Hi all, Had a case tonight that my attending and I both felt a bit wishy washy on and wanted some (kind) opinions on. 45 yo male from the carribean presenting for R knee pain and swelling for 2 days. Also reports warmth to knee as well as chills/feeling feverish. No hx of IVDA. No trauma to the knee. No prior knee surgery. Xray showed large knee effusion and also some osteophyte formation. We were initially thinking along the lines of inflammatory secondary to possible OA. The effusion was actually more suprapatellar. Joint fluid I aspirated was yellowish/blood tinged but still somewhat clear. I would not describe it as purulent. Joint fluid analysis showed yellow/cloudy fluid with a cell count of 41,000 however PMNs of 91%. No organisms seen but abundant PMNs. No crystals. We decided to go ahead with basic labs and crp/esr as well. Wbc 9.3, crp of 124. Sed rate was pending at the end of my shift. Based on the elevated crp and large percentage of PMNs plus a monoarticular joint swelling and decreased ROM we decided to admit for IV abx for probable septic arthritis. It was really not a slam dunk either way and as a newbie PA I would love to hear from you guys. Thanks Sent from my SM-G950U using Tapatalk
Hi everyone, I graduated about 5 months ago and just started my job on January first in the ED (credentialing=longest process ever!). I was an A+ student during PA school, did well on rotations, etc. but I just feel like I am drowning and burdening my docs. This is the first time the ED I'm working in has PAs, and I am just trying to do my best because I want it to work out as I love my coworkers and I love the job. I know everyone has this sentiment as a new PA, I just feel so stressed during some shifts. Some docs are very easy going, don't mind me running things by them constantly since I am new, etc. but others seem to be bothered by my questions and I feel like such a nuisance. I'm also stressed because some of the hospitalists I admit to are so incredibly rude when I call them, partially I think because they aren't used to having PAs admitting to them. They are more critical of my diagnosis/treatment, etc. than if the docs were calling them, but not in a constructive way. Overall, I love love love my job and the ED but I just needed to vent about the stress of being a new grad! Patients don't follow the textbook like they told us they would in school!