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Sun Jan 13 18:24:30 GMT 2008

While I'm sure there are many considered opinions based on anecdotal evidence and individual risk tolerances, I find myself wondering whether the are any published studies out there that would allow for a solid risk analysis? Is anyone aware of any?

John Annen
Zurich, Switzerland

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> Today's Topics:
>
>    1. Standbys in Today's Medicine (Charlene M Morris)
>    2. Re: Standbys in Today's Medicine - ALWAYS (KMATTOX at aol.com)
>    3. Re: Standbys in Today's Medicine - ALWAYS (Jeffrey Hammond)
>    4. Hyponatremia and Pneumothorax (bfletcher at columbus.rr.com)
>    5. Re: Hyponatremia and Pneumothorax (saad shebrain)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Sat, 12 Jan 2008 08:43:15 -0500
> From: "Charlene M Morris" <cvmmorris at gmail.com>
> Subject: Standbys in Today's Medicine
> To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
>     <ca095570801120543g28e0b3a1ycd3c71561d07f43a at mail.gmail.com>
> Content-Type: text/plain; charset=ISO-8859-1
>
>  Recently, I began practicing at my original rural FP position in NC and I
> have had several instances of needing to examine "private parts". In that
> regard, I requested a standby, as that is what I have done for the
> past several years. I would really like opinions: yay or nay? Does it matter
> F-M, MM FF, or M-F?
>
> The NP with whom I work feels comfortable not conscripting a nurse or MA to
> be in the room, although I was told to absolutely not do an unmonitored exam
> at the ERs where I have worked. By way of history, I trained in the late
> '70s with a lady Ob/Gyn and she told me to get used to doing my own exams,
> because as a  female PA, I would be doing the pelvics without assistance.
>
> Opinions welcome and requested! It is the 21st century and we have other
> concerns to ponder.
>
> C M Morris
>
>
> ------------------------------
>
> Message: 2
> Date: Sat, 12 Jan 2008 09:07:37 EST
> From: KMATTOX at aol.com
> Subject: Re: Standbys in Today's Medicine - ALWAYS
> To: trauma-list at trauma.org
> Message-ID: <d17.1e0458f5.34ba23a9 at aol.com>
> Content-Type: text/plain; charset="US-ASCII"
>
> In my view, in today's litigious world, and with all "harassments" being
> defined as being in the eyes of the beholder or recipient, the  
> "SAFEST" route is
> for ALL examiners and interviewers to ALWAYS have some sort of chaperone or
> mechanism to hear and document the conversation and examinations between a
> patient and a physician, or someone acting under the supervision of a
> physician.    Even if the patient being interviewed or examined    
> brought their own
> witness, entrapment cases are not uncommon and the prudent    
> professional would
> have someone accompany her or him with a patient, regardless  of the   
>  gender of
> the examiner or the examinee.
>
> NOW, I am fully aware that both number of personnel AND COST constraints
> prohibit the ideal and safest route.    This then raises  questions of
> practicality.    One could also raise the same  question about  
> translators and mis
> understandings by patients who do not  understand the language or  
> culture of the
> doctor, clinic, or hospital that they  find themselves in.
>
> k
>
>
> In a message dated 1/12/2008 7:44:04 A.M. Central Standard Time,
> cvmmorris at gmail.com writes:
>
> Recently, I began practicing at my original rural FP position in NC and  I
> have had several instances of needing to examine "private parts". In   that
> regard, I requested a standby, as that is what I have done for  the
> past several years. I would really like opinions: yay or nay? Does it   matter
> F-M, MM FF, or M-F?
>
> The NP with whom I work feels comfortable  not conscripting a nurse or MA to
> be in the room, although I was told to  absolutely not do an unmonitored exam
> at the ERs where I have worked. By  way of history, I trained in the late
> '70s with a lady Ob/Gyn and she told  me to get used to doing my own exams,
> because as a  female PA, I would  be doing the pelvics without assistance.
>
> Opinions welcome and  requested! It is the 21st century and we have other
> concerns to  ponder.
>
> C M Morris
> --
> trauma-list : TRAUMA.ORG
> To change your  settings or unsubscribe  visit:
> http://www.trauma.org/index.php?/community/
>
>
>
>
>
> **************Start the year off right.  Easy ways to stay in shape.
> http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489
>
>
> ------------------------------
>
> Message: 3
> Date: Sat, 12 Jan 2008 13:20:00 -0500
> From: Jeffrey Hammond <hammond at umdnj.edu>
> Subject: Re: Standbys in Today's Medicine - ALWAYS
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Cc: trauma-list at trauma.org
> Message-ID: <fc572d194f1a.4788be80 at umdnj.edu>
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> ------------------------------
>
> Message: 4
> Date: Sat, 12 Jan 2008 19:11:22 -0500
> From: <bfletcher at columbus.rr.com>
> Subject: Hyponatremia and Pneumothorax
> To: trauma-list at trauma.org
> Message-ID:
>     <32726757.691011200183082358.JavaMail.root at hrndva-web14-z01>
> Content-Type: text/plain; charset=utf-8
>
> Has anyone ever seen a case of hyponatremia due to pneumothorax.    
> Had a patient who developed profound hyponatremia without a  
> reasonable cause (no head injury, meds etc).  Has some rib fx, scap  
> fx, transverse process fx and a Pneumothorax.
>
> When reviewing the literature, a cause of SIADH is pneumothorax.  If   
>  so Why?  Any ideas.
>
> Thanks
>
>
> ------------------------------
>
> Message: 5
> Date: Sat, 12 Jan 2008 18:03:53 -0800 (PST)
> From: saad shebrain <shebrain1 at yahoo.com>
> Subject: Re: Hyponatremia and Pneumothorax
> To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <582556.27464.qm at web32603.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
>
>  The mechanism of SIADH induced by pnemothorax can be explained ,  
> theoretically, by the both chemical (hypoxia) and Mechanical  
> (decreased pulmonary blood flow) that stimulate
>  the volume receptor and baroreceptor in the left atrium, which  
> thus regulate ADH release. The vasoconstriction caused by hypoxia  
> may also influence left atrial
>  blood filling. Some investigators have also reported that atrial  
> natriuric polypeptide plays an important role in patients with SIADH   
>  .The increase in circulating
>  blood volume caused by an inappropriate secretion of ADH induces  
> atrial natriuric polypeptide secretion and thus results in urinary  
> sodium excretion.
>
>
>  SS
>
>  Ref
>  A Syndrome of Inappropriate
>  Secretion of Antidiuretic Hormone
>  Associated with Pleuritis Caused
>  by OK-432
>  Takeshi Hanagiri
>  Hiroyuki Muranaka
>  Mitunori Hashimoto
>  Akira Nagashima
>  Department of Chest Surgery,
>  Kitakyushu Municipal Medical Center,
>  Kitakyushu, Japan
>  OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
>
>
> bfletcher at columbus.rr.com wrote:  Has anyone ever seen a case of  
> hyponatremia due to pneumothorax. Had a patient who developed  
> profound hyponatremia without a reasonable cause (no head injury,  
> meds etc). Has some rib fx, scap fx, transverse process fx and a  
> Pneumothorax.
>
> When reviewing the literature, a cause of SIADH is pneumothorax. If  
> so Why? Any ideas.
>
> Thanks
> --
> trauma-list : TRAUMA.ORG
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> ------------------------------
>
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> End of trauma-list Digest, Vol 55, Issue 11
> *******************************************
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