Michigan Veterans Benefits Aid & Attendance Lawyer

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Michigan Senior Veterans have an experience attorney to assist them in claiming their non-service connected pension, otherwise known as the Aid & Attendance VA Benefit. Michigan senior veterans who have long-term care costs may be entitled to up to $2,019 per month, tax free. However, oftentimes families need a VA Accredited attorney to help them claim the benefits that they deserve. That is where VA Accredited elder law attorney, Christopher J. Berry, and his firm step in.

Christopher J. Berry, Esq. has devoted his career to the practice of estate planning and elder law, including Medicaid planning, Veterans Benefits and asset preservation planning. As part of his work with the law firm, Mr. Berry has founded the Michigan Elder Law Center whose mission is to help Michigan seniors, veterans and their families navigate the long-term care legal maze.

Attorney Christopher J. Berry has been recognized nationally for his work in assisting Veterans claim their Aid & Attendance by the National Academy of Elder Law Attorneys and made the cover of their national magazine.

Mr. Berry has been selected by his peers as a Top Lawyer for Estate Planning by DBusiness Magazine and Best Lawyers of America as well as being rated 10.0/10.0 (Superb) by Avvo. In addition to these honors he is a recipient of the Spirit of Detroit award for his work and dedication to the Metro-Detroit community.

Mr. Berry is an avid writer, presenter and speaker on elder law topics, including long-term care planning with VA benefits and Medicaid planning. He has been a guest blogger for the national Financial Planning Association as well as WealthCounsel. Additionally, he has had an article published by the National Academy of Elder Law Attorneys on Veterans Benefits and Medicaid Planning.


To learn more about which veterans benefits you or your loved one may be entitled to, please contact Christopher J. Berry’s law firm, Witzke Berry Carter & Wander PLLC where he is a partner at by calling (248) 481-4000 or visiting their website at www.michiganelderlawcenter.com or www.witzkeberry.com.

Is trauma patient going to need a chest tube?

ED Nursing December 1, 2010 Is trauma patient going to need a chest tube?





Your actions can avoid delays Patients with a mechanism of injury relating to chest trauma, such as penetrating or blunt trauma, are more likely to require a chest tube, says Shelley L. Sides, RN, MSN, EMT-I, trauma coordinator at Eastern Maine Medical Center in Bangor, ME.

Gabriela McAdoo, RN, trauma nurse coordinator at Stanford (CA) Hospital & Clinics, says, “Delay in care may result in death. Tension pneumothorax is the most common adverse outcome.” To improve care of a trauma patient requiring a chest tube: in our site eastern maine medical center

* Assess for respiratory distress.

Assess for tachypnea, circumoral cyanosis, pallor, and signs of decreased oxygenation including pulse oximetry if available, says Sides.

* Always consider the nature of injury.

“With any chest trauma or multi-trauma patient, you need to be suspicious of a pneumothorax or hemotoma, or both,” says Sides. “Pay close attention to your patient. Be suspicious of any abnormal findings.” She gives these tips:

— Assess chest wall symmetry.

— Inspect for soft tissue integrity.

— When assessing breathing, look specifically for rate, rhythm, lung sounds, symmetry of chest, presence of spontaneous breathing, chest wall integrity, and skin color.

— With circulation, look at the patient’s skin temperature, color and moisture; central pulses; and any uncontrolled bleeding.

“A pneumothorax or hemotoma, especially a progressing pneumothorax or hemotoma, can present abnormal findings in either of those two steps in the assessment,” says Sides.

* Document the initial drainage output.

“Include description of fluid drainage,” says McAdoo. “Is it bloody, straw-colored, or purulent? Documentation output every shift, and mark the chamber when transferring care.” * Don’t miss delayed injury.

Track and trend vital signs and intake/output to make sure your patient is improving and not deteriorating, advises McAdoo. “There may be times when trauma patients have delayed injury,” she explains.

After any intervention, reassess your patient’s condition, including airway, breathing, and circulation. “This is needed to make sure there are no life-threatening injuries that may have developed during your initial airway or fluid resuscitation,” says McAdoo. (See story on equipment used for this procedure, below, and clinical tip on what to palpate for, right.) Make sure equipment is working properly At the beginning of your shift, make sure that the equipment you will be using is working properly and is ready for an emergency at any given time. “This is an important practice,” says Shelley L. Sides, RN, MSN, EMT-I, trauma coordinator at Eastern Maine Medical Center in Bangor, ME.

At times, Sides has walked into a critical care emergency bay and not had suction available. “The tubing hasn’t been replaced, the suction isn’t hooked up, the wall-mounted suction isn’t hooked up correctly, or Yankauer or French suction tips aren’t available,” says Sides. “This is dangerous and completely preventable.” Do you work in an ED that doesn’t use chest tubes frequently? Sides says to check with an educator to refresh your knowledge on the setup and proper monitoring of the equipment. “Many of the equipment manufacturers have tutorials on setup and maintenance on their web sites,” says Sides. “Identify your resources, and be prepared before you need it.” She recommends these steps: in our site eastern maine medical center

After you use the equipment, get it back in working order as quickly as possible for the next patient.

Know what your chest tube insertion kit contains and what other supplies you might need including chest tubes in multiple sizes, tape/bio-occlusive dressing, drain sponges, and petroleum jelly gauze.

Make sterile gloves and gowns available for the surgeon doing the procedure and any person who is going to be assisting.

Be familiar with the chest tube chamber hook up.

Know how to put your equipment together and get it “usable” for providers.

“Be diligent in making sure your ED is adequately stocked with supplies,” says Sides. “Chest drain systems all work under the same premise. Be familiar with the science and then your equipment.” Palpate patient’s skin for telltale symptom “A surgeon once told me, ‘If you see someone come in with a ‘pumpkin head,’ you need to prep for bilateral chest tubes,'” says Shelley L. Sides, RN, MSN, EMT-I, trauma coordinator at Eastern Maine Medical Center in Bangor, ME.

“Pumpkin head” refers to a large amount of subcutaneous emphysema within the soft tissue, explains Sides. “With chest and lung injuries, the patient can experience some severe subcutaneous air, causing the head to appear swollen,” says Sides. “The feeling of ‘Rice Krispies’ under the skin as you palpate is the usual finding.”

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