Testicular Torsion

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Paul J. V. -

I feel Dr. Tamkin's attitude toward Urology consultation was inappropriate. If I spoke with a consultant in the manner he suggested I would not last long in my community hospital. A mutual respect between the ED Dr. and consultant is more helpful. As opposed to watching episodes of Gray's Anatomy I suspect the urologist is trying to get a good night's sleep so he can be at his best to remove the bladder tumor on the patient I admitted the day before.
I would like a discussion on the sensitivity of doppler ultrasound and an objective discussion of how much time delay to obtain an ultrasound would be acceptable in certain cases (the urologist might be in surgery at the time).

Mel H. -

Paul I think you are right - what Gary was doing is pointing out the idea that when you REALLY need them - you have to get them in - they will turn against you if things go bad - I have seen it many times....by getting them in, you help them - but i agree - this is a last ditch effort - being nice is the first stage....

Whit F. -

There are appropriate times for inappropriate behavior. My nuclear weapon is "I would like you to come here and take care of the patient the way you promised to when you became a doctor." Ouch!

Mitchell C., MD -

My consultants tell me that the best scan is the "retina scan". Open the scrotum and look. When there is push back I gently remind them that I need them I'm doing what they would recommend. The smaller the testes the less sensitive the scan. Unacceptable for peds.

Douglas Y. -

In the section on epididymitis, Dr Tamkin talks about giving quinolones for treatment. The CDC no longer recommends this for treating gonorrhea due to increasing resistance. Patients should get 250 mg of ceftriaxone and either doxycycline or azithromycin

Hafez B. -

I think levaquun is appropriate although cipro is not.

John C. -

The only problem with all of this is when it is not so clear cut (lots of the time) and you end up looking like the guy crying wolf. I usually call them right away when it is the least bit suspicious for "real" torsion; and at times have had them say- "if I come in they are going to surgery". I generally say- "good".

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