Gangrene in Strange Places...

[medic_chick87]

So here is a new one my partners and I ran yesterday. Dispatched to a diabetic event. On scene we find ~50y/o male, AOx2. Sugar was high, but not so much so that we considered that to be the main cause. Pt is a paraplegic. Pt's roommate states that he has been "really weak for a couple of days and acting really sick." And that was the best hx we would get from him. Finally when we move him to the gurney we see that he is incontinent with some dark stools, though not yet tarry. So now we start heading down the GI bleed route. Fact is, we dont really know what the heck is going on. We just figure its a mixture of all of the above. Anyway get him to the hospital and a few mins later Doc comes out and tells us that he actually has, get ready for it...

Gangrene of the Penis!

Poor guy! My partner had noticed that he had edema of the testicles, but we just didnt think anything of it. Guess next time we should pay a little bit more attention. ^_^

 

[Medic9]

Oh that poor man!!

 

[EMERG2011]

Unfortunately, thats probably when you'd hear this over the hospital intercom "Paging doctor Bobbit. Paging Dr. Lorenna Bobbit"

The big question with this (and really with all other major congenital diseases) how do you not notice it?

 

[mikeylikesit]

lets have a moment of silence for the mans penis...............................ok.

 

[VentMedic]

lets have a moment of silence for the mans penis...............................ok.

A moment of silence for the patient might be more appropriate.

Involvement of the testicles in not good. Was there a followup by to see if the man survived? It would have been interesting to know if it was diagnosed as Fournier gangrene what his severity index score was assessed at.

People with any type of paralysis require some special considerations for assessment.

It was a decubitus ulcer (pressure sore) that caused the death of Christopher Reeve.

Autonomic dysreflexia (or hyperreflexia) is something else you will see in quadriplegics and in paraplegics who have loss of sensation at or above the lower rib cage. Learning the basics of it will also enhance you assessment of these patients. Usually a college level A&P and/or pathophysiology course will introduce you to this complication when discussing neuro pathways.