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Ames Phenistix®
CONSULTATIONS A m e s Phenistix ® ~'~
Some time ago I read that Ames Phenistix ® could be • used as a quick check to delineate the presence or absence of aspirin or phenothiazine; the solution turns brown with either of these and gray-green with PKU. ,Further addition of 20N normal sulfuric acid leading to retention of the brown stain indicates aspirin. I wonder if you could elucidate this mechanism and comment on its reliability. I do not remember the source of m y information. Michael E Nesemann, MD Department of Trauma and Emergency Center Gundersen Clinic, Ltd La Crosse, Wisconsin
Phenistix®, the ferric and magnesium buffered salt composition that turns a bluish-gray with phe, nylketones, can be used for detection of salicylate metabolites including aspirin metabolites in urine or serum. 1 It also will
detect large amounts of phenothiazine metabolites in urine. The reagent immediately produces a brownish-purple color in the presence of salicylates. To differentiate a large amount of phenothiazine metabolite from a small amount of salicylate, a drop of concentrated acid (eg, 20N or 50% sulfuric I is added to the reacted strip. Color due to salicylates will disappear, and color due to phenothiazine metabolites will intensify to brilliant pink or purple. Color charts showing typical colors with small (25-50 mg/dL) or large (150 mg/dL) amounts of urine salicylate are available on request from Ames Division Miles Laboratories, Box 70, Elkhart, Indiana 46515. Helen M Free Professional Relations Ames Division Miles Laboratories Elkhart, Indiana
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1. Johnson PK, Free HM, Free AH: A simplified urine and serum screening test for salicylate intoxication. J Pediatr 1963;63: 949-953.
Physician Responsibility and the L a w Q
Three similar cases in our town have raised a number • of questions concerning the rights and responsibiTities of minors, parents, and emergency physicians. In each case a mother brought her daughter to an ED to have evidence of sexual intercourse collected. In our cases the daughters were 13 to 16 years old. In each case it was suspected that the daughter had had a voluntary,, long-standing sexual relationship with a man. In each case the daughter did not want evidence collected because she did not want to get her partner in trouble. A number of questions immediately come to mind. Do emergency physicians have a legal duty to collect evidence, similar to the duty to treat acutely ill patients? Do minors have the right to refuse such examinations? Should minors be told they have the right to actively and, if need be, violently refuse an unwanted pelvic examination? If an examination had not been done, and the physician failed to diagnose an existing pregnancy or sexually transmitted disease, might liability result? Might the patient sue for emotional upset allegedly caused by an unwanted pelvic examination? Would the answers to any questions be different if a court order had been issued demanding the examination? Ray Fish, PhD, MD, FACEP Urbana, Illinois
A •
A legal duty to treat a patient arises out of the establishment of a physician-patient relationship. Except
148/1239
for a medical emergency in which the patient is unable to provide consent, a physician-patient relationship generally is established when the patient agrees to be treate d by the physician and the physician agrees to treat the patient. It is unlikely that a court would conclude that a legally cognizable physician-patient relationshi p was established when a minor female was brought to the hospital against her will by a parent for the sole purpose of obtaining medical proof
George Podgorny, MD - - Editor Winston-Salem, North Carolina
of the minor's voluntary sexual activity. Many states have enacted laws that permit minors to give legal consent to medical treatment for pregnancy or sexually transmitted diseases. Consequently, the minor who enjoys the legal right to consent also would enjoy the legal right to refuse treatment or examination. The United States Supreme Court also has held that female minors have a constitutionally protected right to obtain a legal abortion and that their parents have no legal right to prevent it. A minor patient who is forced to undergo a pelvic examination against her will has a valid cause of action for assault and battery against the physician who performs the examination. This is so even if the minor does not suffer any emotional or physical consequences as a result of the
Annals of Emergency Medicine
14:12 December 1985
Some time ago I read that Ames Phenistix ® could be • used as a quick check to delineate the presence or absence of aspirin or phenothiazine; the solution turns brown with either of these and gray-green with PKU. ,Further addition of 20N normal sulfuric acid leading to retention of the brown stain indicates aspirin. I wonder if you could elucidate this mechanism and comment on its reliability. I do not remember the source of m y information. Michael E Nesemann, MD Department of Trauma and Emergency Center Gundersen Clinic, Ltd La Crosse, Wisconsin
Phenistix®, the ferric and magnesium buffered salt composition that turns a bluish-gray with phe, nylketones, can be used for detection of salicylate metabolites including aspirin metabolites in urine or serum. 1 It also will
detect large amounts of phenothiazine metabolites in urine. The reagent immediately produces a brownish-purple color in the presence of salicylates. To differentiate a large amount of phenothiazine metabolite from a small amount of salicylate, a drop of concentrated acid (eg, 20N or 50% sulfuric I is added to the reacted strip. Color due to salicylates will disappear, and color due to phenothiazine metabolites will intensify to brilliant pink or purple. Color charts showing typical colors with small (25-50 mg/dL) or large (150 mg/dL) amounts of urine salicylate are available on request from Ames Division Miles Laboratories, Box 70, Elkhart, Indiana 46515. Helen M Free Professional Relations Ames Division Miles Laboratories Elkhart, Indiana
A
•
1. Johnson PK, Free HM, Free AH: A simplified urine and serum screening test for salicylate intoxication. J Pediatr 1963;63: 949-953.
Physician Responsibility and the L a w Q
Three similar cases in our town have raised a number • of questions concerning the rights and responsibiTities of minors, parents, and emergency physicians. In each case a mother brought her daughter to an ED to have evidence of sexual intercourse collected. In our cases the daughters were 13 to 16 years old. In each case it was suspected that the daughter had had a voluntary,, long-standing sexual relationship with a man. In each case the daughter did not want evidence collected because she did not want to get her partner in trouble. A number of questions immediately come to mind. Do emergency physicians have a legal duty to collect evidence, similar to the duty to treat acutely ill patients? Do minors have the right to refuse such examinations? Should minors be told they have the right to actively and, if need be, violently refuse an unwanted pelvic examination? If an examination had not been done, and the physician failed to diagnose an existing pregnancy or sexually transmitted disease, might liability result? Might the patient sue for emotional upset allegedly caused by an unwanted pelvic examination? Would the answers to any questions be different if a court order had been issued demanding the examination? Ray Fish, PhD, MD, FACEP Urbana, Illinois
A •
A legal duty to treat a patient arises out of the establishment of a physician-patient relationship. Except
148/1239
for a medical emergency in which the patient is unable to provide consent, a physician-patient relationship generally is established when the patient agrees to be treate d by the physician and the physician agrees to treat the patient. It is unlikely that a court would conclude that a legally cognizable physician-patient relationshi p was established when a minor female was brought to the hospital against her will by a parent for the sole purpose of obtaining medical proof
George Podgorny, MD - - Editor Winston-Salem, North Carolina
of the minor's voluntary sexual activity. Many states have enacted laws that permit minors to give legal consent to medical treatment for pregnancy or sexually transmitted diseases. Consequently, the minor who enjoys the legal right to consent also would enjoy the legal right to refuse treatment or examination. The United States Supreme Court also has held that female minors have a constitutionally protected right to obtain a legal abortion and that their parents have no legal right to prevent it. A minor patient who is forced to undergo a pelvic examination against her will has a valid cause of action for assault and battery against the physician who performs the examination. This is so even if the minor does not suffer any emotional or physical consequences as a result of the
Annals of Emergency Medicine
14:12 December 1985