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LA_EM_PA

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About LA_EM_PA

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  1. More than 1 person with similar symptoms usually prompts me to check VBG for carboxyhemoglobin level. Many very benign presentations with high risk for bad outcome if missed.
  2. Malcolm Gladwell wrote that on average, mastery requires 10,000 hours of practice. 4 weeks of shadowing will never be enough to prepare you to work solo. There are too many ways this job can end up being a nightmare for you. You won’t have enough experience that quickly determine the EM/UC goal of sick versus not sick. This will likely result is stress and burnout, fear of malpractice, excessive referral to the emergency room, prevent you from having time to learn the nuisances of diagnosis and treatment of UC chief complaints, or all of the above. You sound very motivated from your post, but if this truly is the expectation from this position, I would give a strong recommendation to look elsewhere. I will be shocked if the more experienced providers on this forum don’t agree with or add to my concerns about the position.
  3. I would, but this hospital has since closed. After working in multiple emergency departments throughout the state since graduation, it makes sense looking back.
  4. In addition to EMEDPA suggestions: Bladder rupture? I can’t recall immediately off the top of my head the diagnostic test, but would likely see on CT I presume. True feel seatbelt sign would be concerning for spinal cord injury? Also can usually catch on CT but MRI next step of concerned. Could patient walk? Pelvic fracture with referred pain/bleeding into abdominal cavity? And by bothering nurses is he altered/showing signs of shock (presumed hemmhoragic)? Abdominal compartment syndrome? (A diagnosis that I will admit freely I know by name but not much pathophysiology or workup)
  5. Yes I had very similar prior teachings, and didn’t know the differences between the CTA and CT with IV contrast until this month’s Urgent Care RAP has a segment on mesenteric ischemia. A side note from this discussion, but there is a significant amount of literature now showing that IV contrast as used in today’s practice does not increase risk of kidney injury in patients with baseline normal renal function. More studies needed on those with baseline renal insuffiency, but at this point I give almost all patients who have normal kidney function at baseline IV contrast as it helps with evaluation for many more disease processes than a non-contrast study. Still need to be very careful with gadolinium contrast used in MRI studies in patients with any renal impairment as it can lead to neohroenic systemic fibrosis (aka contrast is deposited in skin with high morbidity and mortality). I know this post is getting long, but I can’t give a high enough bump to the comment about CT as having very little utility in non traumatic headache. I find often I get push back from physicians on new onset, persistent vertigo patients with HINTS central exams who recommend CT first, which is frustrating as it is the wrong study and leads to unnecessary radiation and often useless information. I haven’t found a posterior circulation stroke yet (only had MRI indicated on 3 patients), but did find central causes in each case that I did order the MRI (first diagnoses of MS with demylinated nerves, posterior encephalopathy 2/2 chronic uncontrolled hypertension). For full discussion or vertigo workups, EMRAP has a great C3 episode as well as September 2017 and April 2018 episode segments.
  6. Need CTA angio for assessment of mesenteric ischemia. CT with IV contrast only tests one arterial phase, but need venous phase as well to further assess for mesenteric ischemia. It is a good thing lactate is negative. Positive = bowel ischemia aka probably too late for meaningful intervention.
  7. Why no love for fosfomycin? 3 g one time oral dosing with possible redosing in 3 days if no improvement.
  8. I am a recent grad (December 2016) who has been practing Emergency Medicine and Pulm/CC since April. I have become obsessed with EM:RAP, and love their concise and easy to digest material. I use pearls from episodes as a daily part of my practice. I was wondering if anyone has tried the HIPPO education Ugrent Care:RAP or Primary Care:RAP? So many patients that I see even in the main ED fall outside of true emergent etiologies, and was wondering if any has tried or found these resources useful. Thanks for the input.
  9. I just became licensed in January. I agree with the above post, but will just clarify that you can submit all paperwork for your California state license before taking the PANCE. After getting your California license, you can apply for your NPI and DEA number. The California Controlled Substance Course is not required to practice, but I took after getting my DEA number because it removes patient specific approval to prescribe controlled substances. More important in outpatient and office work.
  10. Los Angeles County recently posted a position as a Coroner Investigator Trainee that PAs could apply for. Pay was low, but county jobs come with great benefits.
  11. Also applied at end of December and have received an email from the local DEA office stating my application has been processed and to expect it in 5-7 business days. That was last week, so should be here any day.
  12. I don't want this conversation to turn heated as past discussions of the online program have, but it is important to have accurate information in your posts. I am in the Yale program, graduating next month. We had 16 rotations, 2 of which were dedicated to completing our thesis (these rotations are not listed on the program website, so it isn't fair to not know this without personal knowledge). So both would be 16 rotations in 28 months.
  13. The website states 28 months pretty clearly. Please read things for yourself before commenting.
  14. You would have to take it to New Haven, and then get 15 minute taxi there. Most likely, driving makes a lot more sense in terms of both time and cost effectiveness. Obviously, this depends on where you are coming from. But as a CT local, I can not think of a location where the Amtrak would be the most efficient way to get there.
  15. Yale no longer offers need based scholarships or merit scholarships. Otherwise, I do not know of programs that offer scholarship. Your best bet would be to contact programs you are interested in to inquire.
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