1
Classify
The case begins
A 38-year-old taking trazodone has a painful rigid erection for six hours.
Corpora are rigid and tender; glans is soft.
Which of the following is the most appropriate next step?
2
Corporal blood gas
New information
Select Reveal results to continue.
Dark blood: pH 7.05, low oxygen, high carbon dioxide.
Which of the following is the most appropriate next step?
3
After treatment
New information
Select Reveal results to continue.
Rigidity persists after monitored bedside therapy.
Which of the following is the most appropriate next step?
Must not miss
Critical actions
Calculator / interpretation
Enter values and calculate.
Interpretation rule
Use the result as decision support. Reconcile it with physiology, trajectory, local protocol and specialist input.
Error prevention
Common mistakes—and how to mitigate them
Delaying because of embarrassment
Mitigation: Use direct, nonjudgmental questions and document onset time.
Skipping monitoring
Mitigation: Monitor blood pressure and rhythm during phenylephrine.
Confusing high-flow with ischemic disease
Mitigation: Use pain, rigidity, blood gas and Doppler when needed.
Recap
What the learner should carry forward
- Painful rigidity lasting ≥4 hours is a compartment-like emergency.
- The blood gas confirms ischemia; bedside decompression and sympathomimetic therapy are time critical.
- Failure of first-line therapy requires timely escalation; prolonged ischemia increases erectile dysfunction risk.
Final score interpretation: 80–100 = strong; 50–79 = review missed decisions; below 50 = repeat the case.
Evidence-based sources
AUA/SMSNA Acute Ischemic Priapism Guideline
Links verified September 21, 2026.
Clinical boundary
Educational content only. Apply current local protocols, patient-specific factors, consultant guidance and clinical judgment.