I give a hefty dose of morphine. It still hurts like hell when you start to detorse, but then you can actually feel it ''unwind'' and the patient immediately feels better.
We confirm detorsion with Doppler ultrasound
(sent from mobile phone)
Division Chief, Emergency Medicine
Children's National Medical Center
From: "Larson, Jeremy" <[log in to unmask]>
Subj: Re: manual detorsion?
Date: Wed Aug 12, 2009 17:30
To: "[log in to unmask]" <[log in to unmask]>
Never under sedation, otherwise I'd never know if it was better (I know this flies in the face of pain control, but how else do I know if it gets better since I'm not trained in ultrasound use?). It really only takes a couple of seconds. Last month the patient only experienced partial relief with my first attempt, so I did another 180 degrees to get full relief.
I learned it from a senior colleague in my department.
I was taught years ago to initially try twisting outward, like opening a book when the patient is supine. This is subjective, but it seems the twisted cord wants to untwist when you get it held the right way and get it started. I'm not an expert. I think I've done it 5-6 times in 12 years,(twice in the last 4-5 months). The patient feels better almost immediately.
First time I saw it done was as a 19 yo camp counselor. Watched an ancient urologist in a rural ED do it at 1 am on a 15 yo I'd driven an hour to the hospital for acute pain. The kid said it was wonderful and worth the discomfort when the doc got it fixed.
From: Pamela MURPHY [mailto:[log in to unmask]]
Sent: Wed 8/12/2009 10:48 AM
To: Larson, Jeremy; [log in to unmask]
Subject: RE: manual detorsion?
I'm assuming it's under procedural sedation? And, what's the trick to determine if the torsion is medial or lateral?
Great discussion...................Pam Murphy
Pamela S. Murphy, MD
John C. Lincoln Hospital Deer Valley
Myelomeningocele Planning Clinic
Children's Rehabilitative Services
St. Joseph's Hospital
> Date: Tue, 11 Aug 2009 22:07:14 -0400
> From: [log in to unmask]
> Subject: Re: manual detorsion?
> To: [log in to unmask]
> I have been surprisingly successful with manual detorsion in the ED. It's my first line therapy when the diagnosis is clear. 2/3 of our urologists support this approach, feeling that we can't really make it worse. So far I've done far m
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