On the 6th Day of Christmas Happy Medic gave to me…

6 Priapisms

5 Golden hours

4 Fibbing V-Fibbers

3 Tripple Os

EMS 2.0

and a British Medic dressed in green

OK giggles, if you’re so ready to laugh at there being 6 of them, how about describing for me 6 causes of priapism, or general disconnect between the nervous system and the vascular system for that matter.

Yeah, I thought so.

As silly as this seems it does happen to females as well and can be a key indicator in many cases.  This is not in your primary survey, or secondary for that matter, on all patients, but should be noted if found, then a possible cause considered.

For example:

Ever wonder why all those commercials say that if their result lasts more than four hours the customer should call a doctor?  Because that is the official definition of priapism, an engorging of the sexual member without physical or psycological stimulation and a lack of the member returning to it’s normal state after a period of four hours.

So why should EMTs and Paramedics care about this sign and how it effects their patient?

Trauma is only one.  Recall from school that if your GSW patient with two anterior holes and no exit woulds can not move his feet and has a priapism, there is a disconnect between the vascular and nervous system, likely caused by those bullets.  Your patient has HIGH suspicion of a severe spinal injury.

But Mr Johnson walking painfully to the window of your ambulance and not having taken some of the pharmaceutical aids, is in remarkable discomfort that could be from other causes.  It could be a Brazillian Wandering Spider bite (HAH! Now that’s funny!).  What about cocaine use?  Trazodone has also been noted to have a side effect like this.  It can also be considered an allergic reaction.  Think about it.  An allergic reaction that disrupts two body systems…where have we heard that before?

Point being that while a priapism is indeed a chuckle worthy topic here in front of the computer so close to Christmas (Same sentence…YES!) you need to be ready to interpret that sign and apply it to your differential diagnosis.  And don’t laugh, ladies, from the literature it sounds akin to childbirth according to women who have experienced it.

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