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April 1999

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Subject:
From:
kevin rooney <[log in to unmask]>
Reply To:
UVM Flownet <[log in to unmask]>
Date:
Fri, 9 Apr 1999 10:16:14 -0400
Content-Type:
text/plain
Parts/Attachments:
text/plain (86 lines)
TO ANY FLOWNETTER WITH ADVICE!
        I HAD A PATIENT COME IN WITH ORDERS THAT READ:
                HIST            A. EPISODES OF ATAXIA W/ REPETITIVE
MOVEMENT OF RUE-
                        -SUBCLAVIAN STEAL.
                B. ROTATOR CUFF TORN.
                C. S/P FRACTURE RT SHOULDER (ACTUALLY IT
WAS                              DISLOCATED.
                D. RT CAROTID BRUIT.

ORDERS          A. CAROTID ULTRASOUND WITH IMAGING OF RT SUBC. AND
                        RUE  (WE ALWAYS GET SUBC)
                B. BI LAT ARTERIAL EXAM (PHYSIO)

RESULTS NO EVIDENCE OF CAROTID STENOSIS RT AND LT.
                RT AND LT SUBC TRIPHASIC  RT 130 CM/S  LT  172 CM/S

ART RESULTS     BR ART  204    RAD ART 177   UL ART 157   DIGIT   142
(RIGHT)
                BR ART  178    RAD ART  170  UL ART 160   DIGIT   161
(LEFT)

IMPRESSION      RIGHT

"THIS IS A DIFFICULT STUDY TO INTERPRET, HOWEVER, THE PRESENCE OF A
DROP-OFF FROM THE BRACHIAL PRESSURE RECORDED AS 204  AS COMPARED TO THE
RADIAL AND ULNA PRESSURES RECORDED AS 177 AND 157, RESPECTIVELY, MAY
REFLECT AN OBSTRUCTIVE PROCESS IN THE RIGHT BRACHIAL OR PROXIMAL TO SUCH.
  iN VIEW OF THIS ABNORMALITY, ULTRASOUND IMAGING IS SUGGESTED OF THE
SUBCLAVIAN, AXILLARY, BRACHIAL, ULNA AND RADIAL ARTERIES.   IN ADDITION,
ADSON'S MANEUVER TESTING IS RECOMMENDED WITH THE RECENT KNOWLEDGE OF
PRESENCE OF A CERVICAL RIB.

                LEFT

MOST LIKELY THERE IS A PRESENT IN THE LEFT IN THE LEFT UPPER EXTREMITY A
STENOSIS OR OBSTRUCTIVE PROCESS IN EITHER THE BRACHIAL, AXILLARY OR
SUBCLAVIAN ARTERY.   FURTHER INFORMATION IS SUGGESTED TO BE OBTAINED
THROUGH ARTERIAL IMAGING IN THE LEFT UPPER EXTREMITY.  IN ADDITION,
ADSON'S MANEUVER TESTING, AS WELL AS EXERCISE TESTING IS RECOMMENDED IN
BOTH UPPER EXTREMITIES.


THESE EXAMS WERE DONE BY TECH #1.


TECH #2  MYSELF RECEIVED AN ORDER STATING:
DX:  RT SHOULDER INJURY WITH ABNORMAL UE ARTERIAL STUDY  R/O STENOSIS OF
BRACHIAL ARTERY.  ALSO (+) CERVICAL RIBS/NEW INFO/

ORDER   1. BILATERAL UE DUPLEX IMAGING
        2. NON INVASIVE UE ARTERIAL IMAGING WITH ADSON'S MANEUVER TESTING
FOR T.O.S.

I SPOKE WITH THE PATIENT AND SHE WAS HAVING "BLANK SPELLS".  SHE STATES
THAT WHEN SHE WAS IN THE GROCERY STORE AND WAS PICKING THINGS OFF SHELF
OR SIMILAR MOVEMENTS SHE WOULD GET THIS FEELING THAT WOULD LAST ONLY A
SECOND.  SHE STATED THAT SHE FEELS LIKE SHE WILL FALL TO THE LT OR RT BUT
NEVER FWD OR BACK.  SHE STATED THAT IN OCT 1995 SHE FELL AND DISLOCATED
HER RT SHOULDER, HAD IT SET AND WAS  SENT TO X-RAY,  THE TECH HAD HER
LIFT HER ARM AND IT POPPED OUT AGAIN.  IT WAS RE-SET AND HAS NOT BEEN OUT
SINCE.  SHE DOES NOT HAVE FULL RANGE OF MOTION.  SHE CAN RAISE HER ARM TO
ABOUT 145 DEGREES WITH HELP FROM HER OTHER ARM.  PT ALSO STATED SHE HAD A
TINGLING FEELING IN HER HAND.

HERE IS MY PROBLEM.  I COULD NOT SEE OR IN GOOD FAITH DO THE IMAGING WHEN
THE PATIENT JUST HAD A FULL ARTERIAL ONE WEEK AGO.  AND I FEEL THAT THE
T.O.S. EXAM IS A STRETCH LISTENING TO HER SYMPTOMS AND THAT HER RANGE OF
MOTION IS AT 15% ACCORDING TO WHAT THE PATIENT SAID ORTHO RATED HER AT.
        MY SUPERVISOR IS NO HELP.  SHE SAID THE DOCTOR CAN ORDER WHATEVER
HE WANTS, REGARDLESS OF WHAT THE HOSPITAL GETS PAID FOR BY THE INSURANCE
CO.  I SAID THAT IS NOT THE POINT.  THE REPORTS SAY WE KNOW THERE IS A
PROBLEM ALREADY. (BY THE WAY THE ORDERING DOC HERE IS ALSO THE READING
PHYS AND MED DIRECTOR OF THE LAB)
        SO I DID THE ONLY THE THORACIC STUDY YESTERDAY AND I CAME IN THIS
MORNING TO FIND A NOTE THAT HE WANTS HER BROUGHT BACK IN TO IMAGE.
                        SIGNED   "PULLING MY HAIR OUT"
                        K.R.  IN VA.



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