Moderator EMEDPA Posted April 23, 2004 Moderator Share Posted April 23, 2004 those of you who are students might want to print this out. I got this from a cme lecture: general 1. keep pts waiting 2.don't sit down 3.write see your dr if not better on all charts 4.use medical language with pts 5.don't write down details of h+p 6.never call family/friends of pts for more hx 7.assume everyone is drunk 8.don't read rn notes on chart 9. don't ask pts what they want 10.don't call the f/u doctor eyes 11. give anesthetic eye drops to take home 12.use ophtho steroids without f/u with ophtho 13.don't check visual acuity 14.remove fb's without magnification 15.never look under lids 16.assume all kids with red eyes have conjunctivitis 17.refer to ophtho in 1-2 weeks for acute eye probs 18.neutralize acids with bases in the eye and vis versa febrile kids: 19.use lots of cough syrup 20.keep the air as dry as possible 21.don't lsten to mom 22. don't record general impression or mental status 23.don't record hydration or skin signs 24.have vomiting kids seen in 4 days if not better 25. don't assume child abuse 26.give phone advice frequently 27.use alcohol baths 28.don't watch kids eat/drink after tx for n/v before going home ortho: 29. use circular plaster on acute injuries 30.use long immobilization times without f/u 31. don't comment on joint above + below injury 32.keep hands dependent in splints 33.use heat early instead of ice 34.don't chart motor/sensory findings 35.give 2 weeks of pain meds without f/u 36/37/38.don't splint all wrists/knees/thumbs with acute injuries 39.assume all neg xrays mean no fx 40. assume no fx= no problem head injuries: 41. assume it's the alcohol 42.don't hyperventilate head injuries with aloc 43.don't re=examine pts with long stays in the dept 44.do frequent skull films 45.give lots of fluid boluses 46.don't give instructions to the family at d/c 47.wait to call neurosurgery for as long as possible urology: 48. it's only epididymitis 49. assume all dysuria =cystitis 50.assume 5-10 wbc's in urine=uti= reason for abd pain Quote Link to comment Share on other sites More sharing options...
Sillyg00se Posted April 24, 2004 Share Posted April 24, 2004 Thanks a bunch EMED! It's great that you can think of things that totally help students and practicing PAs even when it is not asked. I am looking forward too see more of these in the future!! -Sillyg00se Quote Link to comment Share on other sites More sharing options...
tool man Posted April 24, 2004 Share Posted April 24, 2004 - Don't R/O meningitis without inpecting ALL skin for purpura - Don't R/O PE without checking for S1Q3T3. It's a long shot, but the first time you don't check, they'll have a small one, which will look huge when the EKG is blown up on a 3 foot by 4 foot poster board. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 24, 2004 Author Moderator Share Posted April 24, 2004 Toolman- good points... a few more when evaluating a pre-verbal child do not write A+Ox4 on the chart, instead list their level of interaction and your general impression of them.. for example: active, alert,nontoxic appearing, playful, resists exam, drinking juice, pulls on stethoscope, recognizes parents,runs around room etc. also on every peds chart I document an o2 sat and the phrase "stripped for exam". Quote Link to comment Share on other sites More sharing options...
Guest Joebird Posted February 22, 2006 Share Posted February 22, 2006 Toolman- good points... a few morewhen evaluating a pre-verbal child do not write A+Ox4 on the chart, instead list their level of interaction and your general impression of them.. for example: active, alert,nontoxic appearing, playful, resists exam, drinking juice, pulls on stethoscope, recognizes parents,runs around room etc. also on every peds chart I document an o2 sat and the phrase "stripped for exam". 22. don't record general impression or mental status :confused: :confused: Any why wouldn't you do #8???? Quote Link to comment Share on other sites More sharing options...
caldje Posted February 22, 2006 Share Posted February 22, 2006 22. don't record general impression or mental status :confused: :confused: Any why wouldn't you do #8???? he's saying don't "don't read RN notes." translation: read RN notes 22 is the same way... don't "dont record general impression and mental status." translation.. record mental status! Quote Link to comment Share on other sites More sharing options...
Guest WVgirl03 Posted February 22, 2006 Share Posted February 22, 2006 Even though I'm in plastics and not in ED.....a lot of these still rang true! Very good thread. Quote Link to comment Share on other sites More sharing options...
Guest ER_PA Posted April 22, 2007 Share Posted April 22, 2007 Don't send home a negative x-ray hip injury in a wheelchair without seeing them put weight on the injury Quote Link to comment Share on other sites More sharing options...
Guest ER_PA Posted April 22, 2007 Share Posted April 22, 2007 Don't repair tendons Quote Link to comment Share on other sites More sharing options...
Guest ER_PA Posted April 22, 2007 Share Posted April 22, 2007 Don't give Antibiotic therapy b/c you don't want to explain what a VIRUS is 2 Quote Link to comment Share on other sites More sharing options...
Guest ER_PA Posted April 22, 2007 Share Posted April 22, 2007 Don't Go by the triage NOTE ask the pt for yourself 1 Quote Link to comment Share on other sites More sharing options...
Chronic Student Posted April 22, 2007 Share Posted April 22, 2007 Don't say, "It sure is QUIET tonight!" -Mike 1 5 1 Quote Link to comment Share on other sites More sharing options...
Guest pac4hire Posted April 22, 2007 Share Posted April 22, 2007 Don't repair tendons Why not, I repair extensor tendon lacs all the time after irrigation and cleansing. I use a 90-90 technique that ortho has shown me. If i dont o it, it will be 4 weeks before then patient sees an orthopod. Now they just do folow ups. 2 Quote Link to comment Share on other sites More sharing options...
Guest ER_PA Posted April 23, 2007 Share Posted April 23, 2007 Why not, I repair extensor tendon lacs all the time after irrigation and cleansing. I use a 90-90 technique that ortho has shown me. If i dont o it, it will be 4 weeks before then patient sees an orthopod. Now they just do folow ups. I look at it this way... What good can come out of a extensor tendon repair in the ED? First of all they don't really need the tendon for most functions. Second a boched repair is more difficult to fix I certainly do not have time to repair a non-emergent tendon If adhesions form and you did the repair, pt. cant extend the finger all the way a lawyer will have a field day on why an emergency PA did this "complex" (not really) repair instead of having a "board certified hand MD" do it A good buddy of mine works at "Union Memorial in baltimore" the "hand center" and even Hand Residents are told not to repair a tendon w/o the fellow or attending (ok bad example they are residents):eek: Quote Link to comment Share on other sites More sharing options...
Guest amylynn3033 Posted May 4, 2007 Share Posted May 4, 2007 I work with an upper extremity orthopod, and he would be P/O'd if an ER PA repaired a lacerated tendon in the ER. He gets these patients into his office quickly and gets them into the O.R. in a reasonable time as well. It's all about referral. Quote Link to comment Share on other sites More sharing options...
Guest pac4hire Posted May 4, 2007 Share Posted May 4, 2007 I work with an upper extremity orthopod, and he would be P/O'd if an ER PA repaired a lacerated tendon in the ER. He gets these patients into his office quickly and gets them into the O.R. in a reasonable time as well. It's all about referral. He'd be pissed for two reasons... 1 he couldnt bill for that proceedure 2. that a PA did just as well of a job as him. Sorry people, I was trianed by our hand guy to do these and have done over 25 of them. the feedback i get from ortho is "' hey thatnks for taking care of that for us last night so we didnt have to come in" 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 4, 2007 Author Moderator Share Posted May 4, 2007 He'd be pissed for two reasons...1 he couldnt bill for that proceedure 2. that a PA did just as well of a job as him. Sorry people, I was trianed by our hand guy to do these and have done over 25 of them. the feedback i get from ortho is "' hey thatnks for taking care of that for us last night so we didnt have to come in" AGREE-extensor tendons are easy, I was trained to do these as well although I am usually too busy to do this and just close superficially, give abx, splint and arrange f/u within 2 days....now I wouldn't try a flexor tendon routinely....too much work locating the lacerated ends..... Quote Link to comment Share on other sites More sharing options...
Guest ER_PA Posted May 14, 2007 Share Posted May 14, 2007 I work with an upper extremity orthopod, and he would be P/O'd if an ER PA repaired a lacerated tendon in the ER. He gets these patients into his office quickly and gets them into the O.R. in a reasonable time as well. It's all about referral. agree amylynn well said:D Quote Link to comment Share on other sites More sharing options...
Guest ER_PA Posted May 14, 2007 Share Posted May 14, 2007 He'd be pissed for two reasons...1 he couldnt bill for that proceedure 2. that a PA did just as well of a job as him. Sorry people, I was trianed by our hand guy to do these and have done over 25 of them. the feedback i get from ortho is "' hey thatnks for taking care of that for us last night so we didnt have to come in" Sean don't be sorry if you were trained then do it! I do Ultrasound guided Central Lines in the ER but then again without the line the person would "die" I won't touch a tendon... No time Plenty of Liablity (ER see's 350+) per day 25 repairs does not seem alot to a Hand fellow / attending that does that many in a WEEK! but who am it to tell you what to do for all I know you could be better than them! At least we know a Lac Tendon Pt. is not "DRUG seeking" .................... or are they? LOL:eek: Quote Link to comment Share on other sites More sharing options...
Guest pac4hire Posted May 14, 2007 Share Posted May 14, 2007 lol funny. Fri night ( 7p-7a) i was actually prepping a patient to do one when the traum pager went off with an ETA of 10 minutes. pager read penetrating chest trauma cpr in progress. I told the patient that we would clean the wound and splint herand she could follow up with a hand doctor. I wasnt going to miss a thoracotomy in the ER for a tendon repair... All PA's in my hospital are 2nd providers in all trauma, we are at the head and the docs at the foot. pretty cool case though. Quote Link to comment Share on other sites More sharing options...
Guest ER_PA Posted May 15, 2007 Share Posted May 15, 2007 lol funny. Fri night ( 7p-7a) i was actually prepping a patient to do one when the traum pager went off with an ETA of 10 minutes. pager read penetrating chest trauma cpr in progress. I told the patient that we would clean the wound and splint herand she could follow up with a hand doctor. I wasnt going to miss a thoracotomy in the ER for a tendon repair... All PA's in my hospital are 2nd providers in all trauma, we are at the head and the docs at the foot. pretty cool case though. Sweet!!! my trauma consists of the DEAD variety....:confused: Quote Link to comment Share on other sites More sharing options...
Guest jcsdawg Posted May 20, 2007 Share Posted May 20, 2007 Also, never write on a pediatic chart "lethargic" (unless they truely are, then I leave that word for the SP to write down on the chart). To lawyers, "lethargic" means toxicity and a case for meningitis. And please read the nurses notes, they frequently write down "lethargic" on their assessments/triage notes...if they do, then remark in your notes that you disagree with nursing assessment...a lot of the time the child just feels bad that they have a fever, think how you feel when you have a fever...this can be confused. If the child is running around the room with a temp of 103, then the child is not lethargic. Quote Link to comment Share on other sites More sharing options...
Guest ER_PA Posted May 25, 2007 Share Posted May 25, 2007 Never give in to a DRUG seeker.................. Quote Link to comment Share on other sites More sharing options...
kbreit Posted December 10, 2007 Share Posted December 10, 2007 Yeah I agree that nothing good can come from repairing a tendon lac in the ER whether PA or ER doctor. I was told early on never to do this, and I know from fellow ortho PA friends that their practice frowns upon tendon repairs in the ED! Quote Link to comment Share on other sites More sharing options...
kbreit Posted December 10, 2007 Share Posted December 10, 2007 Also to add to things any girl/women age 13 (or even younger for that matter) to 50 with any kind of nausea, vomitting or abd pain is pregnant......don't let the very young ages fool you! Quote Link to comment Share on other sites More sharing options...
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