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Aye! Mi Heuvos!


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Old home test for parotiditis that I've also seen done in the ER, so it's not just an 'old wives tale' - it's just an old trick.

Offer the subject something very acidic to taste, like a dill pickle, lemon, lemon drop, etc. If they become *really* unhappy about it [it hurts], they have something going on with the parotid gland: obstruction,. inflammation, etc. because the gland is trying to do it's job and there's something interfering with it.

Sometimes just letting the patient smell the object triggers the salavary response. Or just suggesting they bite it.

Try it on yorself. Think clearly about how it would feel to bite into a big, tangy dill pickle. Bets are, your mouth starts to water.

Like I said - old trick, but it still works.

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Does this pain radiate somewhere else??

Now, does he have a fever??? :wink:

Does the pain get worse when he is standing, sitting, or lying down? What makes it better?

Does he have any bruising in the area?

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Since this happened to a buddy of mine recently with a similar onset... could it possibly be a varicose vein around the testicles? Caused some nasty pain, slower onset.... Any evidence of this? Other than that, let's see what others have asked for....

Wendy

CO EMT-B

MI EMT-B

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Pain does not radiate and is worse when in a sitting position. Better when laying or standing. No bruising. He has a fever of 101.9. States it started about the same time as the pain. There is no bruising in the area.

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Does the patient have CVA pain or tenderness? Do we have access to labs? Can we obtain a full set of vital signs and perform a head to toe exam to include lung sounds and an abdominal assessment. Anything remarkable?

We will need to obtain vascular access, consider fluids, and work on labs/imaging if possible.

Take care,

chbare.

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Chbare - I'm not sure I'd start an iv on this guy. Can you elaborate on why you would get IV access on him?

I'm treating this right now as either a simple testicular pain or epididimitis.

I might get an iv just to have access and if that's where you are going with it then cool but if not please tell me more of your thought process.

we can do this in PM's if you want.

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Your PE shows:

128/88 108 16 99%RA

PERRLA, EOMI, MMM, No pharyngeal erythema or exudates, tenderness and fullness over the TMJs b/l, your partner ate the pcikle that you had with your lunch so you cannot perform a pickle test

-JVD or carotid bruits, +submandibular LAD

LS CTA b/l with good AE

RRR no m/r/g

abd soft, nontender, nl BS, no CVAT

Genital exam as mentioned before

Rectal exam deferred

Extremities unremarkable

Skin show no rashes

Someone was looking for labs. I'm going to assume you wanted a CBC and chem. WBC is 6.5, plt count is 615 otherwise they are wnl. What kind of imaging studies do you want? Do you want any other labs?

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Ruffems, my rationale for the IV is based on my experiences with patients that have had similar complaints. Pyelonephritis and appendicitis were on my list of differentials. Testicular pain can be a symptom of an acute abdominal problem. I want access in the event ABO's, fluids, or prep for the OR is required. In addition, we may need to do a CT with contrast or IVP depending on our resources. I may be a little over aggressive; however, until I rule out more pernicious pathology, I would like to have IV access.

I would like to have a UA in addition to the other labs and a BUN/Creat (Young guy, but let's be safe) in the event we need to go with a contrast study.

Does the pain change with elevation of the testes? What does a flashlight exam reveal. (Shine light through the testes looking for any remarkable findings.)

In addition, this patient has submandibular node swelling? What is his MMR status? This could be an atypical presentation of something not often seen in the USA.

Take care,

chbare.

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thanks chbare. I was leaning actually after reading and thinking more into starting at least a lock. Not sure if I'd go fluids yet.

But more and more of doc's scenarios eventually need the big guns so I'll go with a lock for now.

I am also following your thought process of the submandibular swelling and such.

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