trauma-list Digest, Vol 55, Issue 14

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Hi Mike:
I just wanted to say that my step-father presented this way and had  
Guillan Barre syndrome. Did the lumbar pick up any proteins? If not  
how long will the CFS detect the proteins might be the question? Maybe  
one of the doctors could answer this? What kind of antibiotics did the  
patient receive? Hopefully, the patient was also provided with  
information concerning GBS just in case the problem started back up  
again.
Carol Eisenbrandt


Quoting trauma-list-request at trauma.org:

> Send trauma-list mailing list submissions to
> 	trauma-list at trauma.org
>
> To subscribe or unsubscribe via the World Wide Web, visit
> 	http://list.mistral.net/mailman/listinfo/trauma-list
> or, via email, send a message with subject or body 'help' to
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>
> You can reach the person managing the list at
> 	trauma-list-owner at trauma.org
>
> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of trauma-list digest..."
>
>
> Today's Topics:
>
>    1. Re: trauma-list Digest, Vol 55, Issue 13
>       (czuehlke at frontiernet.net)
>    2. Chaperones (was RE: trauma-list Digest, Vol 55, Issue 13)
>       (Bjorn, Pret)
>    3. RE: Chaperones (was RE: trauma-list Digest, Vol 55, Issue 13)
>       (Harper, M  Jane)
>    4. a likely occurence? (Mike Smertka)
>    5. RE: a likely occurence? (Bjorn, Pret)
>    6. R: Standbys in Today's Medicine (Peter)
>    7. RE: a likely occurence? (Moore, Rick)
>    8. RE: a likely occurence? (Bjorn, Pret)
>    9. RE: a likely occurence? (Moore, Rick)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Tue, 15 Jan 2008 14:35:50 +0000
> From: "czuehlke at frontiernet.net" <czuehlke at frontiernet.net>
> Subject: Re: trauma-list Digest, Vol 55, Issue 13
> To: trauma-list at trauma.org
> Message-ID: <20080115143550.81iexmvsj5k0kgg0 at webmail.frontiernet.net>
> Content-Type: text/plain;	charset=ISO-8859-1;	DelSp="Yes";
> 	format="flowed"
>
> I totally concur, going into a room without a chaparone or tech during
> a female-male exam is setting yourself up for possible law suit.
> Unfortunately, there are too many people who are looking for a reason
> to imply that you did something wrong. I think history is our greatest
> asset and I think you would benefit more to be safe and take someone
> in with you. You have worked hard to get your license and I would not
> recommend taking a chance with it. Just some advice from an ED nurse.
> Carol Eisenbrandt
>
> Quoting trauma-list-request at trauma.org:
>
>> Send trauma-list mailing list submissions to
>> 	trauma-list at trauma.org
>>
>> To subscribe or unsubscribe via the World Wide Web, visit
>> 	http://list.mistral.net/mailman/listinfo/trauma-list
>> or, via email, send a message with subject or body 'help' to
>> 	trauma-list-request at trauma.org
>>
>> You can reach the person managing the list at
>> 	trauma-list-owner at trauma.org
>>
>> When replying, please edit your Subject line so it is more specific
>> than "Re: Contents of trauma-list digest..."
>>
>>
>> Today's Topics:
>>
>>    1. Standbys in Today's Medicine  (bensonblues at comcast.net)
>>    2. Re: Standbys in Today's Medicine (Bjorn, Pret)
>>    3. Re: Standbys in Today's Medicine (William Bromberg)
>>
>>
>> ----------------------------------------------------------------------
>>
>> Message: 1
>> Date: Mon, 14 Jan 2008 17:30:38 +0000
>> From: bensonblues at comcast.net
>> Subject: Standbys in Today's Medicine
>> To: trauma-list at trauma.org
>> Message-ID:
>> 	<011420081730.22568.478B9C3E0000A8CD0000582822120207849C0A9A040D02019C020A0D at comcast.net>
>>
>> Content-Type: text/plain
>>
>> After 15 years of being a program director in EM, I can give you
>> many horror stories of residents who have unknowingly and
>> idealistically tread where no man (or woman) should go: Examining
>> someone of the opposite sex without a friendly (preferrably
>> professional EMT, RN) chaperone. As always, it depends upon your
>> patient population. But, in general, we practicioners in Detroit
>> feel like Lottery Agents for the Michigan State Lottery - it seems
>> everyone wants to sue and made that fast and easy buck. We NEVER
>> exam a patient without a medic or nurse present who is of the
>> patient's sex, unless the patient is in extremis, and even then....
>>
>> To further complicate things, if a patient has gender identification
>>  issues, or, theologic/religious issues, it can be more confusing
>> and  difficult. There are a few moments each day when I wish I could
>>  transform into an amorphous, colorless, and asexual entity so that
>> I  can get my job done with more efficiency. I think my wife wishes
>> that as well....
>>
>> ------------------------------
>>
>> Message: 2
>> Date: Mon, 14 Jan 2008 13:41:40 -0500
>> From: "Bjorn, Pret" <pbjorn at emh.org>
>> Subject: Re: Standbys in Today's Medicine
>> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
>> Message-ID: <9CCE32ECAAFDEB4DA01EC771B6AD951BFB2661 at VALIER.me.emh.org>
>> Content-Type: text/plain;	charset="us-ascii"
>>
>> 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:
>>
>>> Send trauma-list mailing list submissions to
>>>     trauma-list at trauma.org
>>>
>>> To subscribe or unsubscribe via the World Wide Web, visit
>>>     http://list.mistral.net/mailman/listinfo/trauma-list
>>> or, via email, send a message with subject or body 'help' to
>>>     trauma-list-request at trauma.org
>>>
>>> You can reach the person managing the list at
>>>     trauma-list-owner at trauma.org
>>>
>>> When replying, please edit your Subject line so it is more specific
>>> than "Re: Contents of trauma-list digest..."
>>>
>>>
>>> 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>
>>> Content-Type: text/plain; charset="us-ascii"
>>>
>>> An HTML attachment was scrubbed...
>>> URL:
>>>
>> http://list.mistral.net/pipermail/trauma-list/attachments/20080112/46fd4
>> bcf/attachment-0001.htm
>>>
>>> ------------------------------
>>>
>>> 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
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>>>
>>>
>>>
>>> ------------------------------
>>>
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>>>
>>> End of trauma-list Digest, Vol 55, Issue 11
>>> *******************************************
>>>
>>
>>
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
>>
>> ________________________________________________________________________
>> ____________
>> Never miss a thing.  Make Yahoo your home page.
>> http://www.yahoo.com/r/hs
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
>>
>>
>> ------------------------------
>>
>> Message: 3
>> Date: Mon, 14 Jan 2008 15:43:05 -0500
>> From: "William Bromberg" <brombwi1 at memorialhealth.com>
>> Subject: Re: Standbys in Today's Medicine
>> To: <trauma-list at trauma.org>
>> Message-ID: <478B8309.85AB.003A.0 at memorialhealth.com>
>> Content-Type: text/plain; charset=US-ASCII
>>
>> I',m tempted to tp reply that this was too much information but
>> instead I'll just pass along my condolences. :-)
>>
>>>>> <bensonblues at comcast.net> 1/14/2008 12:30 PM >>>
>> After 15 years of being a program director in EM, I can give you
>> many horror stories of residents who have unknowingly and
>> idealistically tread where no man (or woman) should go: Examining
>> someone of the opposite sex without a friendly (preferrably
>> professional EMT, RN) chaperone. As always, it depends upon your
>> patient population. But, in general, we practicioners in Detroit
>> feel like Lottery Agents for the Michigan State Lottery - it seems
>> everyone wants to sue and made that fast and easy buck. We NEVER
>> exam a patient without a medic or nurse present who is of the
>> patient's sex, unless the patient is in extremis, and even then....
>>
>> To further complicate things, if a patient has gender identification
>>  issues, or, theologic/religious issues, it can be more confusing
>> and  difficult. There are a few moments each day when I wish I could
>>  transform into an amorphous, colorless, and asexual entity so that
>> I  can get my job done with more efficiency. I think my wife wishes
>> that as well....
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
>>
>>
>> ------------------------------
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>> End of trauma-list Digest, Vol 55, Issue 13
>> *******************************************
>>
>
>
>
>
>
> ------------------------------
>
> Message: 2
> Date: Tue, 15 Jan 2008 09:49:19 -0500
> From: "Bjorn, Pret" <pbjorn at emh.org>
> Subject: Chaperones (was RE: trauma-list Digest, Vol 55, Issue 13)
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <9CCE32ECAAFDEB4DA01EC771B6AD951BFB266B at VALIER.me.emh.org>
> Content-Type: text/plain;	charset="us-ascii"
>
> We'll never quantify either; but let's admit that the risk to the
> patient for sexual abuse is as real as the risk to the provider of
> malicious accusation.  This is not a one-sided exposure.
>
> A chaperone is there for both of you.  Swallow your cynicism.  Don't
> look for reasons to make the provider-patient relationship needlessly
> adversarial.  Things are hard enough already.
>
> Pret
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of
> czuehlke at frontiernet.net
> Sent: Tuesday, January 15, 2008 9:36 AM
> To: trauma-list at trauma.org
> Subject: Re: trauma-list Digest, Vol 55, Issue 13
>
>
> I totally concur, going into a room without a chaparone or tech during
> a female-male exam is setting yourself up for possible law suit.
> Unfortunately, there are too many people who are looking for a reason
> to imply that you did something wrong. I think history is our greatest
> asset and I think you would benefit more to be safe and take someone
> in with you. You have worked hard to get your license and I would not
> recommend taking a chance with it. Just some advice from an ED nurse.
> Carol Eisenbrandt
>
> Quoting trauma-list-request at trauma.org:
>
>> Send trauma-list mailing list submissions to
>> 	trauma-list at trauma.org
>>
>> To subscribe or unsubscribe via the World Wide Web, visit
>> 	http://list.mistral.net/mailman/listinfo/trauma-list
>> or, via email, send a message with subject or body 'help' to
>> 	trauma-list-request at trauma.org
>>
>> You can reach the person managing the list at
>> 	trauma-list-owner at trauma.org
>>
>> When replying, please edit your Subject line so it is more specific
>> than "Re: Contents of trauma-list digest..."
>>
>>
>> Today's Topics:
>>
>>    1. Standbys in Today's Medicine  (bensonblues at comcast.net)
>>    2. Re: Standbys in Today's Medicine (Bjorn, Pret)
>>    3. Re: Standbys in Today's Medicine (William Bromberg)
>>
>>
>> ----------------------------------------------------------------------
>>
>> Message: 1
>> Date: Mon, 14 Jan 2008 17:30:38 +0000
>> From: bensonblues at comcast.net
>> Subject: Standbys in Today's Medicine
>> To: trauma-list at trauma.org
>> Message-ID:
>>
> <011420081730.22568.478B9C3E0000A8CD0000582822120207849C0A9A040D02019C02
> 0A0D at comcast.net>
>>
>> Content-Type: text/plain
>>
>> After 15 years of being a program director in EM, I can give you
>> many horror stories of residents who have unknowingly and
>> idealistically tread where no man (or woman) should go: Examining
>> someone of the opposite sex without a friendly (preferrably
>> professional EMT, RN) chaperone. As always, it depends upon your
>> patient population. But, in general, we practicioners in Detroit
>> feel like Lottery Agents for the Michigan State Lottery - it seems
>> everyone wants to sue and made that fast and easy buck. We NEVER
>> exam a patient without a medic or nurse present who is of the
>> patient's sex, unless the patient is in extremis, and even then....
>>
>> To further complicate things, if a patient has gender identification
>>  issues, or, theologic/religious issues, it can be more confusing
>> and  difficult. There are a few moments each day when I wish I could
>>  transform into an amorphous, colorless, and asexual entity so that
>> I  can get my job done with more efficiency. I think my wife wishes
>> that as well....
>>
>> ------------------------------
>>
>> Message: 2
>> Date: Mon, 14 Jan 2008 13:41:40 -0500
>> From: "Bjorn, Pret" <pbjorn at emh.org>
>> Subject: Re: Standbys in Today's Medicine
>> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
>> Message-ID: <9CCE32ECAAFDEB4DA01EC771B6AD951BFB2661 at VALIER.me.emh.org>
>> Content-Type: text/plain;	charset="us-ascii"
>>
>> 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:
>>
>>> Send trauma-list mailing list submissions to
>>>     trauma-list at trauma.org
>>>
>>> To subscribe or unsubscribe via the World Wide Web, visit
>>>     http://list.mistral.net/mailman/listinfo/trauma-list
>>> or, via email, send a message with subject or body 'help' to
>>>     trauma-list-request at trauma.org
>>>
>>> You can reach the person managing the list at
>>>     trauma-list-owner at trauma.org
>>>
>>> When replying, please edit your Subject line so it is more specific
>>> than "Re: Contents of trauma-list digest..."
>>>
>>>
>>> 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>
>>> Content-Type: text/plain; charset="us-ascii"
>>>
>>> An HTML attachment was scrubbed...
>>> URL:
>>>
>>
> http://list.mistral.net/pipermail/trauma-list/attachments/20080112/46fd4
>> bcf/attachment-0001.htm
>>>
>>> ------------------------------
>>>
>>> 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
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>>>
>>>
>>>
>>> ------------------------------
>>>
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>>>
>>> End of trauma-list Digest, Vol 55, Issue 11
>>> *******************************************
>>>
>>
>>
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
>>
>>
> ________________________________________________________________________
>> ____________
>> Never miss a thing.  Make Yahoo your home page.
>> http://www.yahoo.com/r/hs
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
>>
>>
>> ------------------------------
>>
>> Message: 3
>> Date: Mon, 14 Jan 2008 15:43:05 -0500
>> From: "William Bromberg" <brombwi1 at memorialhealth.com>
>> Subject: Re: Standbys in Today's Medicine
>> To: <trauma-list at trauma.org>
>> Message-ID: <478B8309.85AB.003A.0 at memorialhealth.com>
>> Content-Type: text/plain; charset=US-ASCII
>>
>> I',m tempted to tp reply that this was too much information but
>> instead I'll just pass along my condolences. :-)
>>
>>>>> <bensonblues at comcast.net> 1/14/2008 12:30 PM >>>
>> After 15 years of being a program director in EM, I can give you
>> many horror stories of residents who have unknowingly and
>> idealistically tread where no man (or woman) should go: Examining
>> someone of the opposite sex without a friendly (preferrably
>> professional EMT, RN) chaperone. As always, it depends upon your
>> patient population. But, in general, we practicioners in Detroit
>> feel like Lottery Agents for the Michigan State Lottery - it seems
>> everyone wants to sue and made that fast and easy buck. We NEVER
>> exam a patient without a medic or nurse present who is of the
>> patient's sex, unless the patient is in extremis, and even then....
>>
>> To further complicate things, if a patient has gender identification
>>  issues, or, theologic/religious issues, it can be more confusing
>> and  difficult. There are a few moments each day when I wish I could
>>  transform into an amorphous, colorless, and asexual entity so that
>> I  can get my job done with more efficiency. I think my wife wishes
>> that as well....
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
>>
>>
>> ------------------------------
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>> End of trauma-list Digest, Vol 55, Issue 13
>> *******************************************
>>
>
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
>
>
> ------------------------------
>
> Message: 3
> Date: Tue, 15 Jan 2008 08:51:43 -0600
> From: "Harper, M  Jane" <M.Jane.Harper at osfhealthcare.org>
> Subject: RE: Chaperones (was RE: trauma-list Digest, Vol 55, Issue 13)
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
> 	<7F1312711CA7474A89B3DF8BA0BA54D00BACAB52 at pmc-rfd-mx01.intranet.osfnet.org>
>
> Content-Type: text/plain; charset=us-ascii
>
> Given the homophobia in this culture, I'd take a chaperone regardless of
> the gender mix of the patient and provider, if a sexual exam is
> involved, especially if one is a Lesbian or gay provider and out at
> work.
>
> ----------------------
> Jane Harper, PhD(c), RN, ACNP, CCNS, CNRN, CCRN
> Rockford, IL
> m.jane.harper at osfhealthcare.org
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
> Sent: Tuesday, January 15, 2008 8:49 AM
> To: Trauma &amp; Critical Care mailing list
> Subject: Chaperones (was RE: trauma-list Digest, Vol 55, Issue 13)
>
> We'll never quantify either; but let's admit that the risk to the
> patient for sexual abuse is as real as the risk to the provider of
> malicious accusation.  This is not a one-sided exposure.
>
> A chaperone is there for both of you.  Swallow your cynicism.  Don't
> look for reasons to make the provider-patient relationship needlessly
> adversarial.  Things are hard enough already.
>
> Pret
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of
> czuehlke at frontiernet.net
> Sent: Tuesday, January 15, 2008 9:36 AM
> To: trauma-list at trauma.org
> Subject: Re: trauma-list Digest, Vol 55, Issue 13
>
>
> I totally concur, going into a room without a chaparone or tech during
> a female-male exam is setting yourself up for possible law suit.
> Unfortunately, there are too many people who are looking for a reason
> to imply that you did something wrong. I think history is our greatest
> asset and I think you would benefit more to be safe and take someone
> in with you. You have worked hard to get your license and I would not
> recommend taking a chance with it. Just some advice from an ED nurse.
> Carol Eisenbrandt
>
> Quoting trauma-list-request at trauma.org:
>
>> Send trauma-list mailing list submissions to
>> 	trauma-list at trauma.org
>>
>> To subscribe or unsubscribe via the World Wide Web, visit
>> 	http://list.mistral.net/mailman/listinfo/trauma-list
>> or, via email, send a message with subject or body 'help' to
>> 	trauma-list-request at trauma.org
>>
>> You can reach the person managing the list at
>> 	trauma-list-owner at trauma.org
>>
>> When replying, please edit your Subject line so it is more specific
>> than "Re: Contents of trauma-list digest..."
>>
>>
>> Today's Topics:
>>
>>    1. Standbys in Today's Medicine  (bensonblues at comcast.net)
>>    2. Re: Standbys in Today's Medicine (Bjorn, Pret)
>>    3. Re: Standbys in Today's Medicine (William Bromberg)
>>
>>
>> ----------------------------------------------------------------------
>>
>> Message: 1
>> Date: Mon, 14 Jan 2008 17:30:38 +0000
>> From: bensonblues at comcast.net
>> Subject: Standbys in Today's Medicine
>> To: trauma-list at trauma.org
>> Message-ID:
>>
> <011420081730.22568.478B9C3E0000A8CD0000582822120207849C0A9A040D02019C02
> 0A0D at comcast.net>
>>
>> Content-Type: text/plain
>>
>> After 15 years of being a program director in EM, I can give you
>> many horror stories of residents who have unknowingly and
>> idealistically tread where no man (or woman) should go: Examining
>> someone of the opposite sex without a friendly (preferrably
>> professional EMT, RN) chaperone. As always, it depends upon your
>> patient population. But, in general, we practicioners in Detroit
>> feel like Lottery Agents for the Michigan State Lottery - it seems
>> everyone wants to sue and made that fast and easy buck. We NEVER
>> exam a patient without a medic or nurse present who is of the
>> patient's sex, unless the patient is in extremis, and even then....
>>
>> To further complicate things, if a patient has gender identification
>>  issues, or, theologic/religious issues, it can be more confusing
>> and  difficult. There are a few moments each day when I wish I could
>>  transform into an amorphous, colorless, and asexual entity so that
>> I  can get my job done with more efficiency. I think my wife wishes
>> that as well....
>>
>> ------------------------------
>>
>> Message: 2
>> Date: Mon, 14 Jan 2008 13:41:40 -0500
>> From: "Bjorn, Pret" <pbjorn at emh.org>
>> Subject: Re: Standbys in Today's Medicine
>> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
>> Message-ID: <9CCE32ECAAFDEB4DA01EC771B6AD951BFB2661 at VALIER.me.emh.org>
>> Content-Type: text/plain;	charset="us-ascii"
>>
>> 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:
>>
>>> Send trauma-list mailing list submissions to
>>>     trauma-list at trauma.org
>>>
>>> To subscribe or unsubscribe via the World Wide Web, visit
>>>     http://list.mistral.net/mailman/listinfo/trauma-list
>>> or, via email, send a message with subject or body 'help' to
>>>     trauma-list-request at trauma.org
>>>
>>> You can reach the person managing the list at
>>>     trauma-list-owner at trauma.org
>>>
>>> When replying, please edit your Subject line so it is more specific
>>> than "Re: Contents of trauma-list digest..."
>>>
>>>
>>> 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>
>>> Content-Type: text/plain; charset="us-ascii"
>>>
>>> An HTML attachment was scrubbed...
>>> URL:
>>>
>>
> http://list.mistral.net/pipermail/trauma-list/attachments/20080112/46fd4
>> bcf/attachment-0001.htm
>>>
>>> ------------------------------
>>>
>>> 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
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>>>
>>>
>>>
>>> ------------------------------
>>>
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>>>
>>> End of trauma-list Digest, Vol 55, Issue 11
>>> *******************************************
>>>
>>
>>
>>
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> ________________________________________________________________________
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>>
>> ------------------------------
>>
>> Message: 3
>> Date: Mon, 14 Jan 2008 15:43:05 -0500
>> From: "William Bromberg" <brombwi1 at memorialhealth.com>
>> Subject: Re: Standbys in Today's Medicine
>> To: <trauma-list at trauma.org>
>> Message-ID: <478B8309.85AB.003A.0 at memorialhealth.com>
>> Content-Type: text/plain; charset=US-ASCII
>>
>> I',m tempted to tp reply that this was too much information but
>> instead I'll just pass along my condolences. :-)
>>
>>>>> <bensonblues at comcast.net> 1/14/2008 12:30 PM >>>
>> After 15 years of being a program director in EM, I can give you
>> many horror stories of residents who have unknowingly and
>> idealistically tread where no man (or woman) should go: Examining
>> someone of the opposite sex without a friendly (preferrably
>> professional EMT, RN) chaperone. As always, it depends upon your
>> patient population. But, in general, we practicioners in Detroit
>> feel like Lottery Agents for the Michigan State Lottery - it seems
>> everyone wants to sue and made that fast and easy buck. We NEVER
>> exam a patient without a medic or nurse present who is of the
>> patient's sex, unless the patient is in extremis, and even then....
>>
>> To further complicate things, if a patient has gender identification
>>  issues, or, theologic/religious issues, it can be more confusing
>> and  difficult. There are a few moments each day when I wish I could
>>  transform into an amorphous, colorless, and asexual entity so that
>> I  can get my job done with more efficiency. I think my wife wishes
>> that as well....
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> 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 13
>> *******************************************
>>
>
>
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> ------------------------------
>
> Message: 4
> Date: Tue, 15 Jan 2008 09:26:21 -0800 (PST)
> From: Mike Smertka <medic0947969 at yahoo.com>
> Subject: a likely occurence?
> To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <412699.43478.qm at web61114.mail.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
>
> Hey everyone,
>
>   Today I was fortunate enough to be presented with a clinical issue  
>  rather than an academic one. But I have not seen anything like it   
> before so I figure I would put it up for discussion. (before anyone   
> asks, yes, I have heard of central cord syndrome, and I realize this  
>  sounds similar at a different location, that is why I am asking)
>
>   11 y/o female, pushed down at school, fell on full backpack.   
> (weight unknown, estimate ~10 lbs) but was also ill at the time with  
>  flu like symptoms.
>
>   Over a course of 7 days (at home and school), developed pain in   
> lower legs, which advanced into lower sacral area, followed by   
> complete loss of motor/sensation in lower extremities. was taken to   
> an outlying facilty by parents. after failed attempts at LP was   
> given antibiotics, antivirals, and transferred to facility here.   
> (regional childrens center) after 2 days the LP was finally done and  
>  nothing abnormal was found. MRI showed soft tissue swelling, in the  
>  lumbar/sacral region. (I have no way to digitally scan the film or  
> I  would put it here) after another 11 days in hospital, function  
> and  sensory returned to lower extremities. Patient was discharged  
> and  complained of fatigue and muscle weakness but didn't want to  
> stay  any longer. Left hospital under her own power. (with parents  
> of  course)
>
>   But my question is such:
>
>   It sounds to me like this patient had some imparement because of   
> soft tissue swelling pressing on the nervous or venous tissues. I   
> was told the greatest fear was a viral infection that would recur   
> and usually leaves permanant damage each time it does. (based on the  
>  flu-like symptoms and absence of brusing.)
>
>   Ultimately neither was ruled in or out. has anyone seen either of   
> these possibilities before? If so, how common is it? Is your first   
> thought trauma or medical? Obviously there is the possibility of   
> both, but having never seen it take 2 days to get an LP, I am of the  
>  mind it was most likely trauma related. here long hospital stays  
> are  not uncommon, but to see a patient walk out with only symptoms  
> of  fatigue, and localized weakness, seems very remarkable if it  
> were a  virus that causes permanant damage. The patient was referred  
> to  physical therapy, but it is doubtful she will go because of   
> financial constraints and will probably be returning to her family   
> physician for follow up. (a considerable distance away)
>
>   Would appreciate your thoughts on the matter.
>
>   Mike
>
>
> ---------------------------------
> Be a better friend, newshound, and know-it-all with Yahoo! Mobile.    
> Try it now.
>
> ------------------------------
>
> Message: 5
> Date: Tue, 15 Jan 2008 12:49:21 -0500
> From: "Bjorn, Pret" <pbjorn at emh.org>
> Subject: RE: a likely occurence?
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <9CCE32ECAAFDEB4DA01EC771B6AD951BFB266D at VALIER.me.emh.org>
> Content-Type: text/plain;	charset="us-ascii"
>
> Disclaimer: Pret Bjorn is a nurse.  And bolder than he is bright.
>
> Were all of her shots up to date?
>
> This is a soft mechanism and an odd story for trauma.  I'd think central
> cord is a reach, especially if nothing lights up on her MRI.
>
> The medical differential (inasmuch as I pretend to understand it) isn't
> much more helpful.  Gets into stuff like Guillian-Barre and polio -- and
> there again, this story is wanting for a good fit.
>
> Might have to settle for a good outcome in the absence of good answers.
> Have you called the Discovery Channel?
>
> Pret Bjorn
> Bangor, ME USA
>
>
>
>
>
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Mike Smertka
> Sent: Tuesday, January 15, 2008 12:26 PM
> To: Trauma &amp, Critical Care mailing list
> Subject: a likely occurence?
>
>
>
> Hey everyone,
>
>   Today I was fortunate enough to be presented with a clinical issue
> rather than an academic one. But I have not seen anything like it before
> so I figure I would put it up for discussion. (before anyone asks, yes,
> I have heard of central cord syndrome, and I realize this sounds similar
> at a different location, that is why I am asking)
>
>   11 y/o female, pushed down at school, fell on full backpack. (weight
> unknown, estimate ~10 lbs) but was also ill at the time with flu like
> symptoms.
>
>   Over a course of 7 days (at home and school), developed pain in lower
> legs, which advanced into lower sacral area, followed by complete loss
> of motor/sensation in lower extremities. was taken to an outlying
> facilty by parents. after failed attempts at LP was given antibiotics,
> antivirals, and transferred to facility here. (regional childrens
> center) after 2 days the LP was finally done and nothing abnormal was
> found. MRI showed soft tissue swelling, in the lumbar/sacral region. (I
> have no way to digitally scan the film or I would put it here) after
> another 11 days in hospital, function and sensory returned to lower
> extremities. Patient was discharged and complained of fatigue and muscle
> weakness but didn't want to stay any longer. Left hospital under her own
> power. (with parents of course)
>
>   But my question is such:
>
>   It sounds to me like this patient had some imparement because of soft
> tissue swelling pressing on the nervous or venous tissues. I was told
> the greatest fear was a viral infection that would recur and usually
> leaves permanant damage each time it does. (based on the flu-like
> symptoms and absence of brusing.)
>
>   Ultimately neither was ruled in or out. has anyone seen either of
> these possibilities before? If so, how common is it? Is your first
> thought trauma or medical? Obviously there is the possibility of both,
> but having never seen it take 2 days to get an LP, I am of the mind it
> was most likely trauma related. here long hospital stays are not
> uncommon, but to see a patient walk out with only symptoms of fatigue,
> and localized weakness, seems very remarkable if it were a virus that
> causes permanant damage. The patient was referred to physical therapy,
> but it is doubtful she will go because of financial constraints and will
> probably be returning to her family physician for follow up. (a
> considerable distance away)
>
>   Would appreciate your thoughts on the matter.
>
>   Mike
>
>
> ---------------------------------
> Be a better friend, newshound, and know-it-all with Yahoo! Mobile.  Try
> it now.
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
>
>
> ------------------------------
>
> Message: 6
> Date: Tue, 15 Jan 2008 18:57:52 +0100
> From: "Peter" <taliente at tiscalinet.it>
> Subject: R: Standbys in Today's Medicine
> To: "'Trauma &amp; Critical Care mailing list'"
> 	<trauma-list at trauma.org>
> Message-ID: <FBCMCL01B02FRZeNUgh0001710e at FBCMCL01B02.fbc.local>
> Content-Type: text/plain;	charset="iso-8859-1"
>
> Couldn't agree more!
> Peter
>
> -----Messaggio originale-----
> Da: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> Per conto di Bjorn, Pret
> Inviato: lunedì 14 gennaio 2008 19.42
> A: Trauma &amp; Critical Care mailing list
> Oggetto: Re: Standbys in Today's Medicine
>
> 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:
>
>> Send trauma-list mailing list submissions to
>>     trauma-list at trauma.org
>>
>> To subscribe or unsubscribe via the World Wide Web, visit
>>     http://list.mistral.net/mailman/listinfo/trauma-list
>> or, via email, send a message with subject or body 'help' to
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>>
>> You can reach the person managing the list at
>>     trauma-list-owner at trauma.org
>>
>> When replying, please edit your Subject line so it is more specific
>> than "Re: Contents of trauma-list digest..."
>>
>>
>> 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>
>> Content-Type: text/plain; charset="us-ascii"
>>
>> An HTML attachment was scrubbed...
>> URL:
>>
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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
>> re