A quick physical examination revealed only a distended bladder for the 72-year-old man. A urethral catheter was placed, and 700 mL of urine was obtained, with much relief for the patient. Not forgetting the patient?s presentation and his stumble while changing stretchers, you decided to perform a thorough neurological examination, and you found nearly absent rectal tone and absence of sensation and vibration below T11. Urgent MRI confirmed your diagnosis of spinal cord compression. You consulted neurosurgery, and the patient was admitted for decompressive laminectomy and eventual chemotherapy.
After taking the history of the 46-year-old febrile woman with HIV and giving her a thorough physical examination, you performed a rectal examination, which showed good rectal tone and no evidence of obstruction. You then performed a pelvic examination (with a chaperone present), and it showed vesicular lesions suggestive of herpes. Adequate pain control was achieved. Ultrasound showed a fully distended bladder. You gave the patient acetaminophen, IV acyclovir, and IV fluids, and you started cardiorespiratory monitoring. You performed complete bladder decompression using a 16F Foley and sent the urine for urinalysis and culture. The urinalysis returned positive for white blood cells, so you gave her IV ceftriaxone and admitted her to medicine for IV antibiotics, IV fluids, and antivirals.
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Last Updated on November 1, 2021