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Grande CM, Stene JK. Airway managment : considerations in the trauma patient. Crit Care Clin 1990 ; 6 : 37-59. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991 ; 324 : 1445-50. Walls RM. Rapid-sequence intubation in head trauma. Ann Emerg Med 1993 ; 22 : 1008-11. Bullock R, Chesnut RM, Clifton G. Guidelines for the management of severe head injury. Eur J Emerg Med 1996 ; 2 : 109-27. Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996 ; 335 : 1864-9. Koleff MH. Critical care. In: Ahya SN. et al. eds. ; . The Washington Manual of medical therapeutics. Lippincott Williams & Wilkins, 2001 ; p. 195-216. Moeschler O, Engler A. Un tournus de mdecine d'urgence au cours de la formation en anesthsiologie. Med Hyg 1998 ; 56 : 2368-73, because generic detrol.

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I. Nontender, no palpable masses c. Vulva i. No lesions, nontender ii. Atrophic changes noted d. Vagina i. Mucosa dry, absent rugae, nontender e. Cervix i. No lesions, no discharge, nontender f. Uterus i. Normal size, nontender g. Adnexa i. No masses, nontender h. Neuro i. Decreased sensation, no anal wink i. Kegel i. j. POPQ i. Aa -3, Ba -3, C -7 ii. GH 2.5, PB 4, TVL 11.5 iii. Ap -1.5, Bp -1.5, D -10 6. Initial Testing a. Urine i. UA, C&S, Cytology ii. PVR: 30cc 7. Initial Assessments and Diagnoses a. Urge related incontinence i. Possible neurogenic ii. Unresponsive to Detrol b. Pelvic Organ Prolapse i. Rectocele: Stage 1 asymptomatic ii. No Cystocele or Uterine prolapse c. Pelvic muscle weakness d. Impaired mobility secondary to CVA e. Normal urinary emptying f. Atrophic vaginitis g. Medications and contributory effect on urge incontinence i. Diuretics Furosemide, Spironolactone 1. increase urinary output 8. Initial Plan of Care a. Kegel exercises i. 10 set, 4 sets day b. Urodynamics study c. Cystoscopy d. Pelvic PT referral i. Evaluations and treatment as indicated ii. Therapeutic exercises iii. Electrical stimulation - if indicated e. Medications i. 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