It's my pleasure and honor to have back on EM cases, the one and only Dave Carr, the infamous Dave Carr that you'll remember from Carr's cases.

We've done a whole slew of best case ever's, everything from anti-NMDA receptor encephalitis to endocarditis.

And, of course, the live podcast from the EM cases courses we did dissection

and anaphylaxis Dave it's great to have you back on the show yeah thanks for having me

it's been way too long so I understand that you have a best case ever that not only brings up some

really interesting medical learning points,

but also some process learning points as well about how we conduct things in the emergency

department. Yeah, so I'm working a busy shift. It's an evening shift. Lots of charts in the

rack. And the nurse, she's coming up to me. Dave, can you come see this person?

She's having difficulty urinating. And I'm just like, look, that's really busy. I got really sick patients. How old is she? Well, she's 24 and she can't pee.

And, you know, I'm thinking myself, okay, well, that's kind of strange. Why don't you give her some water and encourage her to pee? And, you know, she's also complaining of lots of pain. Why don't we just give her some Advil and, uh, or ibuprofen? And I'll get to her. Just let me do my thing. So, you know, I, I do my thing. I'm seeing other patients and the nurse, same nurse says, Dave, look, she's really uncomfortable. I said, well, have you done a post-void residual or can you check a bladder scan? Yeah, I already did that. She has like 700 Cs. Okay, well, that's pretty impressive. You know, is she menstruating? Do we know anything? Yeah, she's complaining of like pelvic pain. And I said,

look, if she can't pee and she has 700 CCs, I mean, my mind's just all over the place because

urinary retention in a female is not like urinary retention in a male. I mean, urinary retention in a male

is, you know, Foley, Flomax and go, right? It's that simple.

With a female, you actually have to use your brain. So I had this woman with urinary retention as a female

and I'm like, I don't know what's going on. My thoughts are, given that she didn't have back pain,

she probably doesn't have cata, maybe she has MS, which we see in this age group with a weird neurological

complaint, or with her complaints of like a pelvic pain, I thought, you know, maybe she has

an STD or a Bartholins abscess or something that was causing an obstructive cause. But what was

clearly needed was we needed to bring this young woman to a private room where I could do a sensitive exam.

And what was important in this case was it was very culturally sensitive because this woman explained to me that it was imperative if we were going to have a gynecological exam that her hymen was left intact and that she had never had a gynecological exam and she wanted to make sure, you know,

that nothing was done to make any abnormalities. So I brought her into a room. Of course, I had a

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