Emergency Notes

Source: An unusual blood gas with severe acidemia

• This is a simple procedure, and often delayed because of unnecessary discomfort (on behalf of the practitioner, not the patient).
• Penile anaesthesia is achieved easily by circumferential superficial infiltration at the base of the penis, or local infiltration at the site of needle placement.
• A 19 or 21G butterfly needle is then introduced next to the peno-scrotal junction at either the 3 or 9 o’clock positions to avoid hitting the neurovascular bundle. It is recommended to aspirate until fresh, red, oxygenated blood is aspirated, and detumescence (can be anywhere from 10ml to 100ml).
• The current recommendation for injecting alpha agonist is phenylephrine 200 micrograms, injected into the corpora once aspiration is finished, repeated every 5-10 minutes. If phenylephrine is not available, then metaraminol (1mg in 5ml of saline), or adrenaline (varying ranges throughout the literature – anywhere from 0.01-0.1mg, diluted from 1-5ml).
  — Phenylephrine is preferred due to its much lower THEORETICAL risk of systemic cardiovascular effects.
  — If one was to use metaraminol, or adrenaline, there is no documented frequency or risk of systemic effects, however it would be prudent to monitor the patient clinically, and reconsider its use in the patient with less than optimal coronary artery flow.
• Recently intracavernosal injection of methylene blue has been advocated (with the curious adverse effects being penile burning and discolouration).

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