Doctor Diaries: USS anyone?

Ultrasound Scans (USS) are what we think of in terms of babies, dating, sexing and anomaly scans.  Yes I have performed USS to look at foetuses, mainly to check for a heartbeat in ED but far more frequently I have used them to look for other things.

Back to the urology rotation, a gentleman was brought into ED with urine retention so I was called to put in a catheter.  Unfortunately for me the man weighed 30 stones/190kg and I couldn’t find his penis.  Believe me I did look …..thoroughly….. and could feel my embarrassment climbing because I knew I couldn't leave the room without successfully relieving his pain from the pressure of his overstretched bladder.  I whipped my head torch off, changed my gloves and went in search of the trusty US scanner.     Dragging it back to the cubicle and having a bit of a chat to the patient (who was surprisingly upbeat considering his pain) I started scanning in the general area of where I might expect the penis to be I found the channel and slipped the tube in….one very relieved patient (and doctor).

There is always the patient with difficult to find veins.  If that patient happens to be an IV drug user they will show you where to find a good vein but other patients…whip out the USS.  I spent a while trying to cannulate a gentleman who had been cannulated in every superficial/surface vein possible during his hospital stay but because of his level of confusion he had pulled them all out.  Now he was septic, he had an overwhelming infection that reduced him to being limp and almost lifeless in the bed, I had a chance ….or so I thought.

USS out and found a vein in the lower leg (this man also didn’t bend very well due to his advancing years), slipped the cannula in and went away feeling oh so proud of myself.  The nursing staff called me back an hour later, yes you guessed it, in an otherwise unseen act of gymnastics he had found every ounce of energy available, bent double and twisted in a corkscrew that would have claimed a 10 in the figure skating championships.  My cannula hit the floor in a millisecond and the nurses were not happy about having to clean up the mess.  Hero to zero in less time than it would have taken him to tie on his skates.

There seems to be a growing camp of men who like to insert things up their penis.  It is not always possible to tell if these objects have all been removed, especially as the patient often continues to feel pain when they have.  Unlike women, where a head torch and some spelunking skills are more appropriate, men it is impossible to see up there without some equipment.  Some of the things I have fished out: a sword from a toy soldier; the USB end off of a USB cable; a marble; a cocktail umbrella; a metal barbecue kebab skewer; the sharp end of a screwdriver; a battery.  In fact I am often amazed at what people can get up there, it makes me wince and I don’t even have a penis.  The trusty USS is an easy first line to see if there is anything obvious near the tip that I can remove pre cystoscopy (inserting a camera) or get an idea if there seems to be a bigger object further in.

I’m sure I’ll talk more on the trend of inserting things into orifices and the tales people tell  another time.