A surgeon in the US has been suspended after he used his cellphone to snap a patient’s penis during surgery. Dr Adam Hansen of the Mayo Clinic in Scottsdale, Arizona, was inserting a catheter into patient during a routine gallbladder operation when he whipped out his mobile and started snapping away at Sean Dubrovik’s schlong. It must have been something to do with the 37-year-old strip club owner’s eye-popping body art.

A year before, Dubrovik, a 37-year-old, had “Hot Rod” tattooed on his peen for a $1,000 bet (let me guess, in large gothic letters, with flames coming out of the base, right?). “It was the most horrible thing I went through in my life,” said Sean of his gallbladder operation genital inking, which just raises the question, why did you do it, dumbass?

Anyway, enough of the heinous penis backstory, let’s get back to the clinic. A scandalized member of the surgical team reported Hansen’s actions to the clinic, but not before tipping off the local newspaper. The surgeon, who had apparently shown his patient’s artwork to his fellow surgeons, called Dubrovik to apologize, assuring him that he had deleted the photo.

“I feel violated, betrayed and disgusted” says Dubrovik, who is considering legal action, of the surgeon’s actions, which is probably similar to how all those folks who saw the photo of his tattoo feel. Meanwhile, the doctor, who is on administrative leave pending an investigation, could lose his job.

Reviewed by Dr Neal Uren, consultant cardiologist and Dr Reginald Odbert, GP

important: this is a brief guide to the emergency help that can be given in the event of a heart attack or cardiac arrest before the arrival of emergency services. It is not intended as a replacement for a first aid or resuscitation course.

What should you do if someone has a heart attack?

If someone has a cardiac arrest or heart attack, there are only a few minutes to act before it is too late. It is vital to know what to do beforehand.

To perform CPR (cardiopulmonary resuscitation) and artificial respiration (mouth to mouth resuscitation) effectively, training and frequent practice on resuscitation dummies are essential.

First aid courses are offered all over the country at night schools or by voluntary organisations such as St John Ambulance or The Red Cross.

How can you tell if someone is having a heart attack?

If the person is unconscious:

• are they breathing? Look at the patient’s chest to see if it is rising and falling.
  
  
• do they have a pulse? Place two fingers on one or other side of the person’s voice box in their throat to feel if they have a carotid pulse.
  
  

If the patient has a pulse but is not breathing:

• could it be because of suffocation? Feel inside the mouth with a finger to see if there is anything blocking it or the windpipe and remove any food or other objects. Provided that dentures are not broken, it is better not to remove them.
  
  
• call for help immediately, stating that the casualty is not breathing, and provide resuscitation (see below) until the patient begins to breathe or the ambulance arrives.
  
  

If there is no breathing or pulse, the patient has had a cardiac arrest.

What help is needed?

• If possible, raise the legs up 12 to 18 inches to allow more blood to flow towards the heart
  
  
• Immediately place the palm of your hand flat on the patient’s chest just over the lower part of the sternum (breast bone) and press your hand in a pumping motion once or twice by using the other hand. This may make the heart beat again.
  
  

If these actions do not restore a pulse or if the subject doesn’t begin to breathe again:

• call for help, stating that the casualty is having a cardiac arrest but stay with the patient.
  
  
• find out if any one else present knows CPR.
  
  
• provide artificial respiration immediately (see below).
  
  
• begin CPR immediately (see below).
  
  

How to give artificial respiration

• Tilt the head back and lift up the chin.
  
  
• Pinch the nostrils shut with two fingers to prevent leakage of air.
  
  
• Take a deep breath and seal your own mouth over the person’s mouth.
  
  
• Breathe slowly into the person’s mouth - it should take about two seconds to adequately inflate the chest.
  
  
• Do this twice.
  
  
• Check to see if the chest rises as you breathe into the patient.
  
  
• If it does, enough air is being blown in.
  
  
• If there is resistance, try to hold the head back further and lift the chin again.
  
  
• Repeat this procedure until help arrives or the person starts breathing again.
  
  

How do I perform CPR (cardiopulmonary resuscitation)?

See if there is breathing. If not, start artificial respiration as described above. Checking for a pulse in the neck (carotid artery) may waste valuable time if the rescuer is inexperienced in this check. The procedure is:

• place your fingers in the groove between the windpipe and the muscles of the side of the neck. Press backwards here to check for a pulse.
  
  

If there is no pulse, or if you are unsure, then proceed without delay thus:

• look at the person’s chest and find the ‘upside-down V’ shaped notch that is made by the lower edge of the ribcage. Place your middle finger in this notch and then place your index finger beside it, resting on the breastbone. Take the heel of your other hand and slide it down the breastbone until it is touching this index finger. The heel of your hand should now be positioned on the middle of the lower half of the breastbone.
  
  
• now place the heel of your other hand on top of the first. Keep your fingers off the chest, by locking them together. Your pressure should be applied through the heels of the hands only.
  
  
• keep your elbows straight, and bring your body weight over your hands to make it easier to press down.
  
  
• press down firmly and quickly to achieve a downwards movement of 4 to 5cm, then relax and repeat the compression.
  
  
• do this 15 times, then give artificial respiration twice, and continue this 15:2 procedure until help arrives.
  
  
• aim for a rate of compression of about 100 per minute. You can help your timing and counting by saying out loud ‘one and two and three and four …’ etc.
  
  

Artificial respiration and CPR should both be performed at the same time

• If possible, get someone else to help - one person to perform artificial respiration and the other to perform CPR. (This is not easily done without prior practice and it is well worth attending sessions on CPR training to become familiar with the technique.)
  
  
• The ratio of chest compressions to breaths is 15:2 for both one-person and two-person CPR.
  
  
• Continue until the ambulance arrives or the patient gets a pulse and starts to breathe again.
  
  
• If the pulse returns and breathing begins but the person remains unconscious, roll them gently onto their side into the recovery position. This way mucus or vomit can get out of the mouth and will not obstruct the patient’s breathing. It also prevents the tongue from falling back and blocking the air passage.
  
  

Make sure the patient continues breathing and has a pulse until the ambulance arrives

• If you succeed in resuscitating the person who has been taken ill, he or she may be confused and alarmed by all the commotion. Keep the patient warm and calm by quietly, but clearly, telling them what has happened.
  
  

Again, it needs to be emphasised that the only way to provide proper first aid and resuscitation is through learning the technique, then regular practice and guidance.

Based on a text by Dr Henrik Omark Petersen

Written by Dr Geoff Hackett, consultant in sexual dysfunction

What is penile injury?

Injury or trauma to the penis can be accidental or deliberate.

Deliberate penile injury is a particularly violent event that is usually self-induced, or inflicted by a jealous partner or their former lover.

Despite the publicity surrounding a case of penile amputation in the USA, deliberate penile injury is rare in Western cultures, but seen more often in the Far East. Common injuries are:

• penile amputation
  
  
• penile fracture.
• Fracture of the penis
  
  Fracture occurs when an abnormal force is applied to the erect penis. The ‘fracture’ is actually a tear in the tunica albuginea, the thick fibrous coat surrounding the corpora cavernosum tissue that produces an erection. It is an uncommon injury, usually but not always the result of damage to the penis during sexual intercourse. Most cases (75 per cent) occur on one side, 25 per cent affect both sides and in 10 per cent the tear extends into the urethra.
  
  
  • A ‘cracking’ noise.
    
    
  • Pain.
    
    
  • Bruising.
    
    
  • Immediate loss of erection.
    
    

  How is penile fracture treated?
  
  Advice should be sought quickly. Key elements in treating a fractured penis are:
  
  

• pain relief
  
  
• ice packs (always cover with a cloth before applying to skin)
  
  
• support
  
  
• anti-inflammatory drugs.
  
  

This regime has satisfactory results in about 80 per cent of patients but in the rest, residual pain and deformity may lead to difficulty with sex. These patients need a urethrogram (a test that shows whether the urethral tube is intact) to exclude urethral damage.

If the urethra is not damaged, any collection of blood (haematoma) is drained and repair is carried out to the damaged corpora and tunica. One report of a series of 17 repairs showed that after surgery all patients had painless erections and comfortable sex; only two patients were left with angulation (’bent’ penis).

Urethral injuries should always be repaired but urethral stricture (narrowing) occurs long term in up to 20 per cent of men after surgery.

Penile amputation

The traumatic removal of part of the penis, or the entire penis, is usually associated with severe rage, jealousy or psychiatric disturbance.

Acute blood loss may be considerable and life threatening, particularly with amputation of the erect penis. Successful outcome of surgery is closely related to the viability (capacity to stay alive) of the severed portion, so the part should be recovered and surgical advice sought as quickly as possible.

The aim of surgery is to restore penile length and the different functions of the penis if possible. Because the nerves to the erectile tissue are not usually damaged, erectile function is frequently maintained.

Microsurgery (fine surgery done with the surgeon looking down a microscope) is necessary to restore any degree of feeling. Compared with other forms of reconstruction, microsurgery offers the best chance of having an adequately functioning urethra (tube in the penis used for urination and ejaculation).

Particular care must be taken to reconnect the veins, especially the deep dorsal vein, to restore venous drainage and prevent swelling and compromised blood flow after the operation.