Placement of foreign bodies within the urethra has intrigued urologists for years. We present the case of a 30-year-old man who had self-inserted 6 kidney beans into his urethra for sexual pleasure. Conservative attempts at removal with bedside interventions were unsuccessful. The patient required operative intervention with cystoscopy and urethral foreign body retrieval. No additional trauma was appreciated and all beans were extracted. Management of patients with a urethral foreign body can be attempted with bedside extraction, however proximal or challenging objects may require surgical extraction via either endoscopic or open approaches.
form part of the routine pre-operative assessment of suitability for carotid endarterectomy under local anaesthetic. We believe the provision of a low dose spinal anaesthetic adjunct facilitated a safe and successful awake carotid endarterectomy in this patient.
In the United States, emergency physicians medically assess millions of patients annually with psychiatric complaints before they are transferred to psychiatric facilities. The goal of the medical assessment is to identify and stabilize unstable medical conditions and medical mimics of psychiatric disease. Despite adequate evidence that the vast majority of significant medical conditions can be identified during the history and physical exam alone, clinicians are routinely required to order comprehensive laboratory testing prior to transferring patients to psychiatric facilities. This chapter analyzes the history and available evidence surrounding the practice previously referred to as “medical clearance,” and it makes recommendations for the emergency physician and psychiatrist to use in their daily practice.
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