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Testicular Torsion

Jessica Mason, MD, Mizuho Spangler, DO, and Bob Jones, MD
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18:03
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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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01:22

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EM:RAP 2016 September Written Summary 655 KB - PDF

What we all were taught to be true regarding diagnosis of testicular torsion may not be as reliable as once believed. Jess Mason discusses with Dr.Bob Jones the caveats we all need to be aware of.

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Todd H. -

how can one view the US vidoes of the arterial flow waves with EmRap HD???

Jess Mason -

You can find the video on EMRAP-HD's YouTube page here: https://youtu.be/IQ5pUWIu6mI

Rabbott -

I've done more than a few of these in the past 40 years. 2 points about manual detorsion:
1. As you rotate, you often get a "detente" stop every 180 degrees - a rather definite "resting" point. It's not a smooth rotation where you can go 90 degrees and see what happens. You go 180 each time.

2. If it is truly a torsion, you will have one or more 180 degree rotations that are easy. Then, the next one (180 degree twist) will be hard, and will go back where that half turn started. When that happens, you are probably done. I'm not aware of ever having gone to far. At that point, you repeat your Ultrasound (or, get your first ultrasound if you were ballsy enough to detorse without first imaging).

3. (I was just kidding, I actually have 3 points). If the testicle won't rotate at all when you try the first half turn rotation - watch carefully here, this may be a difficult concept to grasp - try rotating it the other direction. If that doesn't work, rethink the diagnosis, or if you're certain of the diagnosis, block the cord and try again while the urologist is sharpening her knives.

4. Sorry, can't help myself, one more point. Most of the time, you can do this with a little fentanyl. I prefer this to a cord block, because one can evaluate for cessation of pain if you use fentanyl, whereas with a cord block you can't get a sense of clinical success until the block wears off. Sometimes the pain improves almost immediately with a successful detorsion, Often, it takes 15 minutes or so.

Balls to the walls, guys.

Jonathan G. -

Hi All

So if the US cannot be definitively relied upon to rule out torsion, it would seem from your presentation that you would conceivably need to send each one to the OR for laparoscopy.
But that is not feasible.
What then do you recommend (as opposed to what do you not recommend: do not rely on the neg US)?

Jess Mason -

While no test is perfect, I think ultrasound looking for the specific findings we discussed in the right clinical context is the key. In my opinion, if you are really suspicious that someone has torsion-detorsion and the ultrasound looks negative, that might be a case to involve the specialist and observe the patient.

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The Return Full episode audio for MD edition 257:32 min - 358 MB - M4AEM:RAP 2016 September Canadian Edition Canadian 31:48 min - 44 MB - MP3EM:RAP 2016 September Aussie Edition Australian 25:03 min - 34 MB - MP3EM:RAP 2016 September German Edition Deutsche 115:24 min - 159 MB - MP3EM:RAP 2016 September Spanish Edition Español 78:56 min - 108 MB - MP3EM:RAP 2016 September French Edition Français 46:51 min - 64 MB - MP3EM:RAP 2016 September Board Review Answers 197 KB - PDFEM:RAP 2016 September Board Review Questions 658 KB - PDFEM:RAP 2016 September Individual MP3 Files 302 MB - ZIPEM:RAP 2016 September Written Summary 655 KB - PDFEMRAP Resumen en Español Septiembre 2016 1 MB - PDF

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