows:

His chest x-ray shows no infiltrates.
Which of the following is the most appropriate next step in management?

• A)Corpus cavernosum aspiration
• B)Epidural pain control
• C)Exchange transfusion
• D)Loading dose hydroxyurea
• E)Shunt (glans-cavernosum) procedure

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Definitions:

Rites of Passage

Ceremonies or rituals that mark important transitional periods in a person's life, often signifying the passage from one social status to another.

Stress

Experiences, situations, and events that lead to severe tension or strain.

Positive Transitions

The process of making changes from one state or condition to another in a way that is smooth and beneficial.

Stressful Transitions

Periods of change that cause significant stress, requiring individuals to adapt to new circumstances or environments.