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km88

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About km88

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    Physician Assistant

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  1. I think they are true to size. I love the Casma top and Yola pants. The graphite color is by far my favorite.
  2. Definitely Figs for scrubs. Worth the high price. I also like Medelita's scrub jacket - huge pockets. Both sites have frequent sales of 20-30% off.
  3. Yes, without a Medical Director I'm not sure that Assistant Medical Director is an accurate description. In my case, they were offering an MD Assistant Medical Director so the plan for me to be Associate was intended to be a lesser position. Now the 2 of us have equal titles so I'm happy about that
  4. I recently was given the title of Assistant Medical Director (2 emergency departments)... Original plan was for Associate Medical Director but that changed at some point during contract revisions. I don't use LinkedIn, however, so can't help you with that part.
  5. Scrubs +/- white coat or athletic jacket Check out Medelita -- just got new white coats and scrub jacket from here. It's a PA owned company! The quality is great. Prices are high, but I just used CME $. They seem to have a lot of sales too.
  6. I completely understand your desire to keep your hobbies. I'm more "work to live" than "live to work" too... I am happy that I went the PA route and I love what I do. I work in EM which allows for a lot of schedule flexibility. I prioritize travel in my free time and love that both my schedule and salary allow me to do so. I work 12 shifts a month and get to pick my 12, as long as my coworkers are ok working when I am gone. We have a good system - we all cover for each other. I've already taken two 2 week long international trips this year and just booked a 3rd... plus have made several trips within the US... all without using my PTO (which I can then cash out). So, you can definitely find ways to have a fulfilling career and a full life outside of it.
  7. "Hi, my name is _ and I'm the PA that's going to be seeing you today." "What's a PA?" "I have a masters in medicine and am the provider that will be taking care of you today. What can I do to help you?"
  8. Where in Iowa? What is the hourly rate?
  9. I am lucky enough to have an ER job that allows me to plan around long vacations AND get one month paid time off to use if I ever need it... I work twelve 12s a month and scheduling is very flexible. I'm about to leave for my second ~2 week long international vacation since the start of the year. I had to use 1 PTO shift in January but don't have to take any PTO for my next trip. It kind of sucks to come back jet lagged and then work 12/16 days but I obviously can't complain. I can also cash out any unused PTO at the end of our contract year at my hourly rate. When not traveling, I give myself 5 day weekends at least twice a month.
  10. PS - The urine issue is probably exaggerated in my department because our hospital refuses to restock our disposable urinals, and we have only 2 bathrooms for our patients to share. Add these issues to a patient who can't ambulate without assistance to the restroom, and we've got a nursing disaster. It honestly feels like practicing in a 3rd world country at times :(
  11. Yes I agree -- fluids for any patient with signs of dehydration. In those without evidence of dehydration, sure, a liter bolus won't hurt them. But, it also isn't necessary. It does make them more likely to become fountains of urine. And the cost of nursing time is significant if needing to hold them down, they're a difficult stick, or end up needing to be bathed. The literature shows no difference in length of visit (even though there are few relevant studies). Obviously practice styles and patient populations may differ... but my point is that giving IV fluids doesn't have to be an automatic part of the treatment plan in every intoxicated patient. Waiting until they wake up and can tolerate PO fluids AND make it to the bathroom would have similar benefit of hydration without added cost of time/supplies at the end of the day. Just something to consider in the future!
  12. What's your reasoning for IV fluid bolus being included in every drunk patient? Obviously, if they appear ill, have abnormal vitals, any signs of trauma, or significant medical history etc then IV placement +/- fluids depending on situation. But why do it in the stable, uncomplicated intoxicated patient? It doesn't sober pts up faster or decrease average visit length. Instead, I find that it makes uncomplicated drunk patients urinate more and increase fall risk because they try to get up to find the bathroom. Also makes nurses angry to place the IV and then clean up more urine if they're the bedwetting type. I agree with directly observing the patient ambulating before discharge. Our nurses too are always eager for a quick d/c but they've learned that I'm one of the providers that won't let that slide. Also exam and charting on these patients has to be EXTREMELY thorough every single time.
  13. I work in an ER where alcohol intoxication is our #1 yearly diagnosis. In my 3 years there, I've seen too many of our homeless alcoholic frequent flyers die. Head bleeds, sepsis, freeze/overheat, hit by cars, etc. Last week I had a patient with the highest ETOH level I've seen yet -- 0.649! Workup was otherwise unremarkable and he was walking within 4 hours. Generally, in my ER we don't do much with our drunks. Of course, everyone has a very low threshold for a workup if they are new to us, frequent flyer but looking worse than usual, have any signs of trauma, or have significant past medical history. Otherwise, we let them nap and observe closely. Once they're "clinically sober" I'll discharge, but some elope before I'm comfortable with a discharge. Our security won't restrain them unless I force it, and I frequently don't even know they're walking out the door until it is too late (we don't have security in our department at all times). I HATE hallway beds because of stories like above, and always keep patients on the monitor. We don't give IV fluids or even check alcohol levels on some. 99% of the time all is good and we see them again in a day or 2. Everyone is always worried about that 1% though, because any day could be the day they fall/walk into traffic/take a nap in the wrong place. We will sometimes give cab vouchers to shelters, however this was a significant drain on the department (over $20k per month) so we try to be judicious about this. Luckily we have a detox facility we can send some patients to if level is between 0.2-0.4 and they are ambulatory, but our most frequent patients are banned for various reasons. They are crippling to our department and definitely a contributing factor as to why our hospital is closing in a couple months.
  14. $3500 for PAs in my ER. My coworkers and I were getting this from our private ER group when we lost our contract to a big national group. They agreed to match it but wouldn't cover DEA/license separately, which was a change from our previous employer. A couple coworkers and I will also be at the Costa Rica conference in a couple weeks :)
  15. Unfortunately, sometimes there is nothing you can do to change the outcome. This is probably the hardest thing about emergency medicine. I've been in EM for 2 years and have had 2 cases that I've lost a lot of sleep over and still think about often. In my patients' cases and yours, it doesn't sound like the outcome could have been changed. I dread the day when this isn't the case and I can find some reason to hold myself accountable.
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