February 2022

Rural Medicine: Acute Urinary Retention

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Michelle S. -

So interesting the timing of this for me! I just had to deal with this similar scenario. I was on a somewhat remote scuba diving vacation with a group. One of the seasoned divers who is in his 60s with a history of minimal BPH symptoms was having a lot of trouble clearing his right ear during the dives. He had never had this problem before, but many divers will take pseudoephedrine to help with this problem. He took one. Impatiently took a second, and then a third within about 12 hours. Not only did it not help his ear, the next morning he was unable to urinate more than a few dribbles. Throughout the next 24 hours he was becoming quite ill with fever, anorexia, nausea, and eventually some back pain. I take a mini ER bag full of goodies with me on these trips, but had not considered having a catheter in that bag. I started him on tamsulosin, and initially trimethoprim-sulfa. Well-meaning friends were telling him to drink a lot of fluids because he was "probably just dehydrated". His fever continued and although he got about 100cc of urine out twice during that day, he was getting worse. I changed him to amox/clav and gave a second dose of Tamsulosin. At 24 hours, he finally voided nearly 1600cc of urine. His fever broke and I continued him on amox/clav. You mentioned thinking through suprapubic cath. I was seriously looking around for anything remotely similar to a red robin catheter that I might be able to soak in alcohol to somewhat sterilize (not tequila!) if he didn't void soon. My lesson learned was.....a catheter will be part of my ER bag of goodies moving forward.

For his eustachian tube blockage, I was able to help him clear it with a manual massage technique called the Muncie technique. His right ear opened up and cleared by the following morning.

Vanessa C. -

What a crazy story! Thank you so much for sharing. The longer I am in practice the more things that I add to my travel medicine bag it seems... It used to be a few sutures and some first aid stuff for wounds. Now I have tourniquets and a catheter as well as everything else. Thanks again for listening and writing in.

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