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Wed Jan 16 02:37:17 GMT 2008

"czuehlke at frontiernet.net" <czuehlke at frontiernet.net> wrote:    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?

  >>>no proteins were found in the LP, infact, nothing was. The whole event didn't seem to match anything textbook, which is why I was at a loss and wondered if it might be traumatic instead. But there was not a successful LP untill she got here. (after 2 days of antibiotics and antivirals which were started proactively.) Like I said in last post, I was trying to piece things together. One of my preceptors told me they had no idea, because of the treatment rendered before she got here,  but were happy with a good outcome. (She was at an outlying facility for a couple days before being transferred here) and I was just there for about the last 1/2 hour, but it was the major conversation piece. That is why i figured I would inquire here. i will have to get back to you on antibiotics, i am at home, and she was given a few, so I don't want to make a mistake on them. 

   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.

  >>>The docs overseeing me could not answer. Infact nobody really knew. The story was strange, and my mastery of the local language is a bit lacking too. Yes, the family was advised, in a rather grim fasion I think, but such is the culture. As I mentioned before I couldn't remember for the life of me the name guillan Barre when i typed it up. 

  Mike

Carol Eisenbrandt

Quoting trauma-list-request at trauma.org:

> Send trauma-list mailing list submissions to
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> 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" 
> 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" 

>> Subject: Re: Standbys in Today's Medicine
>> To: "Trauma & Critical Care mailing list" 
>> 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 & 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" 
>>> Subject: Standbys in Today's Medicine
>>> To: "Trauma &, Critical Care mailing list" 
>>> Message-ID:
>>> 
>>> 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: 
>>> 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 
>>> Subject: Re: Standbys in Today's Medicine - ALWAYS
>>> To: "Trauma & Critical Care mailing list" 
>>> Cc: trauma-list at trauma.org
>>> Message-ID: 
>>> 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: 
>>> 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 
>>> Subject: Re: Hyponatremia and Pneumothorax
>>> To: "Trauma &, Critical Care mailing list" 
>>> 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" 

>> Subject: Re: Standbys in Today's Medicine
>> To: 
>> 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. :-)
>>
>>>>> 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" 

> Subject: Chaperones (was RE: trauma-list Digest, Vol 55, Issue 13)
> To: "Trauma & Critical Care mailing list" 
> 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

=== message truncated ===

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