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Testicular Torsion - A recent case has highlighted the importance of considering testicular torsion, even when there is a less common presentation.  A 12 year old boy presented on a Sunday with generalised abdominal and pelvic pain, which had been intermittent over a period of a couple of years and had recently worsened. The patient was doubled up with pain when the pain episodes occurred and there was accompanying vomiting, but no testicular pain. The patient was offered but declined a testicular examination.  The pain increased and a community radiology testicular scan two days following the original presentation demonstrated torsion with a non-viable testis which required surgical removal.

Remember that testicular torsion:

Can occur in neonates but is most common between ages 10 and 25 years.

Usually presents early with severe pain of less than 12 hours, but can be more gradual.

Can cause episodes of intermittent severe pain due to intermittent torsion

Usually causes testicular pain that may radiate to the abdomen but testicular pain is absent in around 10% of clinical presentations.

May cause nausea and vomiting.

The on-call hospital specialists are available to discuss individual cases –see here

See POAC’s testicular torsion policy here

We encourage discussion of this case at peer review. If an anonymsed copy of the case notes are required email sarahh@easthealth.co.nz

Diabetic foot- use of IV antibiotics in primary care for patients with diabetes and active foot disease will only be funded where there is clear documentation of discussion with a named endorsing specialist prior to treatment.

There have been 10 sentinel event cases reported by POAC in last 18 months, in which IV antibiotics have been given in the community without prior discussion, and where the outcome has been hospitalisation and serious events (e.g. amputation).

New dehydration HealthPathway -This pathway covers the management of dehydration alongside the underlying condition. The pathway assists with determining the degree of dehydration and the appropriate venue for management. It highlights the management of moderate dehydration with a trial of anti-emetic plus oral re-hydration under POAC-funded observation before use of IV re-hydration.

Update to Gallstones HealthPathway - an update has been completed to highlight when POAC- funded observation starts for pain management. Initial management with IM/PR analgesia is routine care. Observation time is funded by POAC from the time of giving additional analgesia - see acute management section, point 1, analgesia drop box bullet 1. POAC also funds a clinical review if the pain recurs during the same clinical episode (same drop box, bullet 3).

DVT rescan at 7-10 days for superficial thrombophlebitis-HealthPathway change – The HealthPathway advice has changed and not all cases will require a rescan. If ongoing symptoms at 7-10 days discuss with Haematology. If rescan endorsed, contact POAC with a named endorsement to request rescan. See here management 2 bullet point 3

POAC observation time policy

To assist knowledge of when to claim POAC observation time, a policy has been developed –see here

As a general rule, where a fixed fee is allocated (for example, IV antibiotics) this includes Nurse observation time. If a reaction was to occur, and additional management was required, this could be invoiced in line with the policy

For any clarification on any points within the blog post please email sarahh@easthealth.co.nz


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