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Mon Jan 14 18:41:40 GMT 2008

Risk analysis??  I suppose hard data beats fear or cynicism as a reason
for decency and professionalism; but not by much.  

A patient's dignity and privacy are precious to him/her, as they should
be to us.  That we must invent or exploit other justifications to be
respectful -- much less PROVE them -- is pretty pathetic when you stop
and think about it.

Whether an important medical examination becomes a heartless violation
is chiefly up to the clinician.  Start by explaining what you're up to
and why, and then insist on providing a chaperone as a demonstration of
your dedication to your patient's comfort and confidence.  Thus you've
lost maybe twenty seconds putting everyone at ease.  Time well spent, if
you ask me.

As is almost always the case in REAL LIFE, proper patient care will
generally steer you clear from all manner of harm; but such should be a
benefit of your professionalism, not a motivation for it.

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of John Annen
Sent: Sunday, January 13, 2008 1:25 PM
To: Trauma &amp; Critical Care mailing list
Subject: Re: trauma-list Digest, Vol 55, Issue 11

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

Quoting trauma-list-request at trauma.org:

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> Today's Topics:
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>    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>
> Content-Type: text/plain; charset="us-ascii"
>
> An HTML attachment was scrubbed...
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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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> http://www.trauma.org/index.php?/community/
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>
>
> ------------------------------
>
> --
> trauma-list : TRAUMA.ORG
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> End of trauma-list Digest, Vol 55, Issue 11
> *******************************************
>

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